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Measuring Inflicted Traumatic Brain Injury in Minnesota
Sara Seifert, M.P.H. & Debra HagelInjury & Violence Prevention Unit
Minnesota Department of Health
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Nomenclature
If we can’t name it, how can we measure it?
Shaken Baby Syndrome Shaken Impact Syndrome Abusive Head Trauma Inflicted Traumatic Brain Injury
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Overview Minnesota Trauma Data Bank
Data Sources for iTBI
Strengths & Weaknesses of each Data Source
Epidemiology of Severe iTBI in Minnesota
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MMinnesota innesota TTrauma rauma DData ata BBankank
Pre-hospital
HOSPITALHOSPITAL
Post-hospital
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Hospital Data
Codes assigned by medical records identify diagnoses, procedures, and injury causes.
Minnesota Hospital Association compiles billing data statewide. gender, age, inpatient / ED, date, zip code, charges
MDH abstracts data from medical records. relationship to perpetrator, circumstances of injury,
alcohol / drug use
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Partners
Centers for Disease Control & Prevention Funding to: Identify additional cases Gather new information Assess CPS / public health cost differential
Department of Human Services Midwest Children’s Resource Center Shaken Baby Syndrome Task Force Minnesota Department of Health
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Child Maltreatment in Minnesota
Central Nervous System Injuries
Fatalities
Hospital Treated Cases
Outpatient Cases
Substantiated Reports to CPS
Substantiated Injury Reports to CPS
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Data Sources Deaths
Death Certificates Medical Examiner Reports Child Fatality Review Panel Supplemental Homicide Reports Femicide Report Newspaper Clippings
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Death Certificates Strengths
Population-based Public data Have ICD 10 Codes
Weaknesses Often no perpetrator
information Often limited
information on circumstances
“Abdominal and head injuries”
“Multiple injuries of varying ages”
“Was injured by another person”
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Medical Examiner Reports Don’t know. Anticipate much detail,
especially medical.
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Child Fatality Review Panel Strengths
Lots of information Public data
Weaknesses Only obtain cases
that are reported to Child Protective Services
North Dakota Case
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Supplemental Homicide Reports Strengths
Public data Often have
perpetrator and circumstances
Weaknesses Voluntary system Limited detail
Victim: 1 year old female, Asian, Non-HispanicOffender: 54 year old female, white, Non-Hispanic
Weapon: [blank]
Relationship: Day care provider
Circumstance: Victim violently shaken, causing shaken baby syndrome
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Femicide Report Strengths
Public data Often have
perpetrator and circumstances
Weaknesses Based on voluntary
reporting and newspaper clippings
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Femicide Report continued
11. Austin Olson, 8 months Otsego November 7
Cynthia Henderson of Rogers, 32, was charged with second-degree murder in connection with the death of Austin Olsonof Otsego, 8 months, for whom she was caring. Shortly afternoon on November 5, Henderson called 911 to report thatAustin had been injured when her own child threw a toy athim. She later told investigators . . . A CAT scan on Austinrevealed a skull fracture and other injuries consistent withblunt force trauma and shaking injuries. An autopsy also revealed rib fractures. Cynthia Henderson was sentenced inJune of 2002 to 12 ½ years in prison for unintentional second-degree murder.
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Newspaper Clippings Strengths
Public data Often have
perpetrator and circumstances
Weaknesses Not all cases obtain
coverage Cost/time
“The boy’s brain injuries were consistent with violent shaking, but medical experts can’t rule out the possibility that the accidents played a role in his death.”
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Data Sources continued
Inpatient Hospitalizations & ED Treated Minnesota Hospital Association TBI/SCI Registry Abstracted hospital data Lists from other sources
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Minnesota Hospital Association Strengths
Identify potential cases Have ICD 9 codes
Weaknesses Cannot confirm cases Usually have no
circumstance or perpetrator information
Private data Cost
801.0 Fracture of base of skull, open with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness
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TBI/SCI Registry Strengths
Identify cases Have ICD 9 codes Usually have
perpetrator and circumstances
Weaknesses May lack important
detail Private data
“Alleged fall from jungle gym (suspected child abuse).”
