Traumatic Brain Injury: Epidemiology, Issues and Challenges

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Traumatic Brain InjuryEpidemiology, Issues
and Challenges

• Jean A. Langlois, ScD, MPH
• Centers for Disease Control and Prevention
• Institute of Medicine TBI Workshop
• Washington, DC
• July 18, 2005

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What is TBI?

• A blow or jolt to the head that disrupts
• - the function of the brain
• - a persons life
• - the lives of their families/caregivers.

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Is Concussion a TBI?

• YES!
• Even people with concussion or mild TBI can
  have serious and long-term problems.

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What is mild TBI?

• At the time of initial assessment, the observed
  injury to the brain appears to be mild.
• Mild TBI does not always result in mild
  consequences
• Mild TBI and concussion are frequently missed/not
  diagnosed.

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The Silent Epidemic of TBI One Womans Story

Often I go without things I need because I
cannot do the simple things expected of me. Now
sometimes I cant comprehend simple words in a
sentence, manage incoming mail, fill out forms,
arrange transportation. Marilyn Gelman
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Where do CDC national TBI estimates come from?
At least 1.4 million TBIs occur in the United
States each year.
50,000 Deaths
235,000 Hospitalizations
1,111,000 Emergency Department Visits
???
Average annual numbers, NCHS data, 1995-2001
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Where do CDC state TBI estimates come from?
Surveillance of TBI deaths and hospitalizations
in 30 states
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Who do we miss?

• People with TBI who receive medical care in other
  settings (e.g. doctors offices)
• People who receive medical care, but the TBI
  isnt identified
• People who receive no medical care
• Usually concussion or mild TBI,
• e.g., sports and recreation-related.

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Who experiences TBI?

• About two-thirds are male
• American Indians/Alaska Natives and Blacks have
  the highest rates
• Very young children, older adolescents, and
  adults aged 75 or older are more likely than
  others to sustain a TBI.

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Are there any new TBI populations?

• Increasing numbers of military personnel,
  especially those exposed to bomb blasts
• Survivors of terrorism-related attacks, including
  at the World Trade Center and the Pentagon
• Increasing numbers of older adults.

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What are the trends in TBI?

• Annual numbers of TBI have not changed
• Overall death rates have decreased
• More people are surviving TBI and living with
  disability.

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At least 90,000 Americans each year sustain TBI
resulting in long-term or lifelong disability.
How many people in the U.S. have TBI-related
disability?
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How many people have TBI disability by
state?Number of new cases of TBI disability each
year
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Study in 20 states to begin 8/05
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What are states needs for TBI data?

• All states need their own data
• CDC program needs to improve data dissemination
• HRSA program needs increased knowledge of how to
  interpret and use the data.

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STATE TBI ACTIVITIESCDC HRSA
CDC
HRSA
LINKING
DATA
SERVICE
PEOPLE
AND
DELIVERY
WITH TBI
DATA
SYSTEMS
TO
SYSTEMS
SERVICES
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What happens to people after a TBI?

• Traumatic brain injury
• begins as a medical problem
• becomes a chronic disabling condition.

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SERVICES/SUPPORTS
MEDICAL CARE
LIVING IN THE COMMUNITY
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How can we reduce TBI-related disability?

• Information and services are the keys to
  reducing disability and improving quality of life.

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What information and services do people with TBI
say they need?

• Information about
• Brain injury
• Services and how to get them
• Services to
• Improve memory/problem-solving
• Increase income
• Improve job skills
• Manage money
• Manage stress/emotional upsets.
• Corrigan et al, 2004 Heinemann et al, 2002
  SCTBIFR

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Which groups most often report unmet TBI service
needs?
INADEQUATE SOCIAL SUPPORT
UNEMPLOYED
UNINSURED/MEDICAID
LOW COGNITIVE STATUS
FAIR/POOR HEALTH
NONWHITE MALES

35-54 YEARS OF AGE
PREVIOUS TBI

SINGLE
SC TBI Follow-up Registry, 1-year follow-up data
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What about services for people with mild TBI?

• Research suggests that they can
• benefit from
• Neuropsychological evaluation to determine
  deficits
• Vocational assistance to prevent job loss
• Psychological counseling to cope with changes.

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Summary Challenges to data collection helping
people with TBI get services

• TBI
• Awareness and
• identification
• Diagnosis
• Assessment
• Information
• Service
• Availability
• Access
• Funding