I need to know the annual incidence and prevelence of traumatic brain
injury - US and Europe.  I prefer the most recent year possible, but
need the incidence for any one year from 1998 or later, if that is
possible.  If that is not possible, let me know what year you can get
it for.

As for the European nations, France, Germany, Italy, UK,
Netherlands...and any others that you might be able to add in.

Thank you for your help!

---

Request for Question Clarification by pafalafa-ga on 22 Jun 2004 07:15 PDT

The European data appears to be very fragmented -- some specialty data
exists (e.g. workplace injuries, intentional injuries) but no
across-the-board comparative data -- especially on a query as specific
as "traumatic brain injuries".

Some data for the US might be available, though it's likely to be more
along the lines of "severe head injuries".

If you can tell us a bit more about your need for the information --
are you working on a medical or business research project, for
instance? -- we might be able to find alternative information sources
to assist you.

Let us know what you think.

pafalafa-ga

---

Clarification of Question by crystal4290-ga on 22 Jun 2004 07:37 PDT

Thank you for your interest.  I am VERY willing to be creative - and
if you have an idea....lets go for it.  If you can help in any way
that is great.  I am working on an idea, that I think might be
intersting for stimulating nerves.  I am trying to see where it might
be good to move forward with the research, but need to know how many
patients there are in certain areas.  I can imagine that it is very
difficult to get the numbers, but am willing to think about creative
ways.  Let me know what you are thinking about.

Thank you again for your help.  

Also, do take a look at some of the other areas where I have asked too
- in case that one might be easier.

Thanks so much for your help!!

---

Request for Question Clarification by umiat-ga on 22 Jun 2004 12:42 PDT

Hello again, Crystal,
 I have fairly good data on traumatic brain injury in the United
States, but very little for Europe. US figures have been recently
updated, but the scanty European figures for TBI have not.
 The primary problem with data like this is that numbers that are
collected in earlier years (say 1996 or 1998) are presented in more
recent articles dating to 2000 ore 2001, leading to the conclusion
that this is the most recent data available for citation.
 Let me know your thoughts? If I find nothing more recent for Europe,
would you be okay with the information I have found?
umiat

---

Clarification of Question by crystal4290-ga on 22 Jun 2004 13:08 PDT

I am willing to go with whatever you can find.  I do hope that some of
it will be current - as best as possible.  However, the body has not
changed, nor the majority of disease states....it is just that
reporting has become more accurate and robust.

Please just do the best job that is possible, and that will definately
be good enough.

Please note that I have several other questions posted looking for
disease incidence and prevelence in the neurological area, as this is
information that will help me to decide about a medical research
project that has been funded.  I am in need of the full spectrum, so I
appreciate your help and that of your learned colleagues.

Thank you again!

Hello, Crystal,

 I have tried to focus on gathering statistics for Traumatic Brain
Injury in my research, since TBI is a very specific subset of overall
head injuries. The following statistics for TBI appear to be the most
updated, since they are cited on all the major Brain Injury
organization websites. As you look through these statistics, it is
important to realize that they are compiled from relatively few
studies of limited scope. (In some instances, particularly for Europe
but also in the US, I have lumped in additional statistics for brain
injury - not just TBI - if they were included in the article.)


UNITED STATES
==============

From "AGH Brain Injury Specialists Explore Use of Marijuana Drug
Derivative To Prevent Irreversible Neurological Damage From Head
Injury." WPAHS. June 2003
http://www.asri.edu/news/releases/index.cfm?hera=500B5D&zeus=5B06
 
"According to the National Brain Injury Association, Inc., TBI is the
leading cause of death for children and young adults in the United
States. Each year, head trauma is the cause of more than two million
hospital emergency room visits, 475,000 hospital admissions, 52,000
deaths and approximately 100,000 cases of severe, long-term
disability."

"The annual cost of acute care and rehabilitation in the U.S. for
these injuries is estimated to be as high as $10 billion and lifetime
treatment costs per patient can reach $4 million."


