SURVEILLANCE 

REPORT

UNITED STATES 2016 / 2017

Traumatic Brain 

Injury-related 

Hospitalizations 

and Deaths by 

Age Group, Sex, 

and Mechanism 

of Injury
TBI SURVEILLANCE REPORT TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 UNITED STATES 2016 AND 2017

2 

 

ACKNOWLEDGEMENTS 

This traumatic brain injury surveillance report was prepared by staff from the Division 

of Injury Prevention (DIP), National Center for Injury Prevention and Control (NCIPC), 

Centers for Disease Control and Prevention (CDC), U.S. Department of Health 

and Human Services, Atlanta, Georgia. 

Contributors to this report included 

Alexis B. Peterson, PhD1 

Hong Zhou, MS, MPH2 

Karen E. Thomas, MPH2 

Jill Daugherty, PhD1 

Corresponding Author 

Alexis B. Peterson, PhD1 

Apeterson4@cdc.gov 

This report describes the incidence of traumatic brain injury (TBI) collected from multiple 

data sources. Data on TBI-related hospitalizations were obtained from the 2016 and 

2017 Healthcare Cost and Utilization Project’s National Inpatient Sample, sponsored by 

the Agency for Healthcare Research and Quality. Data on TBI deaths were obtained from 

the National Vital Statistics System’s 2016 and 2017 multiple-cause-of-death files. 

All material in this report may be used and copied without permission and with citation. 

DISCLAIMER 

The findings and conclusions in this report are those of the authors and do not necessarily represent 

the official position of the Centers for Disease Control and Prevention. 

1

Applied Science Branch, DIP, NCIPC, CDC 

2

Data Analytics Branch, DIP, NCIPC, CDC 

SUGGESTED CITATION: Centers for Disease Control and Prevention (2021). Surveillance Report of Traumatic Brain 

Injury-related Hospitalizations and Deaths by Age Group, Sex, and Mechanism of Injury—United States, 2016 and 2017.

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. 
 

 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

EXECUTIVE SUMMARY 

Traumatic brain injury (TBI) is a head injury caused by an external force to the head or body resulting in 

disruption of normal brain function.1

 TBI is preventable. However, it results in death and disability for thousands 

of people each year and remains a serious public health concern. In the United States TBIs were diagnosed in 

nearly 2.9 million emergency department visits, hospitalizations, and deaths that occurred during 2014.2 

This surveillance report describes 2016 and 2017 national incidence estimates of TBI-related hospitalizations 

and deaths by age group, principal mechanism of injury, injury intent, and sex.*

 Estimates of TBI-related 

hospitalizations were calculated from the Healthcare Cost and Utilization Project’s (HCUP) National 

Inpatient Sample (NIS).^ HCUP serves as a resource of encounter-level health care data derived from a suite 

of state-based administrative health care record databases.3

 TBI deaths were assessed from the National 

Vital Statistics System (NVSS),^ which captures data for all deaths registered in all 50 U.S. states and the 

District of Columbia.4

 This TBI surveillance report is an update to the Centers for Disease Control and 

Prevention’s (CDC’s) last TBI surveillance report published in 2019 that described estimates of TBI-related 

hospitalizations and deaths for the 2014 data year.2 

Key Findings 

TBI-RELATED HOSPITALIZATIONS 

• Approximately 227,000 TBI-related hospitalizations occurred in 2016 but counts decreased to 

almost 224,000 in 2017. 

• Children ages 0-17 years accounted for approximately 8.6% of all TBI-related hospitalizations in 

2016 and 7.8% in 2017. 

• Unintentional falls and motor vehicle crashes were the most common mechanisms of injury 

contributing to a TBI-related hospitalization. 

» Unintentional falls accounted for 47.7% (2016) and 49.1% (2017; weighted estimate) of all 

TBI-related hospitalizations. 

» Motor vehicle crashes accounted for 25.0% (2016) and 24.5%, (2017) of all TBI-related hospitalizations. 

• Rates of TBI-related hospitalizations per 100,000 population were highest among the following groups: 

» adults aged ≥75 years (313.4 in 2016 and 320.8 in 2017); 

» those aged 65-74 years (104.8 in 2016 and 102.7 in 2017); and 

» individuals aged 55-64 years (67.7 in 2016 and 67.5). 

• In 2016 males had significantly higher age-adjusted rates compared with females among the major 

unintentional and intentional principal mechanisms of injury that contributed to a TBI-related 

hospitalization. Specifically, males had higher age-adjusted rates of: 

» unintentional falls (36.2 versus 24.0); 

» motor vehicle crashes (23.3 versus 11.4; twofold higher); 

» unintentionally being struck by or against an object (2.5 versus 1.2; twofold higher), 

» intentional self-harm (0.7 versus 0.3; twofold higher), and 

» assault (8.1 versus 1.7; more than fourfold higher). 

*

Note: Identification and classification of TBI morbidity and mortality are described in the “Methodological Appendix.” 

