Kelly Sarmiento

Trends in Traumatic Brain Injury in the U.S. and the public health response: 1995-2009

PROBLEM Traumatic Brain Injury (TBI) is a public health problem in the United States. In 2009, approximately 2.4 million [corrected] patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N=300,667) or were treated and released from emergency departments (EDs; N=2,077,350), outpatient departments (ODs; N=83,857), and office-based physicians (OB-P; N=1,079,338). In addition, 52,695 died with one or more TBI-related diagnoses. METHODS Federal TBI-related laws that have guided CDC since 1996 were reviewed. Trends in TBI were obtained by analyzing data from nationally representative surveys conducted by the National Center for Health Statistics (NCHS). FINDINGS CDC has developed and is implementing a strategy to reduce the burden of TBI in the United States. Currently, 20 states have TBI surveillance and prevention systems. From 1995-2009, the TBI rates per 100,000 population increased in EDs (434.1 vs. 686.0) and OB-Ps (234.6 vs. 352.3); and decreased in ODs (42.6 vs. 28.1) and in TBI-related deaths (19.9 vs. 16.6). TBI Hospitalizations decreased from 95.5 in 1995 to 77.9 in 2000 and increased to 95.7 in 2009. CONCLUSIONS The rates of TBI have increased since 1995 for ED and PO visits. To reduce of the burden and mitigate the impact of TBI in the United States, an improved state- and territory-specific TBI surveillance system that accurately measures burden and includes information on the acute and long-term outcomes of TBI is needed.

Evaluation of the Centers for Disease Control and Prevention's Concussion Initiative for High School Coaches: “Heads Up: Concussion in High School Sports”

BACKGROUND To reduce the number of sports-related concussions, the Centers for Disease Control and Prevention (CDC), with the support of partners and experts in the field, has developed a tool kit for high school coaches with practical, easy-to-use concussion-related information. This study explores the success of the tool kit in changing knowledge, attitudes, and practices related to the prevention and management of concussions. METHODS A mail questionnaire was administered to all eligible high school coaches who received the tool kit. Follow-up focus groups were conducted for additional information. Both quantitative data from the surveys and qualitative data from the focus groups were analyzed to support the objectives of the study. RESULTS Respondents self-reported favorable changes in knowledge, attitudes, and practices toward the prevention and management of concussions. Qualitative responses augmented the quantitative data. CONCLUSION Barriers to concussion prevention and management are complex; however, these results highlight the role that coaches can play in school settings in establishing a safe environment for their athletes.

A 10-year review of the Centers for Disease Control and Prevention's Heads Up initiatives: Bringing concussion awareness to the forefront☆

Children and adolescents are at increased risk for concussions, a type of mild traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or body that can change the way the brain normally works. While most children and adolescents no longer experience symptoms within two weeks of the injury, some—especially those who have a history of concussions—may have symptoms that last for months or even longer (Eisenberg, Andrea, Meehan, & Mannix, 2013). Concussions need to be addressed correctly to help reduce the risk for short- or long-term health problems that can affect a child’s or adolescent’s thinking, learning, behavior, and/or emotions (Brosseau-Lachaine, Gagnon, Forget, & Faubert, 2008; McClincy, Lovell, Pardini, Collins, & Spore, 2006; Moser, Schatz, & Jordan, 2005; Schatz, Moser, Covassin, & Karpf, 2011). To help address this public health concern, the Children’s Health Act of 2000 (H.R. 4365) (Library of Congress, 1999–2000) charged the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control to implement a public information campaign to broaden public awareness of the health consequences of TBI. In response, CDC developed and launched the Heads Up concussion education campaign. Over the last 10 years, CDC’s Heads Up campaign has grown into a cohesive suite of educational initiatives that share a common goal: to help protect children and adolescents from concussions and other serious brain injuries by raising awareness, enhancing knowledge, and informing action to improve prevention, recognition, and response to concussions. Each CDC Heads Up initiative fulfills these goals by (1) translating the latest concussion science into educational products tailored specifically for the target audiences, and (2) working with partner organizations to disseminate and integrate concussion educational materials and messages into their existing systems and programs. This report describes the process CDC employed to develop and carry out the Heads Up campaign.

Help Seniors Live Better, Longer: Prevent Brain Injury: An Overview of CDC's Education Initiative to Prevent Fall-related TBI Among Older Adults

BackgroundFalls are the leading cause of traumatic brain injury (TBI) among older adults aged 75 and older. Despite this burden, many older adults, their caregivers, and professionals are not aware of the importance of TBI as an outcome of falls among older adults. MethodsTo address this important public health problem, the Centers for Disease Control and Prevention (CDC) developed the “Help Seniors Live Better, Longer: Prevent Brain Injury” initiative to help raise awareness about methods to prevent, recognize and respond to fall-related TBIs among older adults aged 75 and older. ResultsThe initiative was launched in March 2008, in collaboration with 26 participating organizations, and included a multipronged outreach strategy to help blanket the country with the messages of the initiative at the national, state, and local levels. ConclusionAdherence to a logical, comprehensive health-education approach has proven to be highly effective in furthering the initial goals of the project.

Reach and knowledge change among coaches and other participants of the online course: "concussion in sports: what you need to know"

Objectives:To describe the reach of the Heads Up “Concussion in Sports: What You Need to Know,” online course and to assess knowledge change. Setting:Online. Participants:Individuals who have taken the free online course since its inception in May 2010 to July 2013. Design:Descriptive, uncontrolled, before and after study design. Main Measures:Reach is measured by the number of unique participants and the number of times the course was completed by state and sport coached and the rate of participation per 100 000 population by state. Knowledge change is measured by the distribution and mean of pre- and posttest scores by sex, primary role (eg, coach, student, and parent), and sport coached. Results:Between May 2010 and July 2013, the online concussion course was completed 819 223 times, reaching 666 026 unique participants, including residents from all US states and the District of Columbia. The distribution of overall scores improved from pre- to posttests, with 21% answering all questions correctly on the pretest and 60% answering all questions correctly on the posttest. Conclusion:Online training can be effective in reaching large audiences and improving knowledge about emerging health and safety issues such as concussion awareness.

