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Traumatic Brain Injury in Nebraska 2004-2008

Traumatic Brain Injury in Nebraska 2004-2008. CSTE Annual Conference ▪ June 14, 2011. Ericka Welsh, PhD Nebraska Injury Prevention and Control Program. Introduction.

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Traumatic Brain Injury in Nebraska 2004-2008

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  1. Traumatic Brain Injury in Nebraska 2004-2008 CSTE Annual Conference ▪ June 14, 2011 Ericka Welsh, PhD Nebraska Injury Prevention and Control Program

  2. Introduction • Traumatic brain injury (TBI) is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. • Each year, about 1.7 million Americans sustain a TBI; about 52,000 die as a result. • Currently, about 5.3 million Americans are living with a TBI-related disability, and 85,000 persons each year will sustain a TBI that results in a permanent disability.

  3. Traumatic Brain Injury in Nebraska 2004-2008 report and fact sheet • Created to inform public health practitioners, policymakers, and the general public about the burden of TBI in Nebraska in order to design and implement effective preventive measures against TBI.

  4. Objectives • Describe the burden of TBI-related deaths, hospitalizations, and emergency department (ED) visits in Nebraska • Frequencies and age-adjusted rates • 5-year trends • Age-specific rates • Leading causes, by gender • Median hospital charge and expected primary payer • Highlight current initiatives in Nebraska to prevent and control TBI

  5. Methods

  6. Data source • Nebraska death certificates • Provided by the NDHHS Office of Vital Statistics • Multiple cause-of-death • Classify injuries by external cause of death

  7. Data source • Hospital discharge data (HDD) • Data collected via 2004 Uniform Billing form (UB-04) • Provided by Nebraska acute care hospitals to the Nebraska Hospital Association (NHA) • E-code data, a subset of HDD containing injury related records, is provided to the Nebraska DHHS by the NHA

  8. Case definitions • TBI-related deaths and hospitalizations CDC State Injury Indicators: Instructions for Preparing 2005 Data (2007)

  9. Case definitions Deaths with ANY of the following International Classification of Diseases (ICD)-10 codes in ANY field of the multiple cause of death file:

  10. Case definitions Hospital discharges with ANY of the following ICD-9-CM diagnostic codes in ANY of the diagnostic fields of the injury hospital discharge (E-code) subset:

  11. Notes • All results are based on deaths and hospital discharges of Nebraska residents. Nebraska residents who died or were treated at hospitals out of state are not included. • Frequencies and rates reflect numbers of discharge records, rather than numbers of patients discharged. • Five-year averages are used to provide more stable rates by reducing the effects of fluctuations from year to year.

  12. Frequencies &Age-adjusted rates

  13. Frequencies and age-adjusted rates, Nebraska residents, 2004-2008 1,610 deaths AA rate= 17.4 per 100,000 pop. AA rate=50.9 per 100,000 pop. 4,750 hospitalizations AA rate=337 per 100,000 pop. 30,265 ED visits ??? Other medical care ??? No medical care

  14. 5-year trends

  15. Age-adjusted rates for TBI-related deaths by year, Nebraska residents, 2004-2008

  16. Age-adjusted rates for TBI-related hospitalizations by year, Nebraska residents, 2004-2008

  17. Age-adjusted rates for TBI-related ED visits by year, Nebraska residents, 2004-2008

  18. A closer look at increasing trends... • Increasing trends similar for 2000-2009 data • From 2000 to 2009: • 115% increase for TBI-related ED visits • 40% increase for TBI-related hospitalizations

  19. A closer look at increasing trends... • From 2005 to 2008: • ~12% increase for injury-related ED visits w/out TBI, but ~52% increase for injury-related ED visits w/ TBI • Greater relative increases among certain causes: MVT, falls, struck by/against, and not specified • Greatest relative increase within “unspecified head injury” category

  20. Case definitions

  21. Age-specific rates

  22. Age-specific rates for TBI-related deaths, Nebraska residents, 2004-2008

  23. Age-specific rates for TBI-related hospitalizations, Nebraska residents, 2004-2008

  24. Age-specific rates for TBI-related ED visits, Nebraska residents, 2004-2008

  25. Leading causes, by gender

  26. TBI-related deaths, by cause and gender, Nebraska residents, 2004-2008 Among TBI-related deaths due to firearm injuries, 82% were suicide, 15% were homicide, and the remaining 3% were unintentional or undetermined intent.

  27. TBI-related hospitalizations, by cause and gender, Nebraska residents, 2004-2008

  28. TBI-related ED visits, by cause and gender, Nebraska residents, 2004-2008 Percent of TBI-related ED visits that were sports-related: 3.5% among females, 11.5% among males.

  29. Median hospital charge and expected primary payer

  30. TBI-related hospitalizations, by expected primary payer, Nebraska residents, 2004-2008 • From 2004 to 2008, the median hospital charge for TBI-related hospitalizations was $17,152.

  31. TBI-related ED visits, by expected primary payer, Nebraska residents, 2004-2008 • From 2004 to 2008, the median hospital charge for TBI-related ED visits was $1,664.

  32. Summary • From 2004- 2008: • Rates for TBI-related death remained relatively stable, while TBI-related hospitalizations and ED visits increased. • Increased coding of “unspecified head injury” • TBI-related death and hospitalization rates were highest among older adults; TBI-related ED visits were highest among infants, young children, adolescents, and older adults.

  33. Summary • From 2004- 2008: • The leading causes of TBI-related deaths were motor vehicle crashes, falls, and firearms (esp. for males). • The leading causes of TBI-related hospitalization and ED visits were falls, motor vehicle crashes, and stuck/by against injuries. • For males, slightly more than 1 in 10 TBI-related ED visits are sports-related

  34. Current initiatives to prevent TBI in Nebraska

  35. Brain Injury Association of Nebraska • NE-BIA director is a member of the Injury Community Planning Group • DHHS working closely with NE-BIA to promote newly passed Nebraska Concussion Awareness Act

  36. Nebraska Concussion Awareness Act (LB260) • Signed into law April 14, 2011 • Prohibits youth who suffer concussions in school-sponsored athletics and in programs run by cities, businesses and nonprofit groups from playing or practicing until cleared by a healthcare professional • Requires that coaches receive training on the warning signs of concussion • Workgroup formed to decide how to best promote to coaches and healthcare professionals

  37. Preventing leading causes of TBI • Motor vehicle crashes • Distracted driving among teen drivers • Older adult falls • Tai Chi: Moving for Better Balance

  38. Acknowledgements • Data support • Jennifer Marcum, DrPH • Alan Xu • Ming Qu, PhD • Program support • Peg Ogea-Ginsburg • Jason Kerkman, MPH • Data providers

  39. Questions? • Contact information: Ericka Welsh, PhD ericka.welsh@nebraska.gov (402) 471-1063 • Website: http://www.dhhs.ne.gov/hew/hpe/Injury/facts.htm

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