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Traumatic Brain Injury Among Children

Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Estimates suggest that each year among people of all ages, 260,000 are hospitalized, 51,000 die, and up to 90,000 have the onset of long-term disability related to TBI. TBI thus represents a public health problem of great magnitude with profound consequences for those affected and for their families. However, the risk factors and consequences of these injuries have not been adequately characterized for the pediatric population. To demonstrate the burden and distribution of TBI incidence among children and adolescents and to highlight gaps in current knowledge, this paper describes the epidemiology of fatal and nonfatal traumatic brain injuries among persons aged 0-19 years, using population-based data. Definitions

The Centers for Disease Control and Prevention (CDC) defines traumatic brain injury as an occurrence of injury to the head (arising from blunt or penetrating trauma or from acceleration-deceleration forces) that is associated with any of the following symptoms or signs attributable to the injury: decreased level of consciousness, amnesia, other neurologic or neuropsychologic abnormalities, skull fracture, diagnosed intracranial lesions, or death.

For this analysis, causes of traumatic brain injury are broadly classified as transport-related, firearm-related, fall-related, and related to other causes. Transport-related injuries are further classified as involving a motor vehicle occupant (i.e., occupants of automobiles, trucks, or buses), motorcyclist, pedal cyclist, or pedestrian. Firearm-related injuries are further classified by intent: unintentional, intentional self-inflicted (suicidal), intentional other-inflicted (assaultive or homicidal), and other (including legal interventions and injuries of undetermined intent).


Age. TBI mortality rates were highest among 15-19 year olds (31.7/100,000 in 1994), almost six-fold higher than among 0-14 year olds (5.4/100,000 in 1994). Between 1980 and 1994, TBI mortality rates decreased for all ages: 34% for 0-4 year olds, 38% for 5-9 year olds, 15% for 10-14 year olds, and 8% for 15-19 year olds.

Sex. Between 1980 and 1994, 71% of TBI-related fatalities among 0-19 year olds were male. In 1994, the rate of TBI-related death among males (16.6/100,000) was 2.8 times higher than the corresponding rate among females (6.4/100,000). The male-to-female ratio increased with increasing age: in 1994, this ratio was lowest among 0-4 year olds and highest among 15-19 year olds.

Cause of Injury

Transport-related Injury. From 1980 to 1994, the transport-related mortality rate associated with TBI decreased 44% among persons aged 0-19 years. Nevertheless, for this entire age group, transport-related injuries remained the leading cause of TBI-related mortality throughout this interval, representing 53% (4,577) of all TBI-related deaths in 1994. Of these deaths, 58% were occupants of a motor vehicle, 17% were pedestrians, and 5% were bicyclists. Another 17%, classified as "unspecified person" involved in a motor vehicle collision, were most likely motor vehicle occupants. Between 1980 and 1994, transport-related TBI mortality rates were consistently highest among 15-19 year olds (15.0/100,000 in 1994), about five-fold higher than among 0-14 year olds. Males had consistently higher transport-related TBI mortality rates than females (7.8/100,000 vs 4.3/100,000 in 1994).

An analysis of rates of TBI-related mortality within specific categories of transport-related TBI identified groups at highest risk. Youths aged 15-19 years, males, and whites were at highest risk of motor-vehicle occupant-related fatalities. Children aged 0-4 years, males, and African Americans were at highest risk of pedestrian-related fatalities. And 10-14 year olds and males were at highest risk of pedal cyclist-related fatalities. Risk for pedal cyclist-related injuries was similar among all races.

Firearm-related Injury. Between 1980 and 1994, the rate of TBI-related deaths attributed to firearms increased 59% among all persons aged 0-19 years. During this period, rates increased 103% for 15-19 year olds and 65% for 10-14 year olds. In 1994, 37% (3,203) of all TBI deaths among persons aged 0-19 years were firearm-related, a rate of 4.3/100,000. Firearm-related TBI mortality rates were far higher among 15-19 year olds (15.2/100,000) than among 0-14 year olds in 1994 (0.9/100,000). Males had consistently higher firearm-related TBI mortality rates than females, although the rate for both sexes increased over this period. African Americans had higher firearm-related TBI mortality rates than whites and other races for all years.

Among persons aged 0-19 years, the TBI-related rate of suicide attributed to firearms rose 49% between 1980 and 1994 (Figure 6). In 1994, the rates of such injury were highest among 15-19 year olds (6.5/100,000) followed by 10-14 year olds (0.9/100,000). The rate among males was about seven times higher than the rate among females. The TBI-related rate of homicide attributed to firearms also increased among 0-19 year olds between 1980 and 1994, from 1.0/100,000 to 1.9/100,000, surpassing the TBI-related rate of suicide attributed to firearms in 1991. In 1994, the rate of TBI-related homicide attributed to firearms was highest among 15-19 year olds (6.8/100,000). The rate for males was four times higher than the rate for females in 1994.

Other Causes. Other important causes of TBI-related death among children and adolescents include child battering and homicides not involving firearms. In 1994, these accounted for 2% and 3%, respectively, of all deaths in this age group. Prevention

The examination of national mortality data as well as combined morbidity and mortality data from seven states points to some success in the prevention of traumatic brain injury among children and adolescents. The overall TBI mortality rate decreased between 1980 and 1994, associated in large measure with decreased rates of transport-related TBI. This finding suggests a degree of success with TBI prevention efforts involving motor vehicle occupant protection and helmet use. Although improved, rates of transport-related TBI remain high and call for further prevention efforts. Our findings, like the findings of other studies, also identify other causes of TBI and groups at increased risk for which focused prevention efforts are needed.

This information came from an
NICHD online article.

*** Any law, statute, regulation or other precedent is subject to change at any time ***

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