Definition

TBI Hospitalizations Rate: The rate of TBIs of all injury intentions resulting in non-fatal hospitalizations per 10,000 population. For all definitions, these cases may include a TBI alone or in combination with other injuries or conditions. ICD-10-CM Hospital Codes for TBI Morbidity: S02.0 (fracture of vault of skull), S02.1 (fracture of the base of the skull); S02.8X (fractures of other specified skull and facial bones), S02.91 (unspecified fracture of skull); S04.02 (injury of optic chiasm), S04.03 (injury of optic tract and pathways), S04.04 (injuries of visual cortex); S06 (intracranial injury); S07.1 (crushing injury of skull); T74.4 (shaken infant syndrome).

Numerator

TBI Hospitalization Rate: The number of TBIs of all injury intentions resulting in hospitalization which meet the case definition mentioned in the data notes explaining ICD-10-CM codes. TBI Hospitalizations and Deaths Percentage: The number of TBIs with a cause or set of causes as defined through medical record review, as part of the TBI Injury Surveillance Database sample.

Denominator

TBI Hospitalization Rate: The total number of persons in the population of Utah.

Data Interpretation Issues

Due to the transition to the ICD-10-CM coding system, data is available beginning in 2016. 2015 data is available from sampled traumatic brain injury (TBI) hospitalization and death cases, provided by the Violence and Injury Prevention Program, Traumatic Brain Injury Surveillance Program; this data was used to report etiology. TBI is defined as an occurrence of injury or death resulting from trauma to the head. With regard to injury, the occurrence must be documented in a medical record with one or more of the following: observed or self-reported loss of consciousness or decreased level of consciousness; amnesia; skull fracture; changes in motor function, sensory function, reflexes, or speech; seizures; or hemorrhages, bruising, or other trauma of the brain. With death, the injury has been listed on the death certificate, autopsy report, or medical examiner's report as a sequence that caused death. Clinical definitions of TBI exclude several conditions including: lacerations or contusions of the face, eye, or scalp without other criteria; fractures of facial bones without other criteria; birth trauma; primary anoxic, inflammatory, toxic, or metabolic encephalopathies which are not complications of head trauma; brain infarction (ischemic stoke); intracranial hemorrhage (hemorrhagic stroke) without associated trauma; airway obstruction (e.g., near-drowning, throat swelling, choking, strangulation, or crush injuries of the chest); seizure disorders (grand mal, etc.); intracranial surgery; and neoplasms.

Why Is This Important?

Traumatic brain injury is a leading cause of death and disability in Utah, costing more than $189 million in hospitalization charges in 2022. During 2022, the age-adjusted rate of Utahns hospitalized due to a TBI was 6.9 per 10,000. Based on sampled 2016-2017 TBI cases, more than half (52.8%) of TBI hospitalizations and deaths are the result of a fall. Motor vehicle traffic crashes (13.4%) are the second leading cause of TBI hospitalizations and deaths in Utah.

Other Objectives

{{style color:#1AA1B7 Healthy People 2030 Objective IVP-05:}}[[br]] Reduce fatal traumatic brain injuries[[br]] '''U.S. Target:''' 16.9 deaths per 100,000 population As compared to Healthy People 2020, Healthy People 2030 no longer provides specific objectives for nonfatal TBI rate reduction. Regardless, nonfatal TBI rates will still be monitored.

How Are We Doing?

The age-adjusted death rate of TBI in Utah in 2023 was 21.0 per 100,000 population. From 2018 to 2023, age-adjusted rates of TBI for both sexes have not changed significantly. In 2023, rates of TBI deaths were greater for males compared to females (32.6 to 9.6). The age-adjusted hospitalization rate of TBI in Utah in 2022 was 6.9 per 10,000 population. This rate was lower than the previous year's rate of 7.1 per 10,000 population, but not significantly so. From 2018 to 2022, age-adjusted rates of TBI for both sexes have not changed significantly. In 2022, rates of TBI hospitalizations were greater for males compared to females (8.6 to 5.2).

How Do We Compare With the U.S.?

