Epidemiology of TBI

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Epidemiology of TBI

• Alexandra Brazinova, MD, MPH, PhD
• IGEH seminar Oct.28,2003

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Traumatic brain injury

• of all types of injury, those to the brain are
  among the most likely to result in death or
  permanent disability
• Estimates of TBI incidence, severity and cost
  enormous losses to individuals, families and
  society
• www.neuroskills.com (USA rehabilitation centers)

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What does epidemiology follow in TBI

• Causes, mechanisms, severity
• Prevalence (morbidity) total no. of cases at any
  given time and certain area
• Incidence new cases at certain time in certain
  area (country, etc.)
• Mortality
• Health outcomes

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Causes, mechanisms, severity

• Causes mechanisms
• MVAs leading cause of TBIs
• Falls second leading cause
• Work-related TBIs
• Firearms
• Alcohol major factor in many TBIs
• Severity mild, moderate, severe

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Prevalence

• is not well documented, because mild cases may
  not be hospitalized. Estimates are often based on
  existing disabilities
• Discrepancies in data collection difference in
  findings of diagnostic imaging at different time
  intervals

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Incidence of TBI (US)

• Mild TBI - 131 cases per 100,000 people
• Moderate TBI 15 cases per 100,000
• Severe TBI 14 cases per 100,000 (with
  prehospital deaths included 21 cases)

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High-risk population

• Young people
• Low-income individuals
• Single individuals
• Members of ethnic minority groups
• Residents of inner cities
• Men
• Individuals with previous history of substance
  abuse
• Individuals with previous TBI

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Health outcomes impairments/disabilities
resulting from TBI

• Cognition concentration, memory, judgment, mood
• Movement abilities strength, coordination,
  balance
• Sensation tactile, vision, etc.
• Seizure disorders (epilepsy)
• Persisting unconsciousness

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TBI related mortality rate (US)

• Deaths outside the hospital 17 per 100,000
  people
• Hospitalized patients 6 per 100,000
• 33 in severe TBI, 2.5 in mild TBI

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Abstracts incidence
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Abstracts

• Epilepsia. 200344 Suppl 102-10.
• The epidemiology of traumatic brain injury a
  review.Bruns J, Hauser WA.Neurology Sergievsky
  Center, College of Physicians and Surgeons
  Department of Epidemiology, Joseph L. Mailman
  School of Public Health, Columbia University
  Department of Emergency Medicine, Mt. Sinai
  School of Medicine, New York, New York, U.S.A.
• Review of studies of TBI incidence of TBI in the
  US is 180-250 per 100,000, higher in Europe and
  South Africa. Groups at high risk males in
  regions with socioeconomic deprivation.

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Abstracts

• Brain Inj. 1997 Sep11(9)649-59.
• Epidemiology of traumatic brain injury in South
  Australia.Hillier SL, Hiller JE, Metzer
  J.Department of Community Medicine, University
  of Adelaide, South Australia.Incidence 322 per
  100,000 (exceeds studies in Europe and US).
  Highest risk population young males living in
  the country and working in manual trades.
  Hospitals in this state have more than 4000 new
  cases of TBI each year.

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Abstracts

• J Neurosurg Sci. 2002 Dec46(3-4)111-9.
• Regional brain injury epidemiology as the basis
  for planning brain injury treatment. The Romagna
  (Italy) experience.Servadei F, Antonelli V,
  Betti L, Chieregato A, Fainardi E, Gardini E,
  Giuliani G, Salizzato L, Kraus JF.Incidence
  rate 250 per 100,000. External causes of injury
  are similar to Western Europe, except very low
  frequency of cases from violence.

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Abstracts

• Acta Neurol Scand. 2003 Apr107(4)256-9.
• Epidemiology of traumatic brain injury a
  population based study in western
  Sweden.Andersson EH, Bjorklund R, Emanuelson I,
  Stalhammar D.Department of Rehabilitation
  Medicine, Central Hospital Boras, SE 501 82
  Boras, Sweden. elisabeth.Andersson_at_vgregion.seIn
  cidence of 546 per 100,000. The external causes
  were dominated by fall from same level (31) and
  fall from different level (27) followed by
  traffic accidents (16) and persons hit by
  objects (15).

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Abstracts

• MMWR Surveill Summ. 2003 Jun 2752(4)1-20.
• Traumatic brain injury-related hospital
  discharges. Results from a 14-state surveillance
  system, 1997.Langlois JA, Kegler SR, Butler JA,
  Gotsch KE, Johnson RL, Reichard AA, Webb KW,
  Coronado VG, Selassie AW, Thurman DJ.National
  Center for Injury Prevention and Control, CDC,
  USA.Motor-vehicle crashes, falls, and assaults
  were the leading causes of injury for TBI-related
  discharges. Rates were highest for American
  Indians and Alaska Natives and Blacks. Data in
  this report indicate the importance of TBI as a
  public health problem.