==


From "Traumatic Brain Injury: Management by the Emergency Medicine
Specialist," by Edward P. Sloan, MD, MPH. Foundation for the Education
and Research of Neurological Emergencies. 2003
http://216.239.57.104/search?q=cache:q8TVWRxd6TIJ:www.uic.edu/com/ferne/slides/Cuba2003/sloantbicuba2003.pps+hospital+admissions+for+%22traumatic+brain+injury%22&hl=en

(This is another PPT presentation that you will need to access by
pasting the complete title into your browser)

* "1.6 million head injuries per year"

* "800,000 receive ED, outpatient care"

* "270,000 hospital admissions"

* "52,000 deaths"

* "90,000 permanent neuro disabilities"

* "52% of all trauma deaths due to TBI"


==


The Centers for Disease Control factsheet on TBI has been updated to June 2004:

From "TBI General Fact Sheet."
http://www.cdc.gov/Migrated_Content/Fact_Sheet/Freeform_Fact_Sheet_(General)/Traumatic_Brain_Injury_updated_May_2004.pdf

Each year in the United States, an estimated

* "1.5 million people sustain a TBI. Of those, 230,000 are hospitalized and 
  survive...

* "50,000 people die from a TBI, which accounts for one-third of all injury 
  deaths." (This is excerpted from 1996 data, but apparently still holds as 
  the most relevant.)

* "80,000 to 90,000 people experience the onset of long-term or lifelong 
  disability associated with a TBI."


Among children ages 0 - 14 years, TBI result in an estimated:

* 3,000 deaths

* 29,000 hospitalizations

* 400,000 emergency department visits (taken from 2001 data reference)


"Of the 1.4 million people who experience a TBI each year,
approximately 1.1 million, or 75% are concussions or other forms of
mild TBI." (CDC 2003)

"An estimated 300,000 sports-related brain injuries of mild to
moderate severity occur in the United States each year." (1996
reference)

"An estimated 15% of persons who sustain a mild brain injury continue
to experience negative consequences one year after injury." (2000)

"The leading causes of TBI are Vehicle Crashes, Firearm use and Falls."

"Firearm use is the leading cause of death related to TBI....causing
about 10% of all TBI's  but accounting for 44% of related deaths."
(CDC 1999)

"People ages 15-24 years and those over age 75 are the two age groups
at highest risk for TBI." (1999)

"African Americans have the highest death rate from TBI." (1999)


==


According to the CDC's "Traumatic Brain Injury from the Injury Fact
Book, 2001-2002." http://www.cdc.gov/doc.do/id/0900f3ec800082e6

* "Each year, about 1.5 million Americans sustain a traumatic brain injury 
  (TBI). That's 8 times the number of people diagnosed with breast cancer and 
  34 times the number of new cases of HIV/AIDS each year." 

* "An estimated 5.3 million Americans - 2% of the U.S. population - currently 
  live with disabilities resulting from TBI." 

* "Among children and young adults, TBI is the type of injury most often 
  associated with deaths from unintentional injuries."
 
* "Estimated TBI rates for African American children ages 0 to 4 are about 40% 
  higher than those for white children."
 
* "Approximately 1 in 4 adults with TBI is unable to return to work one year 
  after injury."
 
* "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." 


==


Some facts from "TBI Inform: Introduction to Brain Injury- Facts and
Stats," by Tom Novack, PhD. Presented at the Recovery after TBI
Conference, September, 1999 (Published February, 2000)
http://main.uab.edu/tbi/show.asp?durki=27492&site=2988&return=57898

* "TBI is an injury that effects a younger population. The occurrence peaks 
  with age groups below 5 years, between 15-24 years, and over 70 years. The 
  maximum peaks are 133 per 100,000 in the 15-24 year age range and 165 per 
  100,000 in the over 65 age group." 

* "The mortality (death) rate for TBI is 30 per 100,000. Of those who die, 50% 
  do so within the first 2 hours of their injury. This is one reason that 
  there is increased emphasis on treatment at the scene of the injury."

* "Three quarters of those injured are males. Only 21.2% of the TBI injuries 
  were to females while 78.8% involved males." 


What are the causes of TBI?
 
* "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." 

* "The cause of the injury varies based on where the data is collected. The 
  Model Systems National Database lists TBI's that result from assaults as 28%
  of cases. The ICRC data combined assaults and gunshot wounds and reported 
  about 21% of cases. This difference probably is because a large amount of 
  data for the National Database comes from downtown Detroit." 

* "Some head injuries are intentional. It is presumed that a motor vehicle 
  crash is unintentional. ICRC data shows 15% of injuries during the 5-year 
  period of data collection were intentional. The cause could be assault with 
  a blunt instrument or a gun. 4% of the intentional injuries were suicide 
  attempts. There has not been sufficient study of those with intentional vs.
  unintentional injury. A current research project at UAB is studying the 
  differences in how individuals in these two groups recover and the services 
  they need." 