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

Importance Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States. Objective To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI. Evidence Review The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015. Findings The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment. Conclusions and Relevance This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.

CDC's approach to educating coaches about sports-related concussion

Abstract Sports-related concussions can happen to any athlete in any sport. Each year in the United States, an estimated 1.6-3.8 million sports and recreation-related traumatic brain injuries (TBIs) occur, most of which can be classified as concussions. To help coaches prevent, recognize, and better manage sports-related concussions, the Centers for Disease Control and Preventions (CDC) National Center for Injury Prevention and Control (CDCs Injury Center) applied a comprehensive health-education approach to developing a multimedia tool kit for high school athletic coaches. From developing an expert panel and pretesting message concepts to pilot testing, promoting, and evaluating the final product, CDC has shown that this undertaking is highly effective. Results of the pilot study and promotion efforts show that the tool kit is well received by coaches and school officials and that it meets a critical health education need.

STEADI: CDC's approach to make older adult fall prevention part of every primary care practice

INTRODUCTION Primary care providers play a critical role in protecting older adult patients from one of the biggest threats to their health and independence-falls. A fall among an older adult patient cannot only be fatal or cause a devastating injury, but can also lead to problems that can effect a patients overall quality of life. METHODS In response, the Centers for Disease Control and Prevention (CDC) developed the STEADI initiative to give health care providers the tools they need to help reduce their older adult patients risk of a fall. RESULTS CDCs STEADI resources have been distributed widely and include practical materials and tools for health care providers and their patients that are designed to be integrated into every primary care practice. CONCLUSION As the population ages, the need for fall prevention efforts, such as CDCs STEADI, will become increasingly critical to safeguard the health of Americans. PRACTICAL APPLICATIONS STEADIs electronic health records (EHRs), online trainings, assessment tools, and patient education materials are available at no-cost and can be downloaded online at www.cdc.gov/STEADI. Health care providers should look for opportunities to integrate STEADI materials into their practice, using a team-based approach, to help protect their older patients.

Evaluation of Field Triage Decision Scheme Educational Resources: Audience Research With Emergency Medical Service Personnel

In an effort to encourage appropriate field triage procedures, the Centers for Disease Control and Prevention (CDC), in collaboration with the National Highway Traffic Safety Administration and the American College of Surgeons–Committee on Trauma, convened the National Expert Panel on Field Triage to update the Field Triage Decision Scheme: The National Trauma Triage Protocol (Decision Scheme). In support of the Decision Scheme, CDC developed educational resources for emergency medical service (EMS) professionals, one of CDC’s first efforts to develop and broadly disseminate educational information for the EMS community. CDC wanted to systematically collect information from the EMS community on what worked and what did not with respect to these educational materials and which materials were of most use. An evaluation was conducted to obtain feedback from EMS professionals about the Decision Scheme and use of Decision Scheme educational materials. The evaluation included a survey and a series of focus groups. Findings indicate that a segment of the Decision Scheme’s intended audience is using the materials and learning from them, and they have had a positive influence on their triage practices. However, many of the individuals who participated in this research are not using the Decision Scheme and indicated that the materials have not affected their triage practices. Findings presented in this article can be used to inform development and distribution of additional Decision Scheme educational resources to ensure they reach a greater proportion of EMS professionals and to inform other education and dissemination efforts with the EMS community.

Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review

Importance In recent years, there has been an exponential increase in the research guiding pediatric mild traumatic brain injury (mTBI) clinical management, in large part because of heightened concerns about the consequences of mTBI, also known as concussion, in children. The CDC National Center for Injury Prevention and Control’s (NCIPC) Board of Scientific Counselors (BSC), a federal advisory committee, established the Pediatric Mild TBI Guideline workgroup to complete this systematic review summarizing the first 25 years of literature in this field of study. Objective To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI. Evidence Review Using a modified Delphi process, the authors selected 6 clinical questions on diagnosis, prognosis, and management or treatment of pediatric mTBI. Two consecutive searches were conducted on PubMed, Embase, ERIC, CINAHL, and SportDiscus. The first included the dates January 1, 1990, to November 30, 2012, and an updated search included December 1, 2012, to July 31, 2015. The initial search was completed from December 2012 to January 2013; the updated search, from July 2015 to August 2015. Two authors worked in pairs to abstract study characteristics independently for each article selected for inclusion. A third author adjudicated disagreements. The risk of bias in each study was determined using the American Academy of Neurology Classification of Evidence Scheme. Conclusion statements were developed regarding the evidence within each clinical question, and a level of confidence in the evidence was assigned to each conclusion using a modified GRADE methodology. Data analysis was completed from October 2014 to May 2015 for the initial search and from November 2015 to April 2016 for the updated search. Findings Validated tools are available to assist clinicians in the diagnosis and management of pediatric mTBI. A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury, delayed recovery from mTBI, and long-term sequelae. However, high-quality studies of treatments meant to improve mTBI outcomes are currently lacking. Conclusions and Relevance This systematic review was used to develop an evidence-based clinical guideline for the diagnosis and management of pediatric mTBI. While an increasing amount of research provides clinically useful information, this systematic review identified key gaps in diagnosis, prognosis, and management.