Problem/Condition: Data indicate that approximately 50,000 U.S. residents die as a result of traumatic brain injury (TBI) annually. Survivors of TBI are often left with neuropsychologic impairments that result in disabilities affecting work or social activity. During 1979–1992, TBI-related death rates declined 22%, from 24.6 to 19.3 deaths/100,000 population. This report describes the epidemiology and trends in TBI-related mortality during 1989–1998.
Reporting Period: January 1, 1989–December 31, 1998.
Description of Systems: The National Center for Health Statistics (NCHS) Multiple Cause of Death public use data were analyzed for this study.
Results: During 1989–1998, an annual average of 53,288 deaths (range: 51,848–54,501) among U.S. residents were associated with TBI. TBI-related death rates declined 11.4%, from 21.9 to 19.4/100,000 population. The major causes of TBI-related deaths were firearm-related (40%), motor-vehicle–related (34%), and fall-related (10%). The leading causes of TBI-related deaths differed among age groups. Among youths aged 0–19 years, motor-vehicle–related TBIs were the leading cause; among persons aged 20–74 years, firearm-related TBIs were the leading cause; and among persons aged >75 years, fall-related TBIs were the leading cause. Comparing rates in 1989 with rates in 1998, motor-vehicle–related causes declined by 22%; the majority of this decline occurred during the first 5 years of the period. During 1989–1998, firearm-related TBI-related deaths declined by 14%; approximately all of this decline occurred during the last 5 years of the period. In contrast, fall-related TBI-related death rates increased by 25% during the period.
Conclusion: This analysis of mortality data identifies recent trends in TBI-related deaths occurring during 1989–1998. Fall-related TBI death rates have increased throughout the period. Firearm-related TBI death rates, which were increasing in the early 1990s, declined. Motor-vehicle–related TBI death rates, which were decreasing until the mid-1990s, have since demonstrated only a limited change.
Public Health Action: More current population-based epidemiologic studies of TBI are needed to assess recent trends of etiologic factors, provide additional guidance for public policy, and evaluate prevention strategies. Despite the decline in fatal TBI incidence, TBI morbidity and mortality remains a public health challenge. Public health, law enforcement, and transportation safety professionals can address these challenges by implementing effective interventions based on a thorough assessment of the factors that influence health-related behaviors.
|1999||Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil. December 1999;14(6):602-615.|
|1995||Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with traumatic brain injury, 1979 through 1992: success and failure. JAMA. June 14, 1995;273(22):1778-1780.|
|2000||Traffic Safety Facts 1999: A Compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System. Washington, DC: U.S. Dept of Transportation, National Center for Statistics and Analysis, National Highway Traffic Safety Administration; December 2000. Report No. DOT HS 809 100.|
|1984||Kraus JF, Black MA, Hessol N, Ley P, Rokaw W, Sullivan C, Bowers S, Knowlton S, Marshall L. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol. 1984;119(2):186-201.|
|2010||Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; March 2010.|
|2004||Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. Atlanta, GA: National Center for Injury Prevention and Contro, Centers for Disease Control and Prevention; October 2004.|
|2009||Lopez-Valdes FJ, Forman J, Kent R, Bostrom O, Segui-Gomez M. A comparison between a child-size PMHS and the Hybrid III 6 YO in a sled frontal impact. In: 53rd Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 5-7, 2009; Baltimore, MD.237-246.|
|2010||Carroll CP, Cochran JA, Price JP, Guse CE, Wang MC. The AIS-2005 revision in severe traumatic brain injury: mission accomplished or problems for future research? In: 54th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 17-20, 2010; Las Vegas, NV.233-238.|
|2010||Seacrist T, Balasubramanian S, García-España JF, Maltese MR, Arbogast KB, Lopez-Valdes FJ, Kent RW, Tanji H, Higuchi K. Kinematic comparison of pediatric human volunteers and the Hybrid III 6-year-old anthropomorphic test device. In: 54th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 17-20, 2010; Las Vegas, NV.97-108.|
