This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (164)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Medical Practice, Other  • Alert me on articles by topic

David Thurman, MD, MPH; Janet Guerrero, MS

JAMA. 1999;282:954-957.

Context  Traumatic brain injury (TBI) is associated with more than 50,000 deaths in the United States each year, and recent observations suggest a substantial decline in TBI-related hospitalizations and deaths.

Objective  To analyze long-term trends in TBI-related hospitalization in the United States.

Design, Setting, and Participants  Analysis of existing data from 1980 through 1995 from the National Hospital Discharge Survey, an annual survey representing the US general population. The number of participating hospitals ranged from 400 to 494.

Main Outcome Measures  Annual rates of TBI-related hospitalization, stratified by age, sex, severity of injury, and outcome.

Results  The annual number of TBI cases identified from the sample during the study period ranged from 1611 to 3129. Overall rates of hospitalization for TBI declined an estimated 51%, from 199 to 98 per 100,000 per year. When analyzed by severity of injury, mild TBIs declined most during this period, from 130 to 51 hospitalizations per 100,000 per year (61% decline; P<.001 compared with intermediate and severe TBI). The decline was greatest among those aged 5-14 years (-66%) and least among those aged 65 years or older (-9%). The ratio of male to female rates showed little variation during the study period (ratio, 1.8; 95% confidence interval [CI], 1.6-2.0), as did the in-hospital mortality rate (mean, 5.3 per 100,000; 95% CI, 3.6-7.1).

CONCLUSIONS  Changes in hospital practices may be a major factor in the declining rates of TBI-related hospital admissions. These practices increasingly appear to exclude persons with less severe TBI from hospital admission and shift their care to outpatient settings.

Author Affiliations: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Ga.

RELATED ARTICLES

September 8, 1999
JAMA. 1999;282(10):1007-1008.
EXTRACT | FULL TEXT  

Traumatic Brain Injury in High School Athletes
John W. Powell and Kim D. Barber-Foss
JAMA. 1999;282(10):958-963.
ABSTRACT | FULL TEXT  

Relationship Between Concussion and Neuropsychological Performance in College Football Players
Michael W. Collins, Scott H. Grindel, Mark R. Lovell, Duane E. Dede, David J. Moser, Benjamin R. Phalin, Sally Nogle, Michael Wasik, David Cordry, Michelle Klotz Daugherty, Samuel F. Sears, Guy Nicolette, Peter Indelicato, and Douglas B. McKeag
JAMA. 1999;282(10):964-970.
ABSTRACT | FULL TEXT  

Neuropsychological Impairment in Amateur Soccer Players
Erik J. T. Matser, Alphons G. Kessels, Muriel D. Lezak, Barry D. Jordan, and Jaap Troost
JAMA. 1999;282(10):971-973.
ABSTRACT | FULL TEXT  

Rehabilitation of Persons With Traumatic Brain Injury
NIH Consensus Development Panel on Rehabilitation of Persons With Traumatic Brain Injury
JAMA. 1999;282(10):974-983.
ABSTRACT | FULL TEXT  

Traumatic Brain Injury and Concussion in Sports
James P. Kelly
JAMA. 1999;282(10):989-991.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pediatric Traumatic Brain Injury Is Inconsistently Regionalized in the United States
Hartman et al.
Pediatrics 2008;122:e172-e180.
ABSTRACT | FULL TEXT  

REMARKABLE DECLINE IN HIP FRACTURE INCIDENCE IN YOUNGER AGE GROUPS IN GERMANY
Icks et al.
Am. J. Public Health 2007;97:1733-1734.
FULL TEXT  

Overlooked But Critical: Traumatic Brain Injury as a Consequence of Interpersonal Violence
Banks
Trauma Violence Abuse 2007;8:290-298.
ABSTRACT  

How common are the "common" neurologic disorders?
Hirtz et al.
Neurology 2007;68:326-337.
ABSTRACT | FULL TEXT  

Diagnostic Imaging of Traumatic Brain Injury.
FURLOW
radtech 2006;78:145-156.
ABSTRACT | FULL TEXT  

Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes * Commentary * Commentary
Covassin et al.
Br. J. Sports. Med. 2006;40:923-927.
ABSTRACT | FULL TEXT  