The most recent U.S. age-adjusted death rate of TBI available is for 2022. Using 2022 values for both Utah and the U.S., the Utah age-adjusted death rate of TBI is greater than that of the U.S. (22.3 to 19.2). The Utah age-adjusted death rate of TBI also exceeds the Healthy People 2030 Objective IVP-05 target of 16.9 deaths per 100,000 population. The U.S. age-adjusted hospitalization rate of TBI was not available for 2022, so comparisons could not be made.

What Is Being Done?

The Utah Department of Health and Human Services, Violence and Injury Prevention Program (VIPP) receives funding from the U.S. Centers for Disease Control and Prevention to conduct TBI surveillance for the state of Utah. This is done through review of hospital discharge data, vital statistics data, and hospital records abstractions. These data are used to develop interventions and policies targeting those at highest risk (such as young people for motor vehicle incidents and the elderly for fall incidents).

Available Services

Established by the Utah State Legislature in 2008, the TBI Fund seeks to educate and empower those whose lives have been impacted by the effects of a traumatic brain injury. Individuals with a TBI may receive help with resource facilitation or neuropsychological testing through the TBI Fund. Resource facilitation is a process that involves working with caring, trained experts who understand what someone with a TBI is going through. These experts provide short-term support to help the person with the TBI and their family members meet their goals and successfully return to school, work, or other daily activities. The TBI Fund is a payor of last resort, meaning individuals have no other financial means available to obtain these services. However, everyone who calls the Utah TBI Fund for help receives a free intake assessment and consultation from a trained brain injury coach. Individuals may also qualify to receive help with physical, occupational, and speech therapy or equipment needed for daily living through the Utah Traumatic Spinal Cord and Brain Injury Rehabilitation Fund. In the 2024 legislative session, the legislature consolidated the BI Fund established in 2008, the Neuro-Rehabilitation Fund established in 2012, and the Pediatric Neuro-Rehabilitation Fund established in 2019 to form the comprehensive Brain Injury and Spinal Cord Injury Fund. Dedicated to serving individuals, families, and caregivers impacted by brain injuries, spinal cord injuries, or non-progressive neurological conditions, this fund aims to provide crucial support and resources. Services include resource facilitation, neuropsychological testing, and rehabilitation therapy, all aimed at empowering individuals to achieve their goals and successfully reintegrate into daily life. Resource facilitation, conducted by compassionate experts, offers short-term assistance to navigate challenges and achieve milestones on the path to recovery, whether in school, work, or daily activities. Additional information can be found at [https://vipp.utah.gov/traumatic-brain-injury/].

Health Program Information

The Violence and Injury Prevention Program (VIPP) is a trusted and comprehensive resource for data related to violence and injury. Through education, this information helps promote partnerships and programs to prevent injuries and improve public health. The VIPP goals are to a) focus prevention efforts on reducing intentional and unintentional injury, b) conduct education aimed at increasing awareness and changing behaviors that contribute to the occurrence of injury, c) strengthen local health department capacity to conduct local injury prevention programs, d) promote legislation, policy changes, and enforcement that will reduce injury hazards and increase safe behaviors, e) collaborate with private and public partners, and f) improve the Utah Department of Health and Human Services capacity to collect mortality and morbidity data from multiple sources and conduct injury epidemiology for use in prevention planning, implementation, and evaluation.

Risk Factors

TBIs are most commonly caused by a fall, firearm-related injury, motor vehicle crash, or an assault. Falls are responsible for nearly half of TBI-related hospitalizations. Firearm-related suicide is the most common cause of TBI-related deaths in the United States. TBIs affect the lives of people of all ages. Anyone can experience a TBI, but data suggest that some groups are at greater risk of dying from a TBI or experiencing long-term health problems after the injury. Examples of groups who are more likely to be affected by TBI, include: older adults, racial and ethnic minorities, service members and veterans, people who experience homelessness, people who are in correctional and detention facilities, survivors of intimate partner violence, and people living in rural areas.

Between 2016 and 2022, TBI hospitalization rates have remained fairly consistent. Male age-adjusted rates are higher than female age-adjusted rates for all years.

