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Abstract
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PURPOSE: This is a descriptive study. It determined the annual, national incidence of head injuries (TBI) to adults and children in motor-vehicle crashes. It evaluated NASS-CDS (National Automotive Sampling System-Crashworthiness Data System) for exposure and incidence of various head injuries in towaway crashes. It evaluated three health databases for emergency department (ED) visits, hospitalizations and deaths due to TBI in motor-vehicle occupants.
METHODS: Four databases were evaluated using 1997-2010 data on adult (15+ years old) and child (0-14 years old) occupants in motor-vehicle crashes: 1) NASS-CDS estimated the annual incidence of various head injuries and outcomes in towaway crashes, 2) NHAMCS (National Hospital Ambulatory Medical Care Survey) estimated ED visits for TBI, 3) NHDS (National Hospital Discharge Survey) estimated hospitalizations for TBI and 4) NVSS (National Vital Statistics System) estimated TBI deaths. The four databases provide annual, national totals for TBI related injury and death in motor-vehicle crashes based on differing definitions with TBI coded by AIS in NASS-CDS and by ICD in the health data.
RESULTS: Adults: NASS-CDS had 16,980 ± 2,411 (risk = 0.43% ± 0.06%) with severe head injury (AIS 4+) out of 3,930,543 exposed adults in towaway crashes, annually. There were 49,881 ± 9,729 (risk = 1.27% ± 0.25%) hospitalized with AIS 2+ head injury, without death. There were 6,753 ± 882 (risk = 0.17% ± 0.02%) fatalities with a head injury cause. The public health data had 89,331 ± 6,870 ED visits, 33,598 ± 1,052 hospitalizations and 6,682 ± 22 deaths with TBI. NASS-CDS estimated 48% more hospitalized with AIS 2+ head injury without death than NHDS occupants hospitalized with TBI. NASS-CDS estimated 29% more deaths with AIS 3+ head injury than NVSS occupant TBI deaths, but only 1% more deaths with a head injury cause. Children: NASS-CDS had 1,453 ± 318 (risk = 0.32% ± 0.07%) with severe head injury (AIS 4+) out of 454,973 exposed children, annually. There were 2,581 ± 683 (risk = 0.57% ± 0.15%) hospitalized with AIS 2+ head injury, without death. There were 466 ± 132 (risk = 0.10% ± 0.03%) fatalities with a head injury cause. The public health data had 19,251 ± 2,803 ED visits, 3,363 ± 255 hospitalizations and 488 ± 6 deaths with TBI. NASS-CDS estimated 24% fewer hospitalized children with AIS 2+ head injury without death than NHDS hospitalization with TBI. NASS-CDS estimated 31% more deaths with AIS 3+ head injury than NVSS child deaths, but 5% fewer deaths with a head injury cause.
CONCLUSIONS: The annual, national incidence of motor-vehicle related head injury (TBI) was estimated using 1997-2010 NASS-CDS from the Department of Transportation and NHAMCS (ED visits), NHDS (hospitalizations) and NVSS (deaths) from the Department of Health and Human Services. The transportation and health databases use different definitions and coding, which complicate direct comparisons. Future work is need where ICD to AIS translators are used if comparisons of serious head injuries in NASS and health datasets are to be made.
Language: en |