Since 1989, when a federal interagency task force named the Centers for Disease Control and Prevention (CDC) the lead federal agency for traumatic brain injury (TBI) activities,1 CDC has played a unique and critical role in tracking, monitoring, and assessing the impact of TBI in the United States. CDC's National Center for Injury Prevention and Control (NCIPC) seeks to (a) prevent TBIs from occurring and (b) reduce the adverse consequences of TBI by ensuring that data and data systems are available, that public awareness about TBI is increased, and that people with TBI get the services they need. The purpose of this special issue is to describe in detail CDC's role in TBI and showcase it through a range of articles.
In this issue, two background articles provide an overview of the public health principles and legislative mandates that guide CDC's TBI activities. Specifically, Binder et al describe the public health model, which provides a useful framework for identifying important efforts needed to reduce the impact of TBI. Langlois et al (“Tracking the Silent Epidemic …”) summarize key CDC TBI activities authorized under the TBI Act of 1996 and the Children's Health Act of 2000.
A distinguishing feature of CDC's research and programs is the collection and analysis of population-based TBI incidence data from both state and national data systems. The article by Langlois et al (“The Incidence of Traumatic Brain Injury Among Children in the United States …”) is an example of the use of national TBI data in which TBI rates for children are calculated by race. Similar detailed national data are also disseminated through CDC reports, for example “Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths.”2 The articles by Rutland-Brown et al and Coronado et al in this issue are examples of the use of state-based data from CDC-funded TBI surveillance systems to investigate factors related to TBI among American Indians and Alaska Natives and among older adults, respectively. Besides showing the impact of TBI, the findings from these epidemiologic studies have important implications for planning for the primary prevention of TBI in these populations.
CDC also supports research on the prevalence of TBI-related disability and other outcomes. In this issue, Selassie et al use population-based follow-up data from the South Carolina Traumatic Brain Injury Follow-up Registry (SCTBIFR) to report a substantial increase in the risk of death within one year after hospitalization with a TBI. This and other forthcoming papers from the South Carolina follow-up study suggest that ongoing monitoring of health status after hospital discharge with a TBI may be critical to maintaining health postinjury. Similarly, Kraus et al show that, 6 months after injury, persons with TBI who are treated and released from the emergency department still have health problems that require medical management. Ensuring that people with TBI get needed posthospital medical care is an important consideration for TBI professionals.
CDC plays an important role in educating the public and increasing awareness about TBI by closing gaps in knowledge through activities that respond to the provisions of the Children's Health Act of 2000. Selected CDC education and awareness activities, including those conducted in collaboration with partners such as the Brain Injury Association of America (BIAA), The Health Resources and Services Administration (HRSA), and the National Association of State Head Injury Administrators (NASHIA), are summarized in the article by Langlois et al (“Tracking the Silent Epidemic …”). These efforts show CDC's commitment to working with other health agencies and organizations to provide needed information about TBI.
In recent years, CDC has begun supporting states with CDC-funded TBI surveillance systems to explore the feasibility of using their data and data systems to help people with TBI find out about and access available services. The article by Sample and Langlois summarizes Colorado's experience in exploring and developing better ways to link state residents with TBI to services so that other states can learn from these efforts.
CDC's goals for TBI also include responding to emerging TBI issues and improving the care of acutely brain-injured patients. Although not represented in this issue, CDC has held expert meetings and conducted research on TBI following terrorism-related events, including a study of TBI among people hospitalized after the World Trade Center attacks. Also, as part of a broad effort to improve the medical care of acutely injured patients, CDC plans to develop guidelines and programs to ensure timely and appropriate acute care for TBI patients. These areas will represent an increasingly important focus for CDC's future work in TBI.
Finally, CDC's work in TBI has benefited greatly from the increased spirit of collaboration among TBI organizations, including the Brain Injury Association of America, the National Association of State Head Injury Administrators, the National Brain Injury Research, Treatment and Training Foundation (NBIRTT), and the North American Brain Injury Society (NABIS), as well as other federal agencies working in TBI: the Defense and Veterans Brain Injury Center (DVBIC), the Health Resources and Services Administration (HRSA), the National Center for Medical Rehabilitation Research (NCMRR) and the National Institute of Neurological Diseases and Stroke (NINDS) of the National Institutes of Health (NIH), the National Institute on Disability and Rehabilitation Research (NIDRR), and the Social Security Administration (SSA). Continued efforts to share knowledge, expertise, ideas, and insights, and to leverage scarce resources, will help move all of us closer to the ultimate goals: the prevention of TBI and an improved quality of life for people with brain injuries and their families.
Sincere thanks go to Wesley Rutland-Brown, MPH, the Assistant to the Editor, for this issue. Without his help, it could not have been possible.
Jean A. Langlois ScD, MPH
Richard W. Sattin, MD
Issue Editors, National Center for Injury Prevention and Control Centers for Disease Control and Prevention, Atlanta, Ga
1. Department of Health and Human Services. Federal Interagency Head Injury Task Force Report
. Washington, DC: Department of Health and Human Services, 1989.
2. Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department Visits, ospitalizations, and Deaths
. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004.