traumatic Brain Injury in the united statesThis body of work is a vital tool for those who devise the strategies for prevention and treatment. However, a critical dimension will be lost if one sees it only as data, if one does not try to put even a fleeting face behind the numbers. They represent people who -if they survived -have had their lives significantly affected. Through research, we are finding better ways to prevent injury and improve acute care. We who are injured may experience improvement both in function and the quality of our lives when we have access to rehabilitation and support to develop and utilize our remaining strengths and abilities. With so many lives affected, we seek and have the potential for independence, to have the chance to move beyond our disabilities and give back to society.As a survivor, as a disabled physician, I applaud this publication as a step toward making that possible." TBI in the United States• An estimated 1.7 million people sustain a TBI annually. 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. TBI by Age• 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 Sex• In every age group, TBI rates are higher for males than for females.• Males aged 0 to 4 years have the highest rates for TBI-related emergency department visits, hospitalizations, and deaths combined. TBI by External Cause• Falls are the leading cause of TBI. Rates are highest for children aged 0 to 4 years and for adults aged 75 years and older.• Falls result in the greatest number of TBI-related emergency department visits (523,043) and hospitalizations (62,334).• Motor vehicle-traffic injury is the leading cause of TBI-related death. Rates are highest for adults aged 20 to 24 years. Additional TBI Findings*• There was an increase in TBI-related emergency department visits (14.4%) and hospitalizations (19.5%) from 2002 to 2006.• There was a 62% increase in fall-related TBI seen in emergency departments among children aged 14 years and younger from 2002 to 2006.• There was an increase in fall-related TBIs among adults aged 65 and older; 46% increase in emergency department visits, 34% increase in hospitalizations, and 27% increase in TBI-related deaths from 2002 to 2006.

Problem/ConditionHigher rates of death in nonmetropolitan areas (often referred to as rural areas) compared with metropolitan areas have been described but not systematically assessed.Period Covered1999–2014Description of SystemMortality data for U.S. residents from the National Vital Statistics System were used to calculate age-adjusted death rates and potentially excess deaths for nonmetropolitan and metropolitan areas for the five leading causes of death. Age-adjusted death rates included all ages and were adjusted to the 2000 U.S. standard population by the direct method. Potentially excess deaths are defined as deaths among persons aged <80 years that exceed the numbers that would be expected if the death rates of states with the lowest rates (i.e., benchmark states) occurred across all states. (Benchmark states were the three states with the lowest rates for each cause during 2008–2010.) Potentially excess deaths were calculated separately for nonmetropolitan and metropolitan areas. Data are presented for the United States and the 10 U.S. Department of Health and Human Services public health regions.ResultsAcross the United States, nonmetropolitan areas experienced higher age-adjusted death rates than metropolitan areas. The percentages of potentially excess deaths among persons aged <80 years from the five leading causes were higher in nonmetropolitan areas than in metropolitan areas. For example, approximately half of deaths from unintentional injury and chronic lower respiratory disease in nonmetropolitan areas were potentially excess deaths, compared with 39.2% and 30.9%, respectively, in metropolitan areas. Potentially excess deaths also differed among and within public health regions; within regions, nonmetropolitan areas tended to have higher percentages of potentially excess deaths than metropolitan areas.InterpretationCompared with metropolitan areas, nonmetropolitan areas have higher age-adjusted death rates and greater percentages of potentially excess deaths from the five leading causes of death, nationally and across public health regions.Public Health ActionRoutine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas.

IntroductionTraumatic Brain Injury (TBI) is an important public health problem in the United States (US) resulting in disabling conditions and long-term societal costs. Thus, there a compelling need for prevention, treatment and rehabilitation initiatives informed by national, population-based data.ObjectiveTo estimate the prevalence and incidence of TBI in the US utilizing several nationally representative data sets.MethodsTo produce national estimates, we averaged and analysed data from 2002–2006 for TBI-related visits to hospital-based emergency departments (EDs), hospitalisations, and deaths from the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the National Vital Statistics System, respectively.ResultsFor 2002–2006, the estimated average annual incidence of TBI was 1.7 million, including 52 000 deaths, 275 000 hospitalisations, and 1 365 000 ED visits. For all age groups, the leading external causes were as follows: falls (35.2%); motor vehicle traffic (17.3%); struck by/against events (16.5%); assaults (10%). Rates were higher for males than females in all age groups. Falls produced the greatest number of TBI-related ED visits, (523 043) and hospitalizations (62 334). Motor vehicle traffic was the leading cause of TBI death, with rates highest among those 20–24 years. Children 0–4 years, adolescents 15–19 years, and adults >65 years were most likely to sustain a TBI and adults >75 years had the highest rate for hospitalisation and death. Annually, almost half a million TBI-related ED visits, 473 947, were made by children aged 0–4 years. TBI was a contributing factor to one third of all injury related deaths in the US.

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Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.