ED, Hospital Admissions for TBI Jump by 300,000
ACEP News
May 2010
By Michele G. Sullivan
Elsevier Global Medical News
WASHINGTON -- Traumatic brain injury accounts for 1.7 million emergency department visits, hospitalizations, and deaths in the United States each year, according to a new report issued by the Centers for Disease Control and Prevention.
The overall number represents an increase of 300,000 from the last CDC report, released in 2006, Lisa McGuire, Ph.D., said in an interview.
Despite the overall increase in traumatic brain injury (TBI), the report did not find a large increase in deaths compared with the 2006 report, she noted. In 2006, an estimated 50,000 people died after being admitted for a TBI; in the new report, that estimate is 52,000 people.
Although the report did not analyze any of the data, "we know from previous research supported by CDC that if we can get the severely injured, including those with TBI, to the right place at the right time, we can decrease fatalities by 25%," said Gail Hayes of the CDC's National Center for Injury Prevention and Control.
"This advancement, coupled with the innovations made in medical science and hospital care, means more people are surviving TBI," she said. "It is likely that these factors contribute to the stabilization of death counts."
An ever-aging U.S. population also could be contributing to the increase in TBI, said Dr. McGuire, the research team leader at the Center's Division of Injury Response. "The number one cause of TBI is falls. We are seeing an increasingly older demographic in the United States, and older adults are more likely to fall."
The report found an increasing number of TBI-related ED visits and hospitalizations, according to Ms. Hayes, but for reasons "we can't explain based on this report, deaths remain stable."
In addition, Ms. Hayes speculated that there might be an increased awareness of TBI, which "results in more people with mild TBI reporting for care [instead of ignoring the injury or going to their family doctors]. Because of changes in our health care system, there may be increased use of EDs for care, and these people may report with milder TBIs. Therefore, it's certainly possible that deaths might not change, while overall ED visits might increase."
Finally, she said, the number of mild TBIs is on the rise. "These increases may also in part be related to general population growth and increases in the number of older adults," Ms. Hayes said.
According to the report, first presented at a poster March 12 at the World Congress on Brain Injury and then later widely released March 17, emergency departments see 1.4 million TBI-related injuries each year; 275,000 are admitted to the hospital, and 52,000 die.
TBIs accounted for 15% of all hospitalizations each year and 31% of all injury-related hospital deaths, the report noted.
The report, titled "Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Death," is based on data during 2002-2006 from three national databases: the National Hospital Discharge Survey, the National Hospital Ambulatory Medical Care Survey, and the National Vital Statistics System. It identifies the leading causes of TBI and its incidence by age, race, and gender.
Falls were the leading cause of TBI, accounting for 35%. Young children and adults aged 65 years and older were particularly at risk for fall-related injury. Falls accounted for 50% of the injuries to children up to 14 years of age, and 61% of the injuries to older adults.
Motor vehicle accidents were the second-leading cause of TBI, accounting for 17% of the injuries. However, they were the leading cause of TBI-related death (32%).
Each year, 523,000 patients are admitted to emergency departments for fall-related TBIs. Of those who are admitted, 62,000 are hospitalized and 9,700 die, the report estimated. By comparison, about half as many patients are admitted for motor vehicle-related TBIs (219,000) and 57,000 are admitted to the hospital, but 16,400 die from their injury.
Children and older people accounted for most of the ED visits for TBI, the report noted. Every year, 474,000 children aged 0-14 years are seen for a TBI; 35,000 are admitted, and 2,000 die. The youngest children--those up to 4 years of age-- have the highest rate of TBI-related ED visits (1,256/100,000 persons), followed by teens aged 15-19 years (757/100,000 persons).
Adults aged 65 and older account for 142,000 ED visits, 81,000 hospital admissions, and 14,000 deaths each year. Those aged 75 years and older had the highest rate of TBI-related hospitalization (339/100,000 persons) and death (57/100,000 persons).
The youngest (up to 4 years) and the oldest (75 and older) had the highest rates of falls (839/100,000 and 599/100,000, respectively). But young adults aged 20-24 years, had the highest rate of TBI from both a motor vehicle accident and from assault (261/100,000 and 175/100,000, respectively).
Compared with females, males in every age group had higher rates of ED visits, hospital admissions, and deaths related to TBI. Every year, 38,000 males die from a TBI, compared with 14,000 females. This disparity between men and women is not unexpected, said Marlena Wald, a CDC epidemiologist and co-author of the paper.
"In every area of injury that we track, men have always outnumbered women," she said in an interview.