Considerations in Fluids and Electrolytes After Traumatic Brain Injury
Rhoney and Parker
Nutr Clin Pract 2006;21:462-478.
ABSTRACT | FULL TEXT  

Medical outcome after immediate computed tomography or admission for observation in patients with mild head injury: randomised controlled trial
Geijerstam et al.
BMJ 2006;333:465.
ABSTRACT | FULL TEXT  

Incidence of Pediatric Traumatic Brain Injury and Associated Hospital Resource Utilization in the United States
Schneier et al.
Pediatrics 2006;118:483-492.
ABSTRACT | FULL TEXT  

An epidemiological study of head injuries in a UK population attending an emergency department
Yates et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:699-701.
ABSTRACT | FULL TEXT  

Incidence Rates of Hospitalization Related to Traumatic Brain Injury--12 States, 2002
JAMA 2006;295:1764-1765.
FULL TEXT  

Prevalence of anterior pituitary insufficiency 3 and 12 months after traumatic brain injury
Schneider et al.
Eur J Endocrinol 2006;154:259-265.
ABSTRACT | FULL TEXT  

Trends in Diagnosis Rates for Autism and ADHD at Hospital Discharge in the Context of Other Psychiatric Diagnoses
Mandell et al.
Psychiatr. Serv. 2005;56:56-62.
ABSTRACT | FULL TEXT  

Reporting of the incidence of hospitalised injuries: numerator issues
Boufous and Williamson
Inj. Prev. 2003;9:370-375.
ABSTRACT | FULL TEXT  

Acute Effects and Recovery Time Following Concussion in Collegiate Football Players: The NCAA Concussion Study
McCrea et al.
JAMA 2003;290:2556-2563.
ABSTRACT | FULL TEXT  

Trends in hospitalization after injury: older women are displacing young men
Shinoda-Tagawa and Clark
Inj. Prev. 2003;9:214-219.
ABSTRACT | FULL TEXT  

Mild Traumatic Brain Injury and Psychiatric Disorders
Mateo and Glod
J Am Psychiatr Nurses Assoc 2003;9:129-133.
ABSTRACT  

Injury Surveillance
Horan and Mallonee
Epidemiol Rev 2003;25:24-42.
FULL TEXT  

Prolonged Therapeutic Hypothermia After Traumatic Brain Injury in Adults: A Systematic Review
McIntyre et al.
JAMA 2003;289:2992-2999.
ABSTRACT | FULL TEXT  

Clinical Correlates of Aggressive Behavior After Traumatic Brain Injury
Tateno et al.
J. Neuropsychiatry Clin. Neurosi. 2003;15:155-160.
ABSTRACT | FULL TEXT  

Practice parameter: Antiepileptic drug prophylaxis in severe traumatic brain injury: Report of the Quality Standards Subcommittee of the American Academy of Neurology
Chang and Lowenstein
Neurology 2003;60:10-16.
ABSTRACT | FULL TEXT  

Repeated mild injury causes cumulative damage to hippocampal cells
Slemmer et al.
Brain 2002;125:2699-2709.
ABSTRACT | FULL TEXT  

Management of Head Trauma*
Marik et al.
Chest 2002;122:699-711.
ABSTRACT | FULL TEXT  

Traumatic Brain Injury Among American Indians/Alaska Natives--United States, 1992-1996
JAMA 2002;288:37-38.
FULL TEXT  

The impact of face shield use on concussions in ice hockey: a multivariate analysis
Benson et al.
Br. J. Sports. Med. 2002;36:27-32.
ABSTRACT | FULL TEXT  

The Epidemiology of Pediatric Traumatic Brain Injury in Minnesota
Reid et al.
Arch Pediatr Adolesc Med 2001;155:784-789.
ABSTRACT | FULL TEXT  

Validation of the ICD/AIS MAP for pediatric use
Durbin et al.
Inj. Prev. 2001;7:96-99.
ABSTRACT | FULL TEXT  

National estimates of non-fatal firearm related injuries other than gunshot wounds
Hootman et al.
Inj. Prev. 2000;6:268-274.
ABSTRACT | FULL TEXT  

Hospitalizations for Minor Traumatic Brain Injury Decline
JWatch Emergency Med. 1999;1999:5-5.
FULL TEXT  

Traumatic Brain Injury and Concussion in Sports
Kelly
JAMA 1999;282:989-991.
FULL TEXT