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					Epidemiology of TBI

  Alexandra Brazinova, MD, MPH, PhD

    IGEH seminar Oct.28,2003
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 (USA – rehabilitation centers)
What does epidemiology
follow in TBI
   Causes, mechanisms, severity
   Prevalence (morbidity)– total no. of
    cases at any given time and certain
   Incidence – new cases at certain time in
    certain area (country, etc.)
   Mortality
   Health outcomes
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

   is not well documented, because mild
    cases may not be hospitalized.
    Estimates are often based on existing
   Discrepancies in data collection :
    difference in findings of diagnostic
    imaging at different time intervals
Incidence of TBI (US)
   Mild TBI - 131 cases per 100,000
   Moderate TBI – 15 cases per 100,000
   Severe TBI – 14 cases per 100,000
    (with prehospital deaths included – 21
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
   Individuals with previous TBI
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
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
Abstracts – incidence
 Country           Per 100,000
 USA               180-250
 South Australia   322
 Italy             250
 Sweden            546
   Epilepsia. 2003;44 Suppl 10:2-10.
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
   Brain Inj. 1997 Sep;11(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.
   J Neurosurg Sci. 2002 Dec;46(3-4):111-
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.
   Acta Neurol Scand. 2003
Epidemiology of traumatic brain injury: a population based
  study in western Sweden.
  Andersson EH, Bjorklund R, Emanuelson I, Stalhammar
  Department of Rehabilitation Medicine, Central Hospital Boras,
  SE 501 82 Boras, Sweden.

    Incidence 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%).
   MMWR Surveill Summ. 2003 Jun 27;52(4):1-
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
   J Trauma. 2001 Sep;51(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%.
   World J Surg. 2001 Sep;25(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,

    Lead cause – road traffic accidents. Mild head injury
    – 52%, moderate – 30%, severe 18%. Total
    mortality 18%.
   World J Surg. 2001 Sep;25(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.

    Japan Neurotrauma Data Bank System introduced
    recently – statistics of 10 major neurotrauma centers
Abstracts – age specific –
   Acta Paediatr. 1997 Jul;86(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,

Age 0-17. Incidence rate 12 per 100,000. The dominant external
  cause was traffic (60%), followed by falls (22%).
Abstracts – age specific –
   Injury. 2003 May;34(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.

    North Staffordshire – registry of children TBI since 1992.
    Incidence 280 per 100,000 children are admitted for >or=24h
    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%).
Abstracts – age specific –
   JAMA. 2003 Aug 6;290(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.

    A total of 152 cases of serious or fatal TBI were
    identified, with 80 (53%) incurring inflicted TBI.
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
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
Health for all – Austria 2000
   SDR, motor vehicle traffic accidents, 0-64 per 100000
   SDR, motor vehicle traffic accidents, all ages per
    100000     9.99
   SDR, motor vehicle traffic accidents, 65+ per 100000
   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
Health for all – Austria 2000
   SDR, transport accidents, per
    100000      11 = 2% of all causes
   SDR, all causes, all ages, per

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