Data on Brain Injury in Massachusetts: A Snapshot

Jean McGuireExecutive Office of Health and Human Services

Presentation to the Brain Injury CommissionFebruary 7th, 2011

Current Types of Data with State Specific Information on Brain Injury

• Acute Care Hospital Discharge Databases• Vital Statistics – Death File• Statewide Trauma Registry Data • Disease Specific Surveillance Data• Brain Injury Symptom Surveillance Data

Acute Care Hospital Discharge Databases

• MA Emergency Department Discharge Database• MA Inpatient Hospital Discharge Database• MA Outpatient Observation Stay Database• This data is maintained by MA Division of Health Care Finance and Policy

Strengths: • Contain discharge information on all cases discharged from any acute care hospital in

Massachusetts• TBI-related cases are determined according to standardized case definitions recommended

by the Centers for Disease Control and Prevention (CDC) and are based upon International Classification of Disease Version 9 Clinical Modification (ICD-9-CM) codes for morbidity and International Classification of Disease Version 9 (ICD-9, 1995-1998) and Version 10 (ICD-10, 1999-2006) codes for mortality

Limitations:• These administrative databases contain information which is collected for billing purposes

but which are used secondarily for surveillance. • Does not tell us prevalence of injury that results in long-term disability• Information has not been validated by medical record review

Emergency Department (ED) Discharges, Inpatient Hospital (HDD) Discharges, and Observation Stay (OBS) Discharges for All and TBI-related

Injury Cases by Leading and Selected Causes of TBI, MA Residents, FY 2008

Cause and Intent of Injury ED - All injuries

ED - TBI associated HDD- All Injuries

HDD- TBI-associated OBS - All Injuries

OBS - TBI associated

Unintentional Fall 186,056 24,644 27,277 3,371 3,254 558Unintentional Stuck by object or person 102,128 12,930 1,184 170 340 87Unintentional MV occupant and MV unspecified (combined) (excludes motorcyclist) 60,995 6,833 2,514 697 573 180

Assaults (all mechanisms) 24,934 4,924 2,033 361 453 116

Bicyclist (MV and NonMV) 9,108 1,071 524 133 131 47

Pedestrian (MV and NonMV) 3,779 465 612 210 92 33

Total (all causes and intents) 709,237 52,339 59,446 5,603 10,027 1,316

Sources: MA Inpatient Hospital, Outpatient Observation Stay and Emergency Department Discharge Databases, MA Division of Health Care Finance and Policy.

Excludes cases dying in the hospital or DOA. Excludes inpatient transfers to another acute care hospital.

Data Prepared by the MA Department of Public Health

Vital Statistics – Death File

• Registry of Vital Records and Statistics• Maintained by MA Department of Public

Health

• Summary statistics can be found in handout: Traumatic Brain Injuries in Massachusetts: Data Summary, September 2008. This report is prepared by MA DPH, Injury Surveillance Program

State Trauma Registry Data

• Erwin Hirsh Statewide Trauma Registry • Maintained by MA Department of Public Health,

Office of Emergency Medical Services• Captures physiologic information providing details on

the severity of injury with clinical markers

Challenges with data source: • Only captures cases which are hospitalized, requiring

interfacility transfer, or cases resulting in death• Data currently being validated

Disease Specific Surveillance Data—Stroke Registry

• The Paul Coverdell National Acute Stroke Registry (PCNASR) collects emergency department and inpatient data on patients arriving to hospitals

• MA is one of 6 states with federal funding to maintain a PCNASR

• In MA, approximately 85% of all stroke hospitalizations (11,000 a year) are captured in the registry

• 58 MA hospitals are currently participating in the registry• This registry is maintained by MA Department of Public

Health

Statistics from Stroke Registry• Strokes can be classified as ischemic (caused by a blood clot occluding vasculature

in the brain thus impeding blood flow and tissue death), hemorrhagic (bleeding in the brain) or TIA (transient ischemic attack – a “mini-stroke” with symptoms resolving within 24 hours of symptom onset). TIAs are predictors of future strokes.