EUROPE
======

According to the International Brain Injury Association
http://www.internationalbrain.org/content.php?pages=facts

"In the European Union, brain injury accounts for one million hospital
admissions per year." (Note that this does NOT differentiate between
types of brain injuries)

==

From "Acquired Brain Injury in children and young people." Child Brain
Injury Trust. http://www.cbituk.org/mainwhatyoushouldknow/MEDICAL.HTM

* Each year 600,000 people in the UK go to A&E with a head injury. (not just 
  TBI)

* 160 per 100,000 children are admitted with traumatic brain injury each year 

* During the period 2000-2001, 112,978 hospital admissions in England were 
  made as a result of a head injury. (again, not specific to TBI) 30% of these 
  were children under 15 years of age. 

* Estimated figures for Wales show 6,700 people were admitted to hospital, 
  again 30% were children under 15. 

==

The following powerpoint presentation has some cited abstracts for
Sweden, Italy, France and the UK. The PPT version only loads one page,
so I have referenced the cached version. You will likely have to copy
and paste the "title AND author" into your browser and click on
"cached". If you simply copy and paste the title, you will get all
sorts of results besides this particular article

See "Epidemiology of TBI," by Alexandra Brazinova, MD, MPH, PhD. IGEH
seminar Oct.28, 2003.
http://66.102.7.104/search?q=cache:yYaCvcw4InQJ:www.igeh.org/docs/epidemiology_tbi_10_2003.ppt+TBI+statistics+%2BEurope&hl=en

Abstracts cited with European statistics: 

"Regional brain injury epidemiology as the basis for planning brain
injury treatment. The Romagna (Italy) experience." Servadei F,
Antonelli V, Betti L, Chieregato A, Fainardi E, Gardini E, Giuliani G,
Salizzato L, Kraus JF. J Neurosurg Sci. 2002 Dec;46(3-4):111-9.
 
"Incidence rate 250 per 100,000. External causes of injury are similar
to Western Europe, except very low frequency of cases from violence."

=

"Epidemiology of traumatic brain injury: a population based study in
western Sweden." Andersson EH, Bjorklund R, Emanuelson I, Stalhammar
D. Acta Neurol Scand. 2003 Apr;107(4):256-9.

"Incidence of 546 per 100,000. The external causes were dominated by
fall from same level (31%) and fall from different level (27%)
followed by traffic accidents (16%) and persons hit by objects (15%)."

=

"Epidemiology of severe brain injuries: a prospective population-based
study." Masson F, Thicoipe M, Aye P, Mokni T, Senjean P, Schmitt V,
Dessalles PH, Cazaugade M, Labadens P. J Trauma. 2001 Sep;51(3):481-9.
 
"19 hospitals in the region. Incidence rate of severe TBI - 17.3 per
100,000. Traffic accidents - 48.3%, falls 41.8%. Fatality rate 30%.

=

"Epidemiology of traumatic brain injury in children and adolescents in
south-western Sweden.
Emanuelson I, v Wendt L. Acta Paediatr. 1997 Jul;86(7):730-5. 

"Age 0-17. Incidence rate 12 per 100,000. The dominant external cause
was traffic (60%), followed by falls (22%)."

Another abstract may be seen here:
http://www.ingenta.com/isis/searching/ExpandTOC/ingenta?issue=pubinfobike://mksg/ane/2003/00000107/00000004&index=3

=

"Prevalence of traumatic brain injury amongst children admitted to
hospital in one health district: a population-based study." Hawley CA,
Ward AB, Long J, Owen DW, Magnay AR. Injury. 2003 May;34(4):256-60.

"North Staffordshire - registry of children TBI since 1992. Incidence
280 per 100,000 children are admitted for >or=24h with a TBI, of these
232 will have a mild brain injury, 25 moderate, 17 severe, and 2 will
die. Children under 2 years of age account for 18.5% of all TBIs,
usually due to falls, being dropped or non-accidental injuries (NAIs).
Falls account for 60% of TBIs in the under 5 years. In the 10-15 age
group road traffic accidents (RTAs) were the most common cause (185,
36.7%)."

