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					 Data on Brain Injury in
Massachusetts: A Snapshot
                 Jean McGuire
Executive Office of Health and Human Services
 Presentation to the Brain Injury Commission
              February 7th, 2011
     Current Types of Data with State
    Specific Information on Brain Injury
•   Acute Care Hospital Discharge Databases
•   Vital Statistics – Death File
•   Statewide Trauma Registry Data
•   Disease Specific Surveillance Data
•   Brain Injury Symptom Surveillance Data
        Acute Care Hospital Discharge Databases
•   MA Emergency Department Discharge Database
•   MA Inpatient Hospital Discharge Database
•   MA Outpatient Observation Stay Database
•   This data is maintained by MA Division of Health Care Finance and Policy
Strengths:
•   Contain discharge information on all cases discharged from any acute care hospital in
    Massachusetts
• TBI-related cases are determined according to standardized case definitions recommended
    by the Centers for Disease Control and Prevention (CDC) and are based upon International
    Classification of Disease Version 9 Clinical Modification (ICD-9-CM) codes for morbidity and
    International Classification of Disease Version 9 (ICD-9, 1995-1998) and Version 10 (ICD-10,
    1999-2006) codes for mortality
Limitations:
• These administrative databases contain information which is collected for billing purposes
    but which are used secondarily for surveillance.
• Does not tell us prevalence of injury that results in long-term disability
•   Information has not been validated by medical record review
         Emergency Department (ED) Discharges, Inpatient Hospital (HDD)
     Discharges, and Observation Stay (OBS) Discharges for All and TBI-related
    Injury Cases by Leading and Selected Causes of TBI, MA Residents, FY 2008

 Cause and Intent                          ED - TBI                                   HDD- TBI-                                  OBS - TBI
 of Injury            ED - All injuries    associated           HDD- All Injuries     associated            OBS - All Injuries   associated

 Unintentional Fall         186,056               24,644               27,277                3,371                 3,254                558
 Unintentional
 Stuck by object or
 person                     102,128               12,930                1,184                 170                   340                 87
 Unintentional MV
 occupant and MV
 unspecified
 (combined)
 (excludes
 motorcyclist)               60,995                   6,833             2,514                 697                   573                 180
 Assaults (all
 mechanisms)                   24,934                 4,924             2,033                 361                   453                 116
 Bicyclist (MV and
 NonMV)                         9,108                 1,071              524                  133                   131                 47
 Pedestrian (MV
 and NonMV)                     3,779                   465              612                  210                   92                  33
 Total (all causes
 and intents)                 709,237                52,339            59,446                5,603                10,027               1,316
Sources: MA Inpatient Hospital, Outpatient Observation Stay and Emergency Department Discharge Databases, MA Division of Health Care Finance
and Policy.

Excludes cases dying in the hospital or DOA. Excludes inpatient transfers to another acute care hospital.

Data Prepared by the MA Department of Public Health
        Vital Statistics – Death File
• Registry of Vital Records and Statistics
• Maintained by MA Department of Public
  Health

• Summary statistics can be found in handout: Traumatic Brain
  Injuries in Massachusetts: Data Summary, September 2008.
  This report is prepared by MA DPH, Injury Surveillance
  Program
       State Trauma Registry Data
• Erwin Hirsh Statewide Trauma Registry
• Maintained by MA Department of Public Health,
  Office of Emergency Medical Services
• Captures physiologic information providing details on
  the severity of injury with clinical markers

Challenges with data source:
• Only captures cases which are hospitalized, requiring
  interfacility transfer, or cases resulting in death
• Data currently being validated
  Disease Specific Surveillance Data—
            Stroke Registry
• The Paul Coverdell National Acute Stroke Registry (PCNASR)
  collects emergency department and inpatient data on
  patients arriving to hospitals
• MA is one of 6 states with federal funding to maintain a
  PCNASR
• In MA, approximately 85% of all stroke hospitalizations
  (11,000 a year) are captured in the registry
• 58 MA hospitals are currently participating in the registry
• This registry is maintained by MA Department of Public Health
       Statistics from Stroke Registry
•   Strokes can be classified as ischemic (caused by a blood clot occluding vasculature
    in the brain thus impeding blood flow and tissue death), hemorrhagic (bleeding in
    the brain) or TIA (transient ischemic attack – a “mini-stroke” with symptoms
    resolving within 24 hours of symptom onset). TIAs are predictors of future strokes.
•   Stroke is the 3rd leading cause of death in MA and in the US.
•   Stroke is one of the leading causes of disability in the US.
•   While 83% of stroke patients are ambulating prior to their stroke hospitalization,
    only 51% are ambulating at the time of discharge.
•   For those suffering a hemorrhagic stroke, the change is from 75% prior to 28% post
    stroke.
•   Half of stroke patients are discharged home, a quarter are discharged to another
    hospital or long term care facility, 6% expire, and 20% are discharged to a rehab
    facility
•   60% of stroke patients receive some degree of rehabilitation during their hospital
    stay.
                Paul Coverdell Acute Stroke Registry Data
      Cases discharged between December 2009 – November 2010