|2012||Stammen JA, Herriott R, Kang Y-S, Bolte J, Dupaix R. Sequential biomechanics of the human upper thoracic spine and pectoral girdle. In: 56th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 14-17, 2012; Seattle, WA.151-162.|
|2013||Lopez-Valdes FJ, Forman JL, Ash JH, Kent R, Alba JJ, Segui-Gomez M. Assessment of a head support system to prevent pediatric out-of-position: an observational study. In: 57th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 22-25, 2013; Quebec City, QC.297-310.|
|2009||Balasubramanian S, Seacrist T, Maltese MR, Arbogast KB, Hopely T, Constans E, Sterner R, Tanji H, Higuchi K. Head and spinal trajectories in children and adults exposed to low speed frontal acceleration. In: Proceedings of the 21st International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 15-18, 2009; Stuttgart, Germany.|
|2011||Kent R, Lopez-Valdes FJ, Lamp J, Lau S, Parent D, Kerrigan J, Lessley D, Salzar R. Characterization of the pediatic chest and abdomen using three post-mortem human subjects. In: Proceedings of the 22nd International Technical Conference on the Enhanced Safety of Vehicles (ESV). June 13-16, 2011; Washington, DC.|
|2008||Balasubramanian S, Seacrist T, Hopely T, Sterner R, Maltese MR, Constans E, Arbogast KB. Electromyography responses of pediatric and adult volunteers in low speed frontal impacts. In: Proceedings of the 36th International Workshop on Human Subjects for Biomechanical Research. November 2, 2008; San Antonio, TX.|
|2005||Arbogast KB, Jermakian JS, Ghati Y, Smith R, Maltese MR, Menon RA. Predictors and patterns of pediatric head injury in motor vehicle crashes. In: Proceedings of the 2005 International IRCOBI Conference on the Biomechanics of Impact. September 21-23, 2005; Prague, Czech Republic.15-27.|
|2009||Lopez-Valdes F, Forman J, Ash J, Kindig M, Lamp J, Kent R, Bohman K, Bostrom O. The frontal-impact response of a booster-seated child-size PMHS. In: Proceedings of the 2009 International IRCOBI Conference on the Biomechanics of Impact. September 9-11, 2009; York, UK.177-188.|
|2013||Lopez‐Valdes FJ, Lorente OJ, Alba JJ. Preventing pediatric out‐of‐position in frontal crashes: impact assessment of a head support system. In: Proceedings of the 2013 International IRCOBI Conference on the Biomechanics of Injury. September 11-13, 2013; Gothenburg, Sweden.394-411.|
|2014||Arbogast KB. A public health priority for only ten percent of the car occupant population: why focus on children and how are they different biomechanically? In: Proceedings of the 2014 International IRCOBI Conference on the Biomechanics of Injury. September 10-12, 2014; Berlin, Germany.1-14.|
|2008||Lau SH, Rafaels KA, Bass CR, Kent RW. An assessment of Macropus Giganteus as a biomechanical model of the pediatric thorax. In: Proceedings of the 4th Ohio State University Injury Biomechanics Symposium. May 19-20, 2008; Columbus, OH.|
|2009||Arbogast KB, Balasubramanian S, Seacrist T, Maltese MR, García-España JF, Hopely T, Constans E, Lopez-Valdes FJ, Kent RW, Tanji H, Higuchi K. Comparison of kinematic responses of the head and spine for children and adults in low-speed frontal sled tests. Stapp Car Crash J. 2009;53:329-372. SAE 2009-22-0012.|
|2009||Kent R, Salzar R, Kerrigan J, Parent D, Lessley D, Sochor M, Luck JF, Loyd A, Song Y, Nightingale R, Bass CRD, Maltese MR. Pediatric thoracoabdominal biomechanics. Stapp Car Crash J. 2009;53:373-401. SAE 2009-22-0013.|
|2012||Wright AD, Laing AC. The influence of headform orientation and flooring systems on impact dynamics during simulated fall-related head impacts. Med Eng Phys. October 2012;34(8):1071-1078.|
|2010||Lopez-Valdes FJ, Forman J, Bostrom O, Kent R. The frontal-impact response of a booster-seated child-size PMHS. Traffic Inj Prev. 2010;11(3):320-327.|
|2007||Stabenfeldt SE. Bioactive Thermoresponsive Hydrogels for Neural Tissue Engineering [PhD thesis]. Atlanta, GA: Georgia Institute of Technology; December 2007.|
|2013||Lopez-Valdes FJ. Mechanics of the Pediatric Thoracic Spine and Its Role in the Kinematics of the Head in Automotive Frontal Impacts [PhD thesis]. Charlottesville, VA: University of Virginia; May 2013.|