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Traumatic Brain Injury
CDC Activities
Congressional
funding for CDC’s traumatic brain injury activities began with the
TBI Act of 1996. Since
then, CDC has supported data collection and follow-up studies in more
than 15 states to track and monitor TBI, to link people with TBI to
information about services, and to find ways to prevent TBI-related
disabilities.
TBI surveillance
yields valuable data
CDC currently funds 12 states to track and monitor traumatic brain
injuries. CDC analysis of data collected by surveillance states in 1997,
to be published in the MMWR in late 2002, indicate that TBI remains an
important public health problem. An additional report that reviews TBI
deaths for 1989–1998 will be published soon. Data in these reports will
inform decisions about TBI prevention efforts and service needs for people
with TBI.
National
estimates on TBI deaths, hospitalizations, and emergency department visits
In 2001, CDC funded an analysis of national TBI data from its National
Center for Health Statistics (NCHS). This analysis will generate national
estimates for TBI deaths, hospitalizations, and emergency department
visits by sex, age, and geographic region. It will also offer information
such as causes of TBI and average number of days TBI patients spent in the
hospital. Results of this analysis will be the subject of a CDC report,
slated for publication in the spring 2003, the first of its kind to
include detailed data about TBI in a single-reference document.
Population-based
follow-up registry of persons with TBI
Since 1998, South Carolina has received CDC funding to collect data about
the health outcomes and service needs of people with TBI in their state.
The information from the registry
developed is particularly important because it is population-based; that
is, it is representative of all persons ages 15 years and older who were
hospitalized with a TBI in South Carolina. Preliminary findings from this
project indicate that trouble with managing money and shopping for
groceries were the most common problems reported by persons with TBI, and
a large proportion of people with TBI in South Carolina reported that they
needed services such as a personal assistant to help with activities of
daily living. Overall, the initial results of this project indicate that a
substantial portion of people hospitalized with TBI have residual deficits
and service needs one year after injury.
Linking people with
TBI to information about TBI services
With CDC funding, the Colorado Department of Public Health and Environment
(CDPHE) has developed a TBI follow-up system and explored ways to link
persons with TBI with needed services. In FY 2001, CDPHE received
additional funds for a pilot project to evaluate the effectiveness of
linking people in the statewide TBI surveillance system to information
about TBI services. CDPHE selected a random sample of 750 persons in its
existing TBI surveillance system and sent them letters about a toll-free
hotline to help them find TBI services. Call volume to the hotline
quadrupled during the months the letter was sent out. This result
indicates that people with TBI want services but may not know about them
or how to access them. Callers from rural settings were overrepresented
among the people who called the hotline, which may indicate that resources
for TBI services are more limited for persons living in rural communities
than for persons in urban settings.
Expert meeting to
discuss the future of TBI registries
In July 2002, CDC convened a meeting of researchers, advocates, experts
from state and federal agencies, and state TBI registry managers to
discuss the future of TBI registries. Participants discussed CDC activities related to the TBI Act
Reauthorization, definition of a TBI registry, state registry needs, and
future steps CDC should take with regard to registries. The proceedings
and recommendations of this meeting will be published in early 2003.
Mild Traumatic Brain
Injury (MTBI): A Report to Congress
In response to public health concerns, Congress passed the TBI Act
Amendments of 2000, which required CDC to report to Congress how best to
measure the rate at which new cases of MTBI occur (i.e., incidence) and
the proportion of the U.S. population at any given time that is
experiencing the signs and symptoms of a MTBI (i.e., prevalence). To that
end, CDC formed the Mild Traumatic Injury Work Group, composed of experts
in the field of brain injury, to determine appropriate and feasible
methods for assessing the incidence and prevalence of MTBI in the United
States. CDC will release a report to Congress at the end of 2002 that
summarizes findings and recommendations of the work group.
Identifying the
number of persons with TBI among World Trade Center survivors
In mass trauma situations, medical personnel focus on identifying and
treating severe injuries and trauma. As a result, less severe,
non-life-threatening injuries, including mild to moderate TBI, may not be
diagnosed. CDC conducted a rapid assessment of injuries among survivors of
the September 11, 2001, World Trade Center attack who were seen in
emergency departments and found only a small percentage had a head injury.
Because other injured people may have had TBI that was not diagnosed, CDC
funded the New York City Department of Health to conduct a retrospective
study to identify the number of people hospitalized with injury after the
WTC attack who may have had a TBI. Researchers are reviewing inpatient
hospital records to identify those with possible TBI and to describe the
nature and cause of their injuries.
Community-based case
management of mild to moderate TBI
Mild to moderate TBI accounts for most patients who are hospitalized or
treated for TBI in emergency departments. Although few deaths are
associated with these injuries, the economic and personal costs can be
quite high. CDC has funded Baylor College of Medicine in Houston, Texas,
to learn about problems resulting from mild to moderate TBI. Preliminary
analysis indicates that 20% of brain-injured patients developed depression
within three to six months after injury, twice the percentage of patients
who sustained trauma not involving the brain. Nearly 40% of the TBI
patients developed at least one of the following secondary conditions
within three to six months of injury: depression, symptoms commonly
resulting from concussion, or symptoms associated with stress disorders
that occur with traumatic events. Of those who developed secondary
conditions and were offered treatment, only 5% actually presented for
treatment.
Measuring
children’s health after a TBI
A TBI can significantly affect a child’s health and development.
However, no standardized, efficient method exists to monitor the health of
children who sustain a TBI. In
FY 2001, CDC funded The Johns Hopkins University to conduct a three-year
evaluation of methods used to measure physical and psychosocial health
outcomes of children with TBI. 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 and will inform policy
and research initiatives.
New TBI education
material developed
- Spanish brochure
about TBI
Understanding brain injury and finding resources can be difficult,
especially if one’s first language is not English. To address the
need for Spanish-language materials about TBI, in summer 2002, CDC
published
Información
Acerca de la Lesión Cerebral Leve
to help Hispanic people and their families understand TBI and its
symptoms and find tips for healing. The first CDC material about TBI
offered in Spanish, this brochure serves as a useful tool for health
care providers in communicating with their Spanish-speaking patients
about TBI and in directing them to resources in the community. The
brochure also highlights a CDC-sponsored help line staffed by
Spanish-speaking operators: 1-800-444-6443.
- TBI toolkit for
primary care physicians
As part of a national initiative to prevent mild traumatic brain
injury (MTBI) and improve clinical management for patients with MTBI,
CDC has developed Heads Up: Brain Injury in Your Practice, a
toolkit for primary care physicians to be distributed in late 2002.
This effort is one of many CDC activities that address the
Congressional TBI Act Amendments of 2000, which mandate response to
this public health concern. Physicians play a key role in this
national initiative by helping their patients prevent MTBI and by
improving patient outcomes when MTBI occurs.
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