                                           Total                        Ischemic                    Hemorrhagic                   TIA


  # strokes                                10574                          7045                           964                      2466


  Average age of stroke
                                            72.7                          73.0                           70.7                     72.9
  patients (years)


                                                                 Discharge Status (%)

  % discharged to
  LTC/Other                                 23.6                          27.0                           25.0                     13.8
  Hospital/Hospice

  % discharged home                         49.5                          41.2                           20.3                     81.6


  % discharged to rehab                     20.0                          25.6                           23.9                     3.3


  % expired                                  6.1                           5.6                           30.5                     .13


  % discharged to other
                                             .71                           .58                           .28                      1.2
  destination



Source: MA Paul Coverdell Acute Stroke Registry, Data accessed February 2010 for the time period December 2009 – November 2010.
Contact: katrina.damore@state.ma.us Heart Disease and Stroke Prevention and Control Program.
  Brain Injury Symptom Surveillance
                 Data
• Maintained by MA Department of Public
  Health
  – One question on Youth Health Survey relative to
    youth reporting symptoms of head injury
    Emergency Department Discharge Rates for Sports-
           related1 Traumatic Brain Injuries,
                 MA Residents, FY2008
       Rate per 100,000




                          400.0                              323.6
                                                291.6
                          300.0
                          200.0
                          100.0     28.9                                  44.9        14.3           5.3        1.5
                            0.0




                                                                                                            +
                                    9



                                               4



                                                            9



                                                                         4



                                                                                     4



                                                                                                 4
                                  0-




                                                                                                           65
                                            -1



                                                         -1



                                                                      -2



                                                                                  -4



                                                                                              -6
                                           10



                                                        15



                                                                     20



                                                                                 25



                                                                                             45
                                                                Age Groups (in years)


 MA youth between the ages of 10 and 19 accounted for 77% of
 all sports-related TBIs treated in the ED (N=2,655).
Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and Policy.
1 Includes
         only cases with E-codes (E886.0, E917.0, E917.5); other sports-related cases not receiving
these codes are not included.
 Percentage of Massachusetts Students1 Reporting Symptoms of
 a TBI2 While Playing with a Sports Team in the Past 12 months,
                 (MA Youth Health Survey, 2009)
                           25                                        23.4
                                    21.6

                           20                                                      19.2
  Percentage of Students




                                                   18.3


                                            14.2                            14.5
                           15                                                                      Male
                                                                                                   Female
                           10                                                                      Total



                            5


                            0
                                        High School                    Middle School
1 Includes                      only students who played on a sports team in the past 12 months.
2 Reported they suffered a blow or jolt to head while playing with a sports team (during a
game or practice) which caused them to get "knocked out", have memory problems,
double or blurry vision, headaches or "pressure" in the head or nausea or vomiting.
    National TBI Estimates and Statistics
• Each year, an estimated 1.7 million people sustain a TBI annually.1
• Of them:
      –   52,000 die,
      –   275,000 are hospitalized, and
      –   1.365 million, nearly 80%, are treated and released from an emergency department.
• TBI is a contributing factor to a third (30.5%) of all injury-related deaths in
  the United States.1
• About 75% of TBIs that occur each year are concussions or other forms of
  mild TBI.2
• *The number of people with TBI who are not seen in an emergency
  department or who receive no care is unknown.
Source: CDC, 2010, http://www.cdc.gov/traumaticbraininjury/statistics.html,
1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department
     visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National
     Center for Injury Prevention and Control; 2010.
2. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report
     to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health
     problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.
  National Statistics by Age and Gender
TBI by Age1
• Children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65
    years and older are most likely to sustain a TBI.
• Almost half a million (473,947) emergency department visits for TBI are made annually
    by children aged 0 to 14 years.
• Adults aged 75 years and older have the highest rates of TBI-related hospitalization and
    death.

TBI by Gender1
• In every age group, TBI rates are higher for males than for females.
• Males aged 0 to 4 years have the highest rates of TBI-related emergency department
    visits, hospitalizations, and deaths.


Source: http://www.cdc.gov/traumaticbraininjury/statistics.html,
1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department
     visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National
     Center for Injury Prevention and Control; 2010.
                Conclusion
• We have a patchwork picture of prevalence of
  TBI in MA
• We have an incomplete picture of prevalence
  of ABI due to focus on TBI in data
• Trends in hospital / ED usage are difficult to
  interpret due to increased awareness around
  brain injury, especially with sports related
  injuries
    Where do we go from here?
• What do we need to know about this
  population to move conversation forward?
• What potential sources may be out there?
• What recommendations would we make
  relative to improved data on brain injury
  population?

				
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