traumatic Brain Injury in the united statesThis body of work is a vital tool for those who devise the strategies for prevention and treatment. However, a critical dimension will be lost if one sees it only as data, if one does not try to put even a fleeting face behind the numbers. They represent people who -if they survived -have had their lives significantly affected. Through research, we are finding better ways to prevent injury and improve acute care. We who are injured may experience improvement both in function and the quality of our lives when we have access to rehabilitation and support to develop and utilize our remaining strengths and abilities. With so many lives affected, we seek and have the potential for independence, to have the chance to move beyond our disabilities and give back to society.As a survivor, as a disabled physician, I applaud this publication as a step toward making that possible." TBI in the United States• An estimated 1.7 million people sustain a TBI annually. Of them:• 52,000 die,• 275,000 are hospitalized, and• 1.365 million, nearly 80%, are treated and released from an emergency department.• TBI is a contributing factor to a third (30.5%) of all injury-related deaths in the United States. TBI by Age• Children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a TBI.• Almost half a million (473,947) emergency department visits for TBI are made annually by children aged 0 to 14 years.• Adults aged 75 years and older have the highest rates of TBI-related hospitalization and death. TBI by Sex• In every age group, TBI rates are higher for males than for females.• Males aged 0 to 4 years have the highest rates for TBI-related emergency department visits, hospitalizations, and deaths combined. TBI by External Cause• Falls are the leading cause of TBI. Rates are highest for children aged 0 to 4 years and for adults aged 75 years and older.• Falls result in the greatest number of TBI-related emergency department visits (523,043) and hospitalizations (62,334).• Motor vehicle-traffic injury is the leading cause of TBI-related death. Rates are highest for adults aged 20 to 24 years. Additional TBI Findings*• There was an increase in TBI-related emergency department visits (14.4%) and hospitalizations (19.5%) from 2002 to 2006.• There was a 62% increase in fall-related TBI seen in emergency departments among children aged 14 years and younger from 2002 to 2006.• There was an increase in fall-related TBIs among adults aged 65 and older; 46% increase in emergency department visits, 34% increase in hospitalizations, and 27% increase in TBI-related deaths from 2002 to 2006.

Problem/ConditionTraumatic 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 Period2007 and 2013.Description of SystemState-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.ResultsIn 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 crash...

Importance It is important to understand the magnitude and distribution of the economic burden of prescription opioid overdose, abuse and dependence to inform clinical practice, research and other decision makers. Decision makers choosing approaches to address this epidemic need cost information to evaluate the cost effectiveness of their choices. Objective To estimate the economic burden of prescription opioid overdose, abuse, and dependence from a societal perspective Design, Setting and Participants Incidence of fatal prescription opioid overdose from the National Vital Statistics System, prevalence of abuse and dependence from the National Survey of Drug Use and Health. Fatal data are for the U.S population, nonfatal data are is a nationally representative sample of the U.S. civilian noninstitutionalized population ages 12 and older. Cost data are from various sources including health care claims data from the Truven Health MarketScan® Research Databases, and cost of fatal cases from the WISQARS™ (Web-based Injury Statistics Query and Reporting System) cost module. Criminal justice costs were derived from the Justice Expenditure and Employment Extracts published by the Department of Justice. Estimates of lost productivity were based on a previously published study. Exposure Calendar year 2013 Main Outcomes and Measures Monetized burden of fatal overdose and abuse and dependence of prescription opioids. Results The total economic burden is estimated to be $78.5 billion. Over one third of this amount (is due to increased health care and substance abuse treatment costs ($28.9 billion). Approximately one quarter of the cost is borne by the public sector in health care, substance abuse treatment, and criminal justice costs. Conclusions and Relevance These estimates can assist decision makers in understanding the magnitude of adverse health outcomes associated with prescription opioid use such as overdose, abuse, and dependence.

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Pediatric abusive head trauma (AHT) is a leading cause of fatal child maltreatment among young children. Current prevention efforts have not been consistently effective. Policies, such as paid parental leave could potentially prevent AHT, given its impacts on risk factors for child maltreatment. To explore associations between California’s 2004 paid family leave (PFL) policy and hospital admissions for AHT, we used difference-in-difference analyses of 1995–2011 US state-level data before and after the policy in California and seven comparison states. Compared to seven states with no PFL policies, California’s 2004 PFL showed a significant decrease of AHT admissions in both < 1 and < 2year-olds. Analyses using additional data years and comparators could yield different results.