Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases

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  • 1 Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;
  • 2 Virginia Tech Carilion School of Medicine, Roanoke, Virginia;
  • 3 Department of Neurosurgery, University of California, Los Angeles, California;
  • 4 Boston University School of Medicine, Boston; and
  • 5 Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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OBJECTIVE

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown.

METHODS

The National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project’s National (“Nationwide” before 2012) Inpatient Sample and National Emergency Department Sample.

RESULTS

In the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013.

CONCLUSIONS

The databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.

ABBREVIATIONS ACS = American College of Surgeons; CDC = Centers for Disease Control and Prevention; ED = emergency department; HCUP = Healthcare Cost and Utilization Project; NEDS = National Emergency Department Sample; NIH = National Institutes of Health; NIS = National (Nationwide) Inpatient Sample; NSP = National Sample Program; NTDB = National Trauma Data Bank; SID = State Inpatient Database; TBI = traumatic brain injury.

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Contributor Notes

Correspondence William B. Gormley: Brigham and Women’s Hospital, Boston, MA. wgormley@bwh.harvard.edu.

INCLUDE WHEN CITING Published online November 20, 2020; DOI: 10.3171/2020.7.JNS201896.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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