PROBLEM/CONDITION: Traumatic brain injury (TBI) has short- and long-term adverse clinical outcomes, including death and disability. TBI can be caused by a number of principal mechanisms, including motor-vehicle crashes, falls, and assaults. This report describes the estimated incidence of TBI-related emergency department (ED) visits, hospitalizations, and deaths during 2013 and makes comparisons to similar estimates from 2007. REPORTING PERIOD: 2007 and 2013. DESCRIPTION OF SYSTEM: State-based administrative health care data were used to calculate estimates of TBI-related ED visits and hospitalizations by principal mechanism of injury, age group, sex, and injury intent. Categories of injury intent included unintentional (motor-vehicle crashes, falls, being struck by or against an object, mechanism unspecified), intentional (self-harm and assault/homicide), and undetermined intent. These health records come from the Healthcare Cost and Utilization Project's National Emergency Department Sample and National Inpatient Sample. TBI-related death analyses used CDC multiple-cause-of-death public-use data files, which contain death certificate data from all 50 states and the District of Columbia. RESULTS: In 2013, a total of approximately 2.8 million TBI-related ED visits, hospitalizations, and deaths (TBI-EDHDs) occurred in the United States. This consisted of approximately 2.5 million TBI-related ED visits, approximately 282,000 TBI-related hospitalizations, and approximately 56,000 TBI-related deaths. TBIs were diagnosed in nearly 2.8 million (1.9%) of the approximately 149 million total injury- and noninjury-related EDHDs that occurred in the United States during 2013. Rates of TBI-EDHDs varied by age, with the highest rates observed among persons aged ≥75 years (2,232.2 per 100,000 population), 0-4 years (1,591.5), and 15-24 years (1,080.7). Overall, males had higher age-adjusted rates of TBI-EDHDs (959.0) compared with females (810.8) and the most common principal mechanisms of injury for all age groups included falls (413.2, age-adjusted), being struck by or against an object (142.1, age-adjusted), and motor-vehicle crashes (121.7, age-adjusted). The age-adjusted rate of ED visits was higher in 2013 (787.1) versus 2007 (534.4), with fall-related TBIs among persons aged ≥75 years accounting for 17.9% of the increase in the number of TBI-related ED visits. The number and rate of TBI-related hospitalizations also increased among persons aged ≥75 years (from 356.9 in 2007 to 454.4 in 2013), primarily because of falls. Whereas motor-vehicle crashes were the leading cause of TBI-related deaths in 2007 in both number and rate, in 2013, intentional self-harm was the leading cause in number and rate. The overall age-adjusted rate of TBI-related deaths for all ages decreased from 17.9 in 2007 to 17.0 in 2013; however, age-adjusted TBI-related death rates attributable to falls increased from 3.8 in 2007 to 4.5 in 2013, primarily among older adults. Although the age-adjusted rate of TBI-related deaths attributable to motor-vehicle crashes decreased from 5.0 in 2007 to 3.4 in 2013, the age-adjusted rate of TBI-related ED visits attributable to motor-vehicle crashes increased from 83.8 in 2007 to 99.5 in 2013. The age-adjusted rate of TBI-related hospitalizations attributable to motor-vehicle crashes decreased from 23.5 in 2007 to 18.8 in 2013. INTERPRETATION: Progress has been made to prevent motor-vehicle crashes, resulting in a decrease in the number of TBI-related hospitalizations and deaths from 2007 to 2013. However, during the same time, the number and rate of older adult fall-related TBIs have increased substantially. Although considerable public interest has focused on sports-related concussion in youth, the findings in this report suggest that TBIs attributable to older adult falls, many of which result in hospitalization and death, should receive public health attention. PUBLIC HEALTH ACTIONS: The increase in the number of fall-related TBIs in older adults suggests an urgent need to enhance fall-prevention efforts in that population. Multiple effective interventions have been identified, and CDC has developed the STEADI initiative (Stopping Elderly Accidents Deaths and Injuries) as a comprehensive strategy that incorporates empirically supported clinical guidelines and scientifically tested interventions to help primary care providers address their patients' fall risk through the identification of modifiable risk factors and implementation of effective interventions (e.g., exercise, medication management, and Vitamin D supplementation). Language: en

