The Children’s Health Act of 2000 enables CDC to provide continued leadership in the study of traumatic brain injury (TBI). CDC supports multiple projects and programs, including those that monitor TBI, link people with TBI to information about services, and prevent TBI-related disabilities.
Research and Programs
Analyzing TBI surveillance data
CDC currently funds 30 states to conduct basic TBI surveillance through the Public Health Injury Surveillance and Prevention Program. CDC analysis of data collected by funded states in 1997 indicates that TBI remains an important public health problem. The data analysis was included in the article “Traumatic Brain Injury-related Hospital Discharges: Results from a 14-state Surveillance System, 1997,” in CDC’s Morbidity and Mortality Weekly Report (MMWR). An additional MMWR report, “Surveillance for Traumatic Brain Injury Deaths: United States 1989–1998,” reviews TBI deaths that occurred over that 10-year period. Both reports are available online at
Generating national estimates for TBI deaths, hospitalizations, and emergency department visits
CDC analyzed TBI data from its National Center for Health Statistics. This analysis generated national estimates for TBI deaths, hospitalizations, and emergency department visits by sex, age, and race. It also provided information such as causes of TBI and average hospital stays for TBI patients. Results of this analysis are published in a 2004 CDC report, Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. The report is the first of its kind to include detailed national data about TBI in a single reference document and
is available online at www.cdc.gov/ncipc/pub-res/TBI_in_US_04/TBI_ED.htm.
Planning the future of TBI registries and data systems
CDC convened a meeting of researchers, advocates, experts from state and federal agencies, and state TBI registry managers to discuss the future of TBI data systems. Participants discussed CDC activities related to the TBI Act Reauthorization, the definition of a TBI registry, state TBI data system needs, and future steps CDC should take to help states build data systems. The proceedings and recommendations of this meeting were published in July 2005. This report is available online at www.cdc.gov/ncipc/tbi/RegistriesDataSys.htm.
Reporting to Congress about mild TBI
The Children’s Health Act of 2000 required CDC to report to Congress on how best to measure the rate at which new cases of mild TBI occur (incidence) and the proportion of the U.S. population that, at any given time, experiences signs or symptoms of a mild TBI (prevalence). To that end, CDC formed the Mild TBI Work Group, composed of experts in the field of brain injury, to determine appropriate and feasible methods for assessing the incidence and prevalence of mild TBI in the United States. The Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a
Serious Public Health Problem, was published in 2003, and presents the findings and recommendations of the Mild TBI Work Group. This report is available online at
Identifying persons with TBI among World Trade Center survivors
CDC conducted a rapid assessment of injuries among survivors of the September 11, 2001, World Trade Center attack who were seen in emergency departments. CDC funded the New York City Department of Health and Mental Hygiene to conduct a retrospective study to identify people hospitalized after the attack who may also have had a TBI. Researchers reviewed inpatient hospital records to identify possible TBIs and to describe the cause and nature.
Identifying TBI in mass casualty events
CDC held an expert meeting to recommend approaches to help ensure that persons who sustain mild TBIs in disaster situations are identified, diagnosed, and educated about potential consequences. Experts in emergency medicine/disaster response and TBI were invited to the meeting to discuss TBI in mass casualty events. CDC will compile the meeting discussion and recommendations into a report. The information in this report will help improve preparedness for future disaster response by informing emergency and hospital personnel about the importance of diagnosing and educating patients about
possible mild TBI.
Educating health care professionals about TBI
CDC published and disseminated a TBI tool kit called Heads Up: Brain Injury in Your Practice. The tool kit contains practical, easy-to-use clinical information, patient information in English and Spanish, scientific literature, and a CD-ROM. More than 125,000 tool kits have been distributed to health care professionals in the United States and internationally. Although the tool kit was originally developed specifically for physicians, many other health care providers, such as nurse practitioners and physical therapists, have also requested the materials. This tool kit is available
Preventing and managing sports-related concussions
CDC developed an educational tool kit, Heads Up: Concussion in High School Sports, for high school athletic coaches. The tool kit includes information about how to prevent and manage sports-related concussions appropriately. The tool kit also contains materials to assist coaches in educating athletes, athletes’ parents, and school officials about sports-related concussions.
The tool kit initiative was launched nationally in September 2005. Tool kits were sent to more than 11,000 coaches, athletic directors, and principals in high schools nationwide. The tool kit may be downloaded or ordered free-of-charge at www.cdc.gov/ncipc/tbi/Coaches_Tool_Kit.htm.
Funding researchers to investigate TBI in children and adolescents
CDC funds TBI research in various academic institutions. Results of these projects will inform development of future programs and policies. Examples of research include the following:
Measuring children’s health after a TBI. A TBI can significantly affect a child’s health and development. However, no efficient, standardized method exists to monitor the health of children who sustain a TBI. To address this, CDC funded The Johns Hopkins University to conduct a three-year study to evaluate different methods for measuring physical and psychosocial health outcomes of children with TBI. Findings from this study will be published in a peer-reviewed journal. Validating and adopting a standardized health status survey that is appropriate for large-scale, ongoing surveillance of children’s health following a TBI
will improve understanding of how these injuries affect children. Such information will inform policy and research initiatives.
Developing tools to measure the effects of mild TBI. CDC is funding a collaborative study between Children’s National Medical Center, the University of Pittsburgh Medical Center Sports Medicine Concussion Program, and Dartmouth College. This study seeks to develop and validate a series of tests for assessing health outcomes of mild TBI among children and adolescents. It will also document factors that influence the outcome of a mild TBI during the recovery period.