Transcript Epidemiology of TBI

Epidemiology of TBI
Alexandra Brazinova, MD, MPH, PhD
IGEH seminar Oct.28,2003
Traumatic brain injury
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“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
www.neuroskills.com (USA – rehabilitation centers)
What does epidemiology
follow in TBI
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Causes, mechanisms, severity
Prevalence (morbidity)– total no. of
cases at any given time and certain
area
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
Prevalence
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is not well documented, because mild
cases may not be hospitalized.
Estimates are often based on existing
disabilities
Discrepancies in data collection :
difference in findings of diagnostic
imaging at different time intervals
Incidence of TBI (US)
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Mild TBI - 131 cases per 100,000
people
Moderate TBI – 15 cases per 100,000
Severe TBI – 14 cases per 100,000
(with prehospital deaths included – 21
cases)
High-risk population
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Young people
Low-income individuals
Single individuals
Members of ethnic minority groups
Residents of inner cities
Men
Individuals with previous history of substance
abuse
Individuals with previous TBI
Health outcomes –
impairments/disabilities resulting
from TBI
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Cognition – concentration, memory,
judgment, mood
Movement abilities – strength,
coordination, balance
Sensation – tactile, vision, etc.
Seizure disorders (epilepsy)
Persisting unconsciousness
TBI related mortality rate (US)
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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
Abstracts
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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
deprivation.
Abstracts
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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.
Abstracts
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J Neurosurg Sci. 2002 Dec;46(3-4):1119.
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.
Abstracts
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Acta Neurol Scand. 2003
Apr;107(4):256-9.
Epidemiology of traumatic brain injury: a population based
study in western Sweden.
Andersson EH, Bjorklund R, Emanuelson I, Stalhammar
D.
Department of Rehabilitation Medicine, Central Hospital Boras,
SE 501 82 Boras, Sweden. [email protected]
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%).
Abstracts
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MMWR Surveill Summ. 2003 Jun 27;52(4):120.
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
problem.
Abstracts
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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%.
Abstracts
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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,
Pakistan. [email protected]
Lead cause – road traffic accidents. Mild head injury
– 52%, moderate – 30%, severe 18%. Total
mortality 18%.
Abstracts
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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, 1738610, Japan. [email protected]
Japan Neurotrauma Data Bank System introduced
recently – statistics of 10 major neurotrauma centers
Abstracts – age specific –
children
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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,
Goteborg,Sweden.
Age 0-17. Incidence rate 12 per 100,000. The dominant external
cause was traffic (60%), followed by falls (22%).
Abstracts – age specific –
children
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Injury. 2003 May;34(4):256-60.
Prevalence of traumatic brain injury amongst children
admitted to hospital in one health district: a populationbased study.
Hawley CA, Ward AB, Long J, Owen DW, Magnay AR.
Centre for Health Services Studies, University of Warwick,
Coventry CV4 7AL, UK. [email protected]
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 –
children
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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.
[email protected]
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
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
44,6
40,1
39,7
40,5
36,9
34,8
33,6
30,9
33,2
33,0
31,9
Health for all – Austria 2000
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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
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SDR, motor vehicle traffic accidents, 0-64 per 100000
9.8
SDR, motor vehicle traffic accidents, all ages per
100000
9.99
SDR, motor vehicle traffic accidents, 65+ per 100000
11.57
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
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SDR, transport accidents, per
100000
11 = 2% of all causes
SDR, all causes, all ages, per
100000
658.48