Data Notes

ICD-10-CM codes for TBI Morbidity: S02.0, S02.1, S02.8X, S02.80, S02.81, S02.82, S02.91, S04.02, S04.03, S04.04, S06, S07.1, or T74.4 with a 7th character of A, B, or missing. ICD-10 codes for TBI Mortality: S01, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. These cases may include a TBI alone or in combination with other injuries or conditions.   [[br]] [[br]] Rates have been age-adjusted to the 2000 U.S. population.

Males have significantly higher rates of TBI-related hospitalizations compared to females in almost all age groups. Rates of TBI-related hospitalizations per 10,000 population were highest among older adults aged 75+.

Data Notes

ICD-10-CM codes for TBI Morbidity: S02.0, S02.1, S02.8X, S02.80, S02.81, S02.82, S02.91, S04.02, S04.03, S04.04, S06, S07.1, or T74.4 with a 7th character of A, B, or missing. ICD-10 codes for TBI Mortality: S01, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. These cases may include a TBI alone or in combination with other injuries or conditions.   [[br]] [[br]] Rates are calculated using TBI-related hospitalizations.

Data Notes

ICD-10-CM codes for TBI Morbidity: S02.0, S02.1, S02.8X, S02.80, S02.81, S02.82, S02.91, S04.02, S04.03, S04.04, S06, S07.1, or T74.4 with a 7th character of A, B, or missing. ICD-10 codes for TBI Mortality: S01, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. These cases may include a TBI alone or in combination with other injuries or conditions.   Rates are calculated using TBI-related hospitalizations.

From 2016-2022, the Utah age-adjusted rate of TBI hospitalizations was 7.1 per 10,000.

Data Notes

ICD-10-CM codes for TBI Morbidity: S02.0, S02.1, S02.8X, S02.80, S02.81, S02.82, S02.91, S04.02, S04.03, S04.04, S06, S07.1, or T74.4 with a 7th character of A, B, or missing. ICD-10 codes for TBI Mortality: S01, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. These cases may include a TBI alone or in combination with other injuries or conditions.   [[br]][[br]]**The estimate has been suppressed because 1) the relative standard error is greater than 50% or 2) the observed number of events is very small and not appropriate for publication. Statistical significance is determined by whether a region's confidence bounds overlap with the state's rate. Rates age-adjusted to the 2000 U.S. standard population.

Of sampled TBI cases, more than half (52.8%) of TBI hospitalizations and deaths are the result of falls. Motor vehicle traffic crashes (13.4%) are the second leading cause of TBI hospitalizations and deaths in Utah.

Data Notes

ICD-10-CM codes for TBI Morbidity: S02.0, S02.1, S02.8X, S02.80, S02.81, S02.82, S02.91, S04.02, S04.03, S04.04, S06, S07.1, or T74.4 with a 7th character of A, B, or missing. ICD-10 codes for TBI Mortality: S01, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. These cases may include a TBI alone or in combination with other injuries or conditions.   '' ''[[br]] [[br]] **Data have been suppressed and do not meet DHHS standards for reliability. [[br]] For more information, please go to [https://ibis.utah.gov/ibisph-view/pdf/resource/DataSuppression.pdf]. Bicycle crashes include traffic- and non-traffic-related crashes. Cases of TBI with unknown etiology are not included in this chart. Causes of TBI as displayed in this chart are not mutually exclusive; that is, a single TBI could be sustained through a combination of these causes, in which case it would be counted in multiple categories. Numbers represent TBI-related deaths and hospitalizations and are extrapolated from the number of cases in a representative sample from the VIPP TBI database. The 2016-2017 TBI hospitalization and death sample is the most recent one available in the TBI database.

Data Source

Utah Department of Health and Human Services Office of Health Promotion and Prevention, Violence & Injury Prevention Program, TBI database

References and community resources

Centers for Disease Control and Prevention, Injury Center [[br]] [https://www.cdc.gov/injury/index.html] Centers for Disease Control and Prevention, Traumatic Brain Injury and Concussion [[br]] [https://www.cdc.gov/traumatic-brain-injury/index.html] Utah Department of Health and Human Services, Violence and Injury Prevention Program, Traumatic Brain Injury [[br]] [https://vipp.utah.gov/traumatic-brain-injury/] Centers for Disease Control and Prevention, WISQARS: Web-based Injury Statistics Query and Reporting System [[br]] [https://www.cdc.gov/injury/wisqars/index.html]