• Stroke is the 3rd leading cause of death in MA and in the US. • Stroke is one of the leading causes of disability in the US.• While 83% of stroke patients are ambulating prior to their stroke hospitalization,

only 51% are ambulating at the time of discharge.• For those suffering a hemorrhagic stroke, the change is from 75% prior to 28% post

stroke.• Half of stroke patients are discharged home, a quarter are discharged to another

hospital or long term care facility, 6% expire, and 20% are discharged to a rehab facility

• 60% of stroke patients receive some degree of rehabilitation during their hospital stay.

Paul Coverdell Acute Stroke Registry DataCases discharged between December 2009 – November 2010

Total Ischemic Hemorrhagic TIA

# strokes 10574 7045 964 2466

Average age of stroke patients (years)

72.7 73.0 70.7 72.9

Discharge Status (%)

% discharged to LTC/Other Hospital/Hospice

23.6 27.0 25.0 13.8

% discharged home 49.5 41.2 20.3 81.6

% discharged to rehab 20.0 25.6 23.9 3.3

% expired 6.1 5.6 30.5 .13

% discharged to other destination

.71 .58 .28 1.2

Source: MA Paul Coverdell Acute Stroke Registry, Data accessed February 2010 for the time period December 2009 – November 2010.  Contact: katrina.damore@state.ma.us Heart Disease and Stroke Prevention and Control Program.

Brain Injury Symptom Surveillance Data

• Maintained by MA Department of Public Health– One question on Youth Health Survey relative to

youth reporting symptoms of head injury

Emergency Department Discharge Rates for Sports-related1 Traumatic Brain Injuries,

MA Residents, FY2008

28.9

291.6 323.6

44.9 14.3 5.3 1.50.0

100.0

200.0

300.0

400.0

Age Groups (in years)

Rat

e p

er 1

00,0

00

Source: MA Emergency Department Discharge Database, MA Division of Health Care Finance and Policy.

1 Includes only cases with E-codes (E886.0, E917.0, E917.5); other sports-related cases not receiving these codes are not included.

MA youth between the ages of 10 and 19 accounted for 77% of all sports-related TBIs treated in the ED (N=2,655).

Percentage of Massachusetts Students1 Reporting Symptoms of a TBI2 While Playing with a Sports Team in the Past 12 months,

(MA Youth Health Survey, 2009)

21.623.4

14.2 14.5

18.319.2

0

5

10

15

20

25

High School Middle School

Pe

rce

nta

ge

of

Stu

de

nts

Male

Female

Total

1 Includes only students who played on a sports team in the past 12 months.

2 Reported they suffered a blow or jolt to head while playing with a sports team (during a game or practice) which caused them to get "knocked out", have memory problems, double or blurry vision, headaches or "pressure" in the head or nausea or vomiting.

National TBI Estimates and Statistics

• Each year, an estimated 1.7 million people sustain a TBI annually.1 • Of them:

– 52,000 die,– 275,000 are hospitalized, and – 1.365 million, nearly 80%, are treated and released from an emergency department.

• TBI is a contributing factor to a third (30.5%) of all injury-related deaths in the United States.1

• About 75% of TBIs that occur each year are concussions or other forms of mild TBI.2

• *The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

Source: CDC, 2010, http://www.cdc.gov/traumaticbraininjury/statistics.html, 1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department

visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

2. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.

National Statistics by Age and GenderTBI by Age1

• Children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a TBI.

• Almost half a million (473,947) emergency department visits for TBI are made annually by children aged 0 to 14 years.

• Adults aged 75 years and older have the highest rates of TBI-related hospitalization and death.

TBI by Gender1

• In every age group, TBI rates are higher for males than for females.• Males aged 0 to 4 years have the highest rates of TBI-related emergency department

visits, hospitalizations, and deaths.

Source: http://www.cdc.gov/traumaticbraininjury/statistics.html, 1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic brain injury in the United States: emergency department

visits, hospitalizations, and deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.

Conclusion

• We have a patchwork picture of prevalence of TBI in MA

• We have an incomplete picture of prevalence of ABI due to focus on TBI in data

• Trends in hospital / ED usage are difficult to interpret due to increased awareness around brain injury, especially with sports related injuries

Where do we go from here?

• What do we need to know about this population to move conversation forward?

• What potential sources may be out there?• What recommendations would we make

relative to improved data on brain injury population?