Hi,
In order to answer this in detail, I've broken it into two sections,
brain injuries and spinal injuries resulting in paraplegia or
quadriplegia (tetraplegia). According to the Centers for Disease
Control and Prevention (CDC), 11,000 Americans annually sustain a
traumatic Spinal Cord Injury (SCI) and approximately 1.5 million cases
of Traumatic Brain Injury (TBI) are reported.
http://www.helpnetwork.org/frames/resources_factsheets_SCI_TBI.pdf
1. The costs of traumatic brain injury (TBI)
1984-86 data - $37.8 billion annually
1991-92 data - $48.3 billion annually
2001-02 data - $56.3 billion annually
The figures for traumatic brain injury (TBI) are not broken down into
closed head and penetrating (PBI) brain injury. Most individuals are
injured in motor vehicle crashes. The national statistics cite between
50 and 70% of traumatic brain injuries are the result of a motor
vehicle crash (MVC).
The ICRC data found that MVC's are the cause of 64% of TBI's and in
over half of these, 53%, the driver was under the influence of
alcohol. Other causes were gunshot wounds to the brain (13%) and
assaults (8%). Sports related TBI's ranked last with about 1% of
cases.
It can be assumed that gunshots are not closed head injuries, but with
the other causes it is less easy to determine whether the trauma
resulted in a penetrating or closed head injury. The bulk of the
research deals with closed head injuries.
It seems that the focus on closed head brain injuries is the result of
penetrating head injuries being fatal in many cases. The statistics do
not include suicides and others who were dead on arrival at the
hospital, but the survival rate within the first 48 hours is low for
penetrating brain injuries. 91% of firearm-related TBIs result in
death, as do 11% of fall-related TBIs (http://www.taliant.com/10/).
Very little of the cost of rehabilitation and aftercare is used by
those who have sustained a gunshot or other penetrating injury to the
brain. The population of survivors of PBIs who need long term care or
rehabilitation is a very small percentage of the overall TBI group.
A very comprehensive report was published in the North Carolina
Medical Journal in 2001. An excerpt from this report states:
"The financial costs associated with TBI represent the economic burden
imposed on individuals, organizations, and societies by injury-related
illness, disability, and premature death. Commonly identified costs
include the direct costs for medical treatment, rehabilitation, and
ongoing care, and the indirect costs of earnings lost to disability
and death. The most comprehensive study of TBI-related costs was
published in 1991. Using 1984-86 data from the National Hospital
Discharge Survey, the National Medical Care Utilization and
Expenditure Survey, the National Nursing Home Survey, and the National
Council on Compensation Insurance Detailed Claim Information data
bases, Max and her colleagues estimated the total annual costs of TBI
at $37.8 billion (Max W, MacKenzie EJ, Rice DP. Head injuries: costs
and consequences. J Head Trauma Rehabil 1991; 6:76-91.).
A 1992 report prepared by Lewin-ICF for the National Foundation for
Brain Research updated those figures to 1991 dollars ($48.3 billion
annually). Charges for acute hospitalization and inpatient
rehabilitation accounted for less than 8% of the total, and all
medical services constituted only 12%. The remaining 88% represents
estimates of wages lost due to death and disability. Disability due to
injuries requiring hospitalization accounted for $31.7 billion in lost
wages, and fatalities for another $16.6 billion. The average lifetime
cost per survivor was $111,578, while the average cost per fatality
was $454,717.
...If we use the Consumer Price Index to translate the Max figures
into 2001 dollars, we calculate that annual costs now exceed $62
billion."
http://www.ncmedicaljournal.com/nov-dec-01/ar110113.pdf
This report does not give separate figures for closed and open TBI.
The authors caution that the figures are probably underestimated. Only
those who are hospitalized due to their injuries are counted in the
statistics. The report estimates that one million people who suffer a
closed head TBI are treated in the Emergency Department of their local
hospital and then released with no follow-up. Add to these those who
suffer what seem to be mild injuries and do not seek treatment at all
and you can see the staggering number of cases which are not included.
The Centers for Disease Control
(http://www.cdc.gov/ncipc/fact_book/29_Traumatic_Brain_Injury.htm)
reported in the “Injury Fact Book, 2001- 2002” that, “TBIs requiring
hospitalization cost the nation about $56.3 billion each year.
