California’s System for Passive Surveillance of Traumatic Brain Injury (TBI) Roger Trent, PhD and Julie Cross, PhD Epidemiology and Prevention for Injury Control Branch (EPIC) California Department of Health Services - Sacramento, CA 129th Annual Meeting of the American Public Health Association Atlanta, GA - October 2001

Background TBIs are serious and costly Often result in death or life-long disability Many are preventable, e.g. through use of helmets, passenger restraints and firearm safety devices Numbers and external causes have been largely unknown –Much analysis based on diagnosis codes (N-codes) rather than external cause of injury codes (E-codes) –Surveillance generally relies on expensive record abstraction

California’s Surveillance System California’s system is completely passive –Based entirely on available computerized data –Can be maintained for entire state (34 million population) by a single epidemiologist We use CDC definition of TBI: Dx of skull fracture, intracranial lesion, or intracranial hemorrhage Fatal TBI ascertained from Multiple Cause of Death files Severe, nonfatal TBI ascertained from Hospital Discharge data files

Methods Here we aggregate 4 years of data ( ) California residents only Describe cases by disposition and demographics –disposition (nonfatal/fatal) –age, sex and race/ethnicity

Results (Rates/100,000) During , there were 105,843 cases –87,979 nonfatal cases and 17,864 deaths (Fatality Ratio = 17 %) Overall rate: 80 per 100,000 population –66 nonfatal cases (21,995 per year) –13 fatal cases (4,466 per year) Highest rates among infants, late-teens and elderly –98.5 under 1 year old (540 per year) – to 20 year olds (2,625 per year) –163those 65 years and older (5,826 per year) Rates for males are higher than females –True at all age groups

Results Leading causes of fatal TBI –Firearm, Suicide: 31% (1,398 cases per year) –MV Occupant: 15% (669 cases per year) –Falls:15% (659 cases per year) –Firearm, Assault: 12% (527 cases per year) Leading causes of nonfatal TBI –Falls: 32% (7,002 cases per year) –MV Occupant: 24% (5,323 cases per year) –Non-firearm, Assault: 10% (2,235 cases per year)

Rates of TBI by Age California residents, Source: California Statewide TBI Surveillance System fill

Rates of TBI by Age and Sex California residents, Source: California Statewide TBI Surveillance System MALE FEMALE

Rates of TBI by Race/Ethnicity California residents, Source: California Statewide TBI Surveillance System a

Leading Causes of TBI By disposition, California residents, Source: California Statewide TBI Surveillance System FATAL NONFATAL

Leading Causes of TBI By disposition, California residents,

Leading Causes of TBI by Sex California residents, Source: California Statewide TBI Surveillance System MALEFEMALE A

Leading Causes of TBI among Specific Age Groups California residents, Source: California Statewide TBI Surveillance System 96.1 < 1 YR16-20 YRS 65 + YRS AA

Applications in Policy and Public Health Practice Motorcycle helmet laws Bicycle helmet laws Child safety seat/booster seat laws Fall prevention among seniors Shaken Baby Syndrome

Conclusions TBIs account for nearly 4,500 deaths and 22,000 hospitalizations among residents of California each year. Some of the leading causes of TBI are preventable through the use of passenger restraints, helmets or firearm safety devices. The statewide TBI surveillance system provides valuable data to monitor this serious type of injury. The surveillance system is passive and can be maintained by minimal personnel.