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Jean McGuire Executive Office of Health and Human Services Presentation to the Brain Injury Commission February 7th, 2011
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 of Injury Unintentional Fall Unintentional Stuck by object or person Unintentional MV occupant and MV unspecified (combined) (excludes motorcyclist) Assaults (all mechanisms) Bicyclist (MV and NonMV) Pedestrian (MV and NonMV) Total (all causes and intents) ED - All injuries 186,056 ED - TBI associated 24,644 HDD- All Injuries 27,277 HDD- TBIassociated 3,371 OBS - All Injuries 3,254 OBS - TBI associated 558
102,128
12,930
1,184
170
340
87
60,995
24,934 9,108 3,779 709,237
6,833
4,924 1,071 465 52,339
2,514
2,033 524 612 59,446
697
361 133 210 5,603
573
453 131 92 10,027
180
116 47 33 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
Paul Coverdell Acute Stroke Registry Data Cases discharged between December 2009 November 2010
Total
Ischemic
Hemorrhagic
TIA
10574
7045
964
2466
72.7
73.0
70.7
72.9
23.6
27.0
25.0
13.8
49.5
41.2
20.3
81.6
% discharged to rehab
20.0
25.6
23.9
3.3
6.1
5.6
30.5
.13
.71
.58
.28
1.2
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.
Emergency Department Discharge Rates for Sportsrelated1 Traumatic Brain Injuries, MA Residents, FY2008
291.6
323.6
28.9
44.9
14.3
-4 4
5.3
-6 4
1.5
+ 65
-1 4
-1 9
10
15
20
-2 4
25
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.
45
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 21.6 23.4 19.2
Percentage of Students
20 14.2
18.3 14.5
15
10
0 High School
1 Includes 2 Reported
Middle School
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.
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.
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