Included in this cost are decreased tax revenues and increased welfare
costs that result when injured persons or their caregivers are unable
to return to work.”
A report from Pharmos Corporation, the makers of a drug used in
treating TBI, states:
"Annually within the U.S., there are about two million emergency room
visits for head injury, roughly 300,000 admissions for head trauma,
nearly 52,000 deaths and approximately 80,000-90,000 cases of severe
long-term disability. The annual cost of acute care and rehabilitation
in the U.S. for new cases is estimated to be as high as $10 billion.
Additionally, survivors of severe head injury often face five to ten
years of intensive rehabilitative treatment and lifelong disability.
Lifetime treatment costs can reach $4 million [per individual]. A
study by the National Foundation for the Brain estimates the annual
societal cost in the U.S. for TBI is $48.3 billion [1992 figures]."
http://www.pharmoscorp.com/development/dexanabinol.html
In a 2002 article, Management of head trauma, by Paul E. Marik
(http://www.findarticles.com/cf_0/m0984/2_122/90868726/p1/article.jhtml?term=cost+of+closed+head+injuries)
the figure of approximately $100 billion is given, but it seems out of
line with other estimates.
“TBI is a leading cause of death and disability in children and adults
in their most productive years. It is estimated that there are nearly
1.6 million head injuries every year in the United States, with >
250,000 of these patients being admitted to the hospital. Overall,
each year there are approximately 60,000 deaths from TBI and an
estimated 70,000 to 90,000 patients are left with permanent neurologic
disabilities. The financial burden of TBI in terms of both lost
productivity and the cost of medical care is estimated to be
approximately $100 billion annually in the United States alone. Motor
vehicle accidents are the most common cause of closed head injuries
and are especially common in teenagers and young adults. Falls are
responsible for the next largest group of injuries and are more common
at the extremes of age. Alcohol as been shown to be a contributing
factor in approximately 40% of all severe head injuries.”
(Chest, August 01 2002 by Paul E. Marik, Joseph Varon, Todd Trask
Page(s): 21)
The Georgia Model Brain Injury System (GAMBIS) of Emory University has
a good section on the costs of TBI including popup movies of the
section of the brain affected.
http://www.emory.edu/WHSC/MED/REHAB/gambis/mainweb/about_tbi.htm
There is a lot of information on traumatic brain injury (TBI) on
lawyer's sites. One that is actually very fact filled and informative
is http://www.neurolaw.com/brain.html.
The Traumatic Brain Injury Research & Publications Registry funded by
the National Institute on Disability and Rehabilitation Research
(NIDRR) is a good source of research data. The data that a search
pulls up is only in abstract form, but you can locate the relevant
research publications to supplement your online information. Searching
this database for "costs" results in a list of sources:
http://search.atomz.com/search/?sp-q=costs&sp-a=sp10022e7f&sp-f=ISO-8859-1
Just a note – the acronym, CHI, is sometimes used for closed head
injury, but since it is also a common statistical term is gets
confusing and its use in this manner is discouraged.
A good general reference:
http://home.attbi.com/~ortbitf/resource_materials.htm
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2. The costs of Spinal Injuries
1987 data - $7.4 billion annually
1998 data - over $6 billion annually (only direct medical costs)
2002 data - $9.7 billion annually
You asked for information on quadriplegia and paraplegia - many of the
charts refer to tetraplegia.
“Tetraplegia literally means paralysis in all 4 limbs. It results from
injury to the spinal cord within the neck region of the vertebral
column. There is loss of sensation and movement in the arms, legs and
trunk, as well as loss of bladder and bowel function”
(http://home.pacific.net.sg/~wtyoung/tetra.html). Technically,
quadriplegics are a subset of the people with tetraplegia. However,
the two terms are often used interchangeably.
There have been very few studies done to analyze the costs of spinal
injuries in the United States. Most of the figures are for all spinal
injuries and do not specify how severe the disability is. The
exception is the chart from the University of Alabama that breaks the
figures into theses classifications, but gives an estimate of the
individual lifetime costs per disability.
According to the Spinal Cord Injury Program, Washington University,
School of Medicine, St Louis Missouri, estimated overall costs for
nonfatal injuries in 1985 exceeded 158 billion dollars with spinal
cord injury accounting for about two-thirds of these costs – a little
more than 105 billion dollars
(http://www.neuro.wustl.edu/sci/risk.htm).