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Abstracted Hospital Data Strengths
Identify cases Have ICD 9 codes Have most detail
Weaknesses Private data Cost May vary by facility May not be
conclusive
“Shaken baby syndrome with old tibia fracture. Large subdural hematoma with herniation seizure. Severe disability. Delay in seeking treatment for 16 hours although 1 month was unresponsive. Siblings removed from home. Suspected shaken baby syndrome by dad also old left tibia fracture. Child later became ward of state.”
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Abstracted Hospital Data continued
“There is nothing here except 1) face sheet 2) order for full skeletal series with reason noted as suspected shaken baby syndrome 3) request from County Child Protective Services for all medical records. Lots of unknowns.”
“2 subdural hematomas of varying ages. County Social Services unable to prove anything, so child discharged to home.”
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Child Protective Services Need to explore this data more. Identify TBIs, unclear if only due to iTBI
and how complete.
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Clinic, Home or No Treatment
No data at this time.
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Key Messages About Data Sources With some effort you can access death data
for iTBI cases The IVPU can provide summary data on
inpatient iTBI hospitalizations The IVPU can provide more limited
summary data on ED treated iTBI No data available on clinic or untreated
iTBI at this time
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Major Limitations of iTBI Data Requires
Identification, Documentation, Coding & Submission of cases.
Have many unknown/unclear cases May not obtain cases treated out-of-state
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Key Findings for Severe iTBI in Minnesota, 1999-2001 Small number of cases Majority are boys Majority are under one year of age Nearly half have documented previous
abuse Most perpetrators are a parent or parent’s
partner Majority of perpetrators are male
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Severe iTBI RatesMN, 1999-2001, Ages 0-4
Note: Cases identified from Death Certificates, Abstracting TBI Cases, and TBI Registry. Actual N’s = 32, 35, and 46 respectively.
Rate of severe iTBI appears to be rising but that is likely due to incomplete data in 1999 and 2000
9.7510.44
13.5912.80
13.42 13.59
Actual Estimated
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How does Minnesota compare?Ages 0-1
46.89
29.7
21.3
05
101520253035404550
Minnesota (n=32) North Carolina(n=71)
Wales (n=15)
Note: Different case definitions and data collection methods.
CI=(33.8, 60.0) CI=(22.9, 36.7) CI=(1.78, 40.82)
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Deaths and Inpatient Hospitalizations by Gender and Age, MN, 1999-2001
Note: Information available only for TBI Registry and abstracted cases
58%
8%
0% 0% 0%3% 3% 3% 2%
24%
Under 1 Age 1 Age 2 Age 3 Age 4
Boys Girls
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Perpetrator for Inpatient HospitalizationsMN, 1999-2001, Ages 0-4
Note: Information available only for abstracted cases
0% 0% 0% 0% 0%
21%
3%0% 0% 0% 0%
43%
2% 2%2%
29%
Parent(blood, step,
foster)
Day careprovider
Babysitter -non-family
Caregiver -sibling
Babysitter -other family
Other Parent'ssignificant
other
Unknown
Male Female
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Previous Abuse for Inpatient HospitalizationsMN, 1999-2001, Ages 0-4
44%
31%
25%
Yes No UnknownNote: Information available only for abstracted cases
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Hospital Charges, MN,1999-2001
iTBI, Inpatient Hospitalizations (n=66)
CM, Inpatient Hospitalizations (n=58)
CM, ED Treated (n=110)
Mean $36,219 $9,361 $776
Median $20,234 $5,461 $310
Sum $2,390,476 $541,912 $85,573
Note: Information available only for abstracted cases
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Payer Source for Inpatient Hospitalizations, MN,1999-2001
Note: Information available only for abstracted cases
32%
52%
3%
12%
Medicaid Other Othergov Self-pay
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Conclusions We can estimate incidence of severe iTBI in
Minnesota and provide descriptive information. Limited data at local level due to small numbers
and lack of access to data sources other than deaths.
The majority of severe iTBI victims in Minnesota are boys under age one. Nearly half have a documented history of previous hospital/ED treated abuse.