Abstract and Introduction
Traumatic brain injury (TBI), which can disrupt normal brain function and result in short- and long-term adverse clinical outcomes, including disability and death, is preventable. To describe the 2018 incidence of nonfatal TBI-related hospitalizations in the United States by sociodemographic characteristics, injury intent, and mechanism of injury, CDC analyzed data from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample. During 2018, there were 223,050 nonfatal TBI-related hospitalizations; rates among persons aged ≥75 years were approximately three times higher than those among persons aged 65–74 years, and the age-adjusted rate among males was approximately double that among females. Unintentional falls were the most common mechanism of injury leading to nonfatal TBI-related hospitalization, followed by motor vehicle crashes. Proper and consistent use of recommended restraints (i.e., seatbelts, car seats, and booster seats) and, particularly for persons aged ≥75 years, learning about individual fall risk from health care providers are two steps the public can take to prevent the most common injuries leading to nonfatal TBIs. The findings in this report could be used by public health officials and clinicians to identify priority areas for prevention programs.
Estimates for nonfatal TBI-related hospitalizations were obtained from the 2018 HCUP National Inpatient Sample files. The National Inpatient Sample is a stratified sample of approximately 20% of hospital discharges in the United States and is sponsored by the Agency for Healthcare Research and Quality. Records were included if the primary diagnosis was an injury and a TBI-related International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code (S02.0, S02.1–, S02.80X–S02.82X, S02.91, S04.02, S04.03–, S04.04–, S06–, S07.1, and T74.4) was present in any diagnosis field. A record could potentially include multiple external cause of injury codes; injury mechanism/intent categories were based on the first cause code found, as it was considered the first valid external cause of injury code. ICD-10-CM codes and more detailed methods are available online. Rates were calculated using bridged race population estimates obtained from the National Center for Health Statistics as denominators. Nonfatal hospitalizations were weighted to provide national estimates, and 95% CIs were calculated using complex survey procedures in SAS (version 9.4; SAS Institute). Age-adjusted rates were calculated using the direct method and the 2000 U.S. Census Bureau standard population. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.*
In 2018, there were 223,050 nonfatal TBI-related hospitalizations in the United States. Among nonfatal TBI-related hospitalizations with known age, 16,480 (7.4%) occurred among infants, children, and adolescents aged 0–17 years, and 70,445 (31.6%) occurred among adults aged ≥75 years (Table 1). National rates of nonfatal TBI-related hospitalizations were highest among persons aged ≥75 years (321.4 per 100,000 population) and among males (81.3 per 100,000 population, age-adjusted). The rate of nonfatal TBI-related hospitalizations among persons aged ≥75 years was approximately three times higher than that among those aged 65–74 years (105.5 per 100,000 population), and the rate among males was approximately double that among females (44.4 per 100,000 population, age-adjusted). Age-adjusted rates of nonfatal TBI-related hospitalizations were similar among non-Hispanic White persons (59.0 per 100,000 population), non-Hispanic Black persons (60.0 per 100,000 population), and Hispanic persons (59.6 per 100,000).
In 2018, approximately 75% of nonfatal TBI-related hospitalizations were caused by either unintentional falls (51.0%) or motor vehicle crashes (23.8%) (Table 2). Rates for nonfatal TBI-related hospitalizations attributable to unintentional falls were highest among adults aged ≥75 years (263.3 per 100,000 population), 65–74 years (69.9 per 100,000 population), and 55–64 years (33.2 per population). Among all age groups, the highest rates of motor vehicle crashes leading to a nonfatal TBI-related hospitalization were among persons aged 15–24 years (24.6 per 100,000 population) and aged 25–34 years (21.9 per 100,000 population). Among the major examined unintentional and intentional mechanisms of injuries that contributed to a nonfatal TBI-related hospitalization (e.g., motor vehicle crashes, falls, being struck by or against an object, self-harm, and assault), higher total estimates and age-adjusted rates were observed among males compared with females for all mechanisms of injury (Table 3).