This seems to be out of line with other sources. The Center for
Disease Control’s article,
(http://www.cdc.gov/mmwr/preview/mmwrhtml/00000022.htm) Acute
Traumatic Spinal Cord Injury Surveillance -- United States, 1987
states,
“The direct medical costs of these injuries to the federal government
exceed $4 billion per year. Lost earnings associated with SCI are
estimated to be $3.4 billion (in 1987 dollars) annually (Department of
Rehabilitation Medicine, University of Alabama/ Birmingham,
unpublished data).”
*In December 1998, the CDC released additional figures in their
report, “Injury in the United States,” stating that the costs of
spinal cord injuries had risen to over $6 billion. They did not
estimate the other costs such as lost earnings in this report.
http://oph.dhh.state.la.us/injuryprevention/docs/injuryintro.pdf
“Between 183,000 and 230,000 individuals in the United States are
living with spinal cord injuries (SCI). Approximately one fourth of
these are gun-related. The annual direct costs of traumatic SCI
…caused by acts of violence (including gun shot wounds)… are estimated
to be $1.81 billion. In the first year after an SCI due to violence,
average medical expenses are $217,868. During every year for the rest
of the person's life, the average cost is $17, 275.”
http://www.helpnetwork.org/frames/resources_factsheets_SCI_TBI.pdf
“There are approximately two million people worldwide living with
spinal cord injury. 11,000 new injuries are reported every year in the
United States, with a new injury occuring every 49 minutes.
Spinal cord injuries cost the nation at least $9.7 billion per year
for medical care, equipment and disability support. This is $81 every
year for every taxpayer.
Paraplegia (losses of movement and sensation in the lower body)
affects 47% of the SCI population and 52% are affected by quadriplegia
(losses of movement and sensation in both the arms and legs).”
http://www.christopherreeve.org/News/News.cfm?ID=149&c=32
Christopher Winslow (May, 2002) wrote in “Impact of respiratory
complications on length of stay and hospital costs in acute cervical
spine injury” that, “Spinal cord injury is the second most expensive
condition treated in US hospitals, with mean acute-care hospital
charges of $53,000.”
http://www.findarticles.com/cf_0/m0984/5_121/87103212/p9/article.jhtml?term=cost+of+spinal+injuries
“The number of people in the United States who are alive today and who
have Spinal Cord Injuries (SCI) has been estimated to be between 721
and 906 per million population. This corresponds to between 183,000
and 230,000 persons.
Estimated lifetime costs by Age at Injury (discounted at 2%)
Severity of Injury………….………………….25 years old……………… 50 years old
High Tetraplegia (C1-C4)………………..…. $2,185,667 ……………… $1,286,714
Low Tetraplegia (C5-C8)………………..….. $1,235,841………………... $782,628
Paraplegia ……………………………..……..$730,277………………….. $498,095
Incomplete Motor Functional at any Level….. $487,150 ………………….$353,047
These figures do not include any indirect costs such as losses in
wages, fringe benefits and productivity which could average almost
$49,312 but vary substantially based on education, severity of injury
and pre-injury employment history.”
http://www.spinalcord.uab.edu/show.asp?durki=21446
Average Hospital Charges:
Quadriplegics $118,900
Paraplegics $ 85,100
http://www.neurolaw.com/spine.html#Cost%20of%20Injury
Overall days hospitalized in the acute care for those with spinal cord
injury has declined from 25 days in 1974 to 15 days in 1996. Similar
down trends have been noted for days in rehab: 115 days to 44 days.
Services for people with paralysis do not provide ample rehabilitation
and after care.
http://www.christopherreeve.org/hopenetwork/hopenetwork.cfm?ID=370&c=53&Type=s
The reduction of time spent in hospital and rehab does not mean that
the costs have been reduced. The cost of medical care has increased an
average of 5% per year since the early 90s. There is less treatment
but it costs more.
Search terms
costs closed head injuries United States
statistics TBI
Brain injury costs
costs spinal cord injury United States
statistics quadriplegic
costs paraplegia
If you need additional information, please post a clarification.
Thanks for the interesting question!
Regards,
bcguide-ga |
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