The Children's Health Act of 2000 enables CDC to provide continued leadership in the study of traumatic brain injuries (TBI). CDC supports multiple projects and programs, including those that track and monitor TBI, link people with TBI to information about services, and prevent TBI-related disabilities. 

Analyzing TBI surveillance data
CDC currently funds 12 states to track and monitor TBI. CDC analysis of data collected by funded states in 1997 indicate that TBI remains an important public health problem. This data was published in 2003 and is available from the CDC MMWR website. An additional report that reviews TBI deaths for 1989–1998 was published in 2002 and also is available from the CDC MMWR website. Data in these reports inform decisions about TBI prevention efforts and service needs for people with TBI.

Generating national estimates for TBI deaths, hospitalizations, and emergency department visits
In 2001, CDC funded an analysis of national TBI data from its National Center for Health Statistics. This analysis will generate national estimates for TBI deaths, hospitalizations, and emergency department visits by sex, age, and geographic region. It will also offer information such as causes of TBI and average hospital stays for TBI patients. Results of this analysis will be the subject of a CDC report, slated for publication in 2004. This report will be the first of its kind to include detailed national data about TBI in a single-reference document. 

Linking people with TBI to information about TBI services
With CDC funding, the Colorado Department of Public Health and Environment (CDPHE) studied the effectiveness of linking people in a statewide TBI surveillance system to information about TBI services. CDPHE selected a random sample of 750 persons in its existing TBI surveillance system and sent them letters about a toll-free helpline to help them find TBI services. Call volume to the hotline quadrupled during the months the letter was sent out. This result indicates that people with TBI want services but may not know about them or how to access them. Callers from rural settings were overrepresented among the people who called the helpline, which may indicate that resources for TBI services are more limited for persons living in rural communities than for persons in urban settings.

Planning the future of TBI registries and data systems
In July 2002, CDC convened a meeting of researchers, advocates, experts from state and federal agencies, and state TBI registry managers to discuss the future of TBI registries. Participants discussed CDC activities related to the TBI Act Reauthorization, the definition of a TBI registry, state TBI data system needs, and future steps CDC should take to help states build data systems. The proceedings and recommendations of this meeting will be published by December 2004.

Reporting to Congress about mild traumatic brain injury
The Children's Health Act of 2000 requires CDC to report to Congress how best to measure the rate at which new cases of mild traumatic brain injury (MTBI) occur (incidence) and the proportion of U.S. population which, at any given time, experiences signs or symptoms of an MTBI (prevalence). To that end, CDC formed the MTBI Work Group, composed of experts in the field of brain injury, to determine appropriate and feasible methods for assessing the incidence and prevalence of MTBI in the United States. The Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem presents the findings and recommendations of the MTBI Work Group.

Identifying the number of persons with TBI among World Trade Center survivors
CDC conducted a rapid assessment of injuries among survivors of the September 11, 2001, World Trade Center attack who were seen in emergency departments and found only a small percentage had a head injury. Because other injured people may have had a TBI that was not diagnosed, CDC is funding the New York City Department of Health to conduct a retrospective study to identify the number of people hospitalized with injury after the World Trade Center attack who may have also had a TBI. The study will review inpatient hospital records to identify those with possible TBI and describe the cause and nature of their injuries.

Measuring children’s health after a TBI
A TBI can significantly affect a child’s health and development. However, no standardized, efficient method exists to monitor the health of children who sustain a TBI. CDC funded The Johns Hopkins University in 2001 to evaluate different methods used to measure physical and psychosocial health outcomes of children with TBI. Validating and adopting a standardized health status survey that is appropriate for large-scale, ongoing surveillance of children’s health following a TBI will improve understanding of how these injuries affect children. This information also will inform policy and research initiatives.

Developing tools to measure the effects of MTBI
CDC is funding a collaborative study between Children’s National Medical Center and the University of Pittsburgh Medical Center Sports Medicine Concussion Program. This study seeks to develop and validate a series of tests for assessing health outcomes of MTBI in children and adolescents. It will also document factors that influence the outcome of an MTBI during the recovery period.

Developing toolkits to promote MTBI awareness
As part of a national initiative to prevent MTBI and improve clinical management for patients with MTBI, CDC has developed Heads Up: Brain Injury in Your Practice, a tool kit for primary care physicians. The tool kit, available free of charge, contains practical, easy-to-use clinical information, patient information in English and Spanish, scientific literature, and a CD-ROM. .

CDC is currently developing a tool kit for high school coaches to raise awareness about sports-related concussions. This tool kit will provide information on how to prevent and manage sports-related concussions appropriately. It will be distributed to a select group of states for evaluation by fall 2004.