/pdf/traumatic-brain-injury-related-emergency-department-visits-2wq2wb127h.pdf

Traumatic brain injury-related emergency department visits, hospitalizations, and deaths - United States, 2007 and 2013

The high prevalence of drug abuse, delinquency, youth violence, and other youth problems creates a need to identify and disseminate effective prevention strategies. General principles gleaned from effective interventions may help prevention practitioners select, modify, or create more effective programs. Using a review-of-reviews approach across 4 areas (substance abuse, risky sexual behavior, school failure, and juvenile delinquency and violence), the authors identified 9 characteristics that were consistently associated with effective prevention programs: Programs were comprehensive, included varied teaching methods, provided sufficient dosage, were theory driven, provided opportunities for positive relationships, were appropriately timed, were socioculturally relevant, included outcome evaluation, and involved well-trained staff. This synthesis can inform the planning and implementation of problem-specific prevention interventions, provide a rationale for multi-problem prevention programs, and serve as a basis for further research.

http://209.198.129.131/images/AmPsy_WhatWorksInPrevention_6-7-2003.pdf

What works in prevention. Principles of effective prevention programs.

Risky behavior can be an expression of a normal, genetically influenced personality trait, sensation seeking. Its expression in risky behaviors such as extreme and risky sports, vocations, substance abuse, unsafe sex, and crime, among others, is the topic of this fascinating and accessible book. In "Sensation Seeking and Risky Behavior", Marvin Zuckerman offers a comprehensive view of the role of sensation seeking in a wide range of behaviors, from risky driving and sports through substance use, sex, and crime or other antisocial behaviors. How the personality trait sensation seeking relates to these risky behaviors is described and explained in terms of genetics, biology, attitudes, and expectancies. Insights into prevention and treatment of maladaptive forms of sensation seeking, like substance abuse and unsaf sexual activity, based on the published research, are offered.

Sensation Seeking And Risky Behavior

Present time perspective as a predictor of risky driving

Accident risk and risk-taking behaviour among young drivers.

This paper describes differences between younger and older drivers on a number of measures of risky driving, risk perception, and risk utility taken during a national household survey (N=2,207) conducted in Canada in 1986. Young drivers (16 to 24) were more likely to engage in risky driving habits (e.g., following too closely, speeding) and they were more likely to have been involved in accidents and violations. Only the 21- to 24-year-olds were less likely to report seat belt use than the older drivers. Moreover, there was some indication that impaired driving was reported more frequently among the youngest age group (16 to 20). Young drivers perceived less danger in a variety of driving situations (e.g., driving while impaired, unbelted in front seat) and they perceived safety countermeasures to be less effective overall in reducing casualties. With respect to risk utility, young drivers placed less importance on safety features when buying a new car compared to older drivers but it was actually the oldest drivers (50 and over) who were least willing to pay for safety features. Intercorrelation of the risky behaviours revealed a moderate degree of consistency, but this consistency appeared to be greater among youth. There was little evidence that the predictors of risky driving differed substantially as a function of age.

Youth and risk: age differences in risky driving, risk perception, and risk utility

A study was conducted to assess the effect of a Selective Traffic Enforcement Program on seat belt usage. The program consisted of increased enforcement of the seat belt legislation and publication of this enforcement. It was predicted that during the program, there would be increases in seat belt usage and subjective probability of being apprehended in the experimental city, whereas there would be no changes in these variables in the control city. Seat belt usage (N equals 23,910) and telephone (N equals 1,738) surveys were conducted before, during, 1 month after, and 6 months after the program in both cities. In the experimental city observed belt usage increased from 58% to 80% during the program, dropping to 70% 6 months after the program. Reported belt use and subjective probability also increased during the program. In the control city an increase in subjective probability was observed, but there was no increase in belt usage noted. The role of subjective probability as a mediator of the effect of enforcement on driver behavior is discussed.

Nancy E. Dawson

Papers

Youth and risk: age differences in risky driving, risk perception, and risk utility

Effects of a selective traffic enforcement program on seat belt usage

Are formally trained motorcyclists safer

Predicting reported seat belt use from attitudinal and normative factors

Predicting individual subjective responses to traffic noise.