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Abstracts

• J Trauma. 2001 Sep51(3)481-9.
• Epidemiology of severe brain injuries a
  prospective population-based study.Masson F,
  Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V,
  Dessalles PH, Cazaugade M, Labadens P Aquitaine
  Group for Severe Brain Injuries Study.Department
  of Anesthesia, University Hospital of Bordeaux,
  33076 Bordeaux cedex, France.19 hospitals in
  the region. Incidence rate of severe TBI 17.3
  per 100,000. Traffic accidents 48.3, falls
  41.8. Fatality rate 30.

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Abstracts

• World J Surg. 2001 Sep25(9)1230-7.
• Neurotrauma in Pakistan.Raja IA, Vohra AH, Ahmed
  M.Department of Neurosurgery, King Edward
  Medical College, 40-C, Zafar Ali Road, Gulberg V,
  Lahore, Pakistan. aliraja_at_brain.net.pkLead
  cause road traffic accidents. Mild head injury
  52, moderate 30, severe 18. Total
  mortality 18.

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Abstracts

• World J Surg. 2001 Sep25(9)1205-9.
• Neurosurgical trauma in Japan.Maejima S,
  Katayama Y.Department of Neurological Surgery,
  Nihon University School of Medicine, Oyaguchi
  Kami-machi 30-1, Itabashi-Ku, Tokyo, 173-8610,
  Japan. smaejima_at_med.nihon-u.ac.jpJapan
  Neurotrauma Data Bank System introduced recently
  statistics of 10 major neurotrauma centers

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Abstracts age specific children

• Acta Paediatr. 1997 Jul86(7)730-5.
• Epidemiology of traumatic brain injury in
  children and adolescents in south-western
  Sweden.Emanuelson I, v Wendt L.Bracke Ostergard
  Regional Pediatric Rehabilitation Centre,
  Goteborg,Sweden.
• Age 0-17. Incidence rate 12 per 100,000. The
  dominant external cause was traffic (60),
  followed by falls (22).

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Abstracts age specific children

• Injury. 2003 May34(4)256-60.
• Prevalence of traumatic brain injury amongst
  children admitted to hospital in one health
  district a population-based study.Hawley CA,
  Ward AB, Long J, Owen DW, Magnay AR.Centre for
  Health Services Studies, University of Warwick,
  Coventry CV4 7AL, UK. c.a.hawley_at_warwick.ac.ukNo
  rth Staffordshire registry of children TBI
  since 1992. Incidence 280 per 100,000 children
  are admitted for gtor24h with a TBI, of these 232
  will have a mild brain injury, 25 moderate, 17
  severe, and 2 will die. Children under 2 years of
  age account for 18.5 of all TBIs, usually due to
  falls, being dropped or non-accidental injuries
  (NAIs). Falls account for 60 of TBIs in the
  under 5 years. In the 10-15 age group road
  traffic accidents (RTAs) were the most common
  cause (185, 36.7).

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Abstracts age specific children

• JAMA. 2003 Aug 6290(5)621-6.
• A population-based study of inflicted traumatic
  brain injury in young children.Keenan HT, Runyan
  DK, Marshall SW, Nocera MA, Merten DF, Sinal
  SH.Department of Social Medicine, University of
  North Carolina at Chapel Hill, NC 27599-7240,
  USA. hkeenan_at_med.unc.eduA total of 152 cases of
  serious or fatal TBI were identified, with 80
  (53) incurring inflicted TBI.

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Statistics Austria Fatal accidents per 100,000
inhab.

• 1992 44,6
• 1993 40,1
• 1994 39,7
• 1995 40,5
• 1996 36,9
• 1997 34,8
• 1998 33,6
• 1999 30,9
• 2000 33,2
• 2001 33,0
• 2002 31,9

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Health for all Austria 2000

• SDR, external cause injury and poison, 0-64 per
  100000  38.97
• SDR, external causes of injury and poison, age
  0-4 years  10.65
• SDR, external causes of injury and poison, age
  5-19 years  7.09
• SDR, external cause injury and poison, all ages
  per 100000  47.56
• SDR, external cause injury and poison, 65 per
  100000  117

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Health for all Austria 2000

• SDR, motor vehicle traffic accidents, 0-64 per
  100000  9.8
• SDR, motor vehicle traffic accidents, all ages
  per 100000  9.99
• SDR, motor vehicle traffic accidents, 65 per
  100000 
• 11.57
• SDR, other external causes, 0-64 per
  100000  13.18
• SDR, other external causes, all ages per
  100000 19.14
• SDR, other external causes, 65 per 100000  67.38

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Health for all Austria 2000

• SDR, transport accidents, per 100000  11 2 of
  all causes
• SDR, all causes, all ages, per 100000 
• 658.48