==

The Worksupport.com website has some research articles pertaining to
traumatic head injury statistics in some of the European countries. As
usual, the article dates are more recent than the data, thereby
suggesting that the data is the most recent available.
http://www.worksupport.com/Archives/tbiPrograms.asp

See:

5. Engberg, Aa. W. & Teasdale, T.W. (2001). Traumatic brain injury in
Denmark 1979-1996. A national study of incidence and mortality.
European Journal of Epidemiology, 17, 437-442.

7. Firsching, Baimund M.D. & Woischneck, Dieter M.D. (2001). Present
status of neurosurgical trauma in Germany. World Journal of Surgery,
25 (9), 1221-1223.


==


 I hope this information is helpful! I realize the European data is
not as comprehensive as you would like, but it is all I have found
after several hours of research. There is just not much statistical
information available for the European region as a whole. Perhaps you
can use some of it to gain a rough, overall picture.

 Again, if you need further clarification, please don't hesitate to ask.

 
umiat  


Google Search Strategy
CDC AND traumatic brain injury +statistic
"brain injury" data OR statistics
"brain injury" data OR statistics +Europe
head injuries +Europe
Statistics on head injuries +Europe
Traumatic Brain Injury organizations AND Europe
hospital admissions for head injury
hospital admissions for "traumatic brain injury"

---

Clarification of Answer by umiat-ga on 22 Jun 2004 14:52 PDT

Sorry about that link for the TBI General Fact Sheet! Try this one:
http://www.cdc.gov/doc.do/id/0900f3ec8016dc26

---

Clarification of Answer by umiat-ga on 23 Jun 2004 00:20 PDT

A few more!


"National Study of Traumatic Brain Injury - Wheel Related Sports."
National SAFE KIDS Campaign.
http://www.safekids.org/content_documents/ACF15C.pdf

"Traumatic Brain Injury (TBI) is the leading killer and disabler of
children. Each year, 3,000 chldren are killed and approximately 29,000
are hospitalized due to TBI."

(Read more statistics... 

==

From "Brain Injury Awareness Week - 15-21 March 2004." BBC
http://www.bbc.co.uk/health/awareness/brain.shtml

UK statistics

* An estimated 1 million people in Britain attend hospital each year as a 
  result of a head injury. 

* Minor head injuries, resulting in unconsciousness for 15 minutes or less, 
  will affect 150,000 people a year. 

* 10,000 people will suffer moderate head injury, which can cause 
  unconsciousness for up to six hours. After five years, some will still have 
  physical or psychological problems. 

* 11,600 people will suffer severe head injury and remain unconscious for six 
  hours or longer. After five years, only 15% will have returned to work.

==

From "APPABIG: Submission to Dept of Work & Pensions in response to
the First Stage of the Employers Liability Compulsory Insurance
Review. Oct 2003. Part One." Headway.
http://www.headway.org.uk/default.asp?step=4&pid=15 

To quote the Health Select Committee Report into Brain Injury
Rehabilitation in March 2001:
 
"Head injury is the foremost cause of death and disability in young
people". There is a growing population of head-injured people in this
country, as improved medical techniques have led to many head-injured
people now surviving their accident and living into old age, with a
normal life expectancy." [i]
 
** "In the UK, approximately one million people attend hospital
accident and emergency departments every year with some form of
traumatic brain injury. According to Health and Safety Executive
statistics, five per cent of over-three-day injuries to employees in
2000/1 were head injuries[ii]. This is likely to be an underestimate
due to the difficulties in accurately recognising and recording head
injury."
 
"Although brain injury can result from accidents at work, assaults,
sports injuries and accidents in the home, the largest group of people
with brain injury are men aged 15-29 who were involved in a road
traffic incident.  Brain injury generally does not alter life
expectancy, therefore these young men may face a lifetime of
challenges"[iii].

As usual - umiat - a stellar job!  This information will really direct the research!

Everything I have read on the subject thus far has indicated that at
present there is no effective, systematic approach to collecting data
on the incidence and prevalence of traumatic brain injury.

tutuzdad-ga

Dear Tutuzdad

Thank you for your comment.  I am most willing to approach this from
an alternate angle - meaning head injury - or any other way.  Do you
have any thoughts, since perhaps you have already looked into this. 
Thank you for anything you can offer.

I must admit...I was quite impressed by Umiat's answer.  I had looked,
and just didn't think the info was out there.

Nice work!

paf

Thank you very much, Crystal! And thank you, Paf!!!!