^Note: Data sources analyzed for TBI morbidity and mortality and data exclusions are described in the “Methods” section. 3 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

4 

• In 2017 males had significantly higher age-adjusted rates compared with females among the major 

unintentional and intentional principal mechanisms of injury that contributed to a TBI-related 

hospitalization. Specifically, males had higher age-adjusted rates of: 

» unintentional falls (35.6 versus 23.9); 

» motor vehicle crashes (22.5 versus 10.8; twofold higher); 

» unintentionally being struck by or against an object (2.3 versus 0.9; more than twofold higher); 

» intentional self-harm (0.8 versus 0.3; more than twofold higher); and 

» assault (7.5 versus 1.7; more than fourfold). 

• The most common principal mechanisms of injury for TBI-related hospitalizations among children 

aged 0-17 years were falls (rate of 8.3 in 2016 and 7.7 in 2017) and motor vehicle crashes (7.4 in 

2016 and 6.8 in 2017). 

TBI-RELATED DEATHS 

• Approximately 60,000 TBI-related deaths occurred in 2016, and deaths increased to over 61,000 

in 2017. 

• Children ages 0-17 years accounted for approximately 4.5% of all TBI-related deaths in both years. 

• Suicide and unintentional falls were the most common mechanisms of injury contributing to a 

TBI-related death. Suicide accounted for 33.8% of all TBI-related deaths in 2016 and 34.7% in 

2017. Unintentional falls accounted for approximately 28% of all TBI-related deaths in both years. 

• Rates of TBI-related deaths per 100,000 population were highest among adults aged ≥75 years 

(75.5 in 2016 and 77.0 in 2017), those aged 65-74 years (24.2 in 2016 and 24.3 in 2017), and 

individuals aged 55-64 years (19.1 in 2016 and 19.5 in 2017). 

• In 2016, males had significantly higher age-adjusted rates compared with females among the 

major unintentional and intentional principal mechanisms of injury that contributed to a TBIrelated death. Specifically, males had higher age-adjusted rates of: 

» unintentional falls (6.1 versus 3.2); 

» motor vehicle crashes (5.2 versus 1.9; more than twofold higher); 

» suicide (12.3 versus 1.9; more than sixfold higher); and 

» homicide (2.7 versus 1.0; more than twofold higher). 

• In 2017, males had significantly higher age-adjusted rates compared with females among 

the major unintentional and intentional principal mechanisms of injury that contributed to a 

TBI-related death. Specifically, males had higher age-adjusted rates of: 

» unintentional falls (6.3 versus 3.2); 

» motor vehicle crashes (4.9 versus 1.8; more than twofold higher); 

» suicide (13.0 versus 1.9; more than sixfold higher); and 

» homicide (2.7 versus 1.0; more than twofold higher). 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

Limitations 

• The analysis presented in this surveillance report did not differentiate by injury severity, although some 

codes included in the CDC’s TBI surveillance definition are indicative of a more severe injury. 

• Findings presented do not include patients who sought care in the emergency department or outside

 of the hospital setting (e.g., primary care, urgent care, specialty care) or individuals who did not seek 

care for their TBI. 

• This report does not include TBIs from Veterans Administration (VA), military, or federal hospitals. 

• The mechanism and intent of injury are unknown for a portion of hospitalizations (7.8% in 2016, 8.3% 

in 2017). As a result, estimates of TBI-related hospitalizations by mechanism of injury and injury intent 

are undercounts. 

• This analysis disaggregated TBI estimates into broad categories of mechanism of injury, which 

limits the specificity of conclusions that can be drawn regarding primary causes of TBI-related 

hospitalizations and deaths. 

Conclusions 

• The oldest age group (≥75 years) had the highest numbers and rates of TBI-related hospitalizations 

and deaths during both 2016 and 2017. 

• Unintentional falls were the leading cause of injury for TBI-related hospitalizations during 2016 and 

2017. Annually, half of TBI-related hospitalizations attributed to falls were among the oldest age group 

(≥75 years), which suggests a need to intensify prevention efforts related to falls, particularly among 

older adults. 

• Suicide was the leading cause of TBI-related deaths during 2016 and 2017, accounting for 33.8% and 

34.7%, respectively, of all TBI-related deaths. This mirrors the increase in suicide rates overall in the 

United States,5

 suggesting the need for promotion of programs and practices# with the best available 

evidence for preventing suicide. 

#https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf 5 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

NOTABLE REPORT CHANGES FROM 2014 DATA 

YEAR TO 2016 AND 2017 DATA YEARS 

TRANSITION FROM INTERNATIONAL CLASSIFICATION OF DISEASES, NINTH EDITION, CLINICAL 

MODIFICATION TO TENTH EDITION, CLINICAL MODIFICATION (ICD–9–CM TO ICD–10–CM) 

Beginning October 1, 2015, the Department of Health and Human Services required all hospitals and health 

care providers covered by the Health Insurance Portability and Accountability Act (HIPAA) to use ICD–10– 

CM when reporting medical diagnoses.6

 Although the coding structure of ICD–10–CM is based on ICD–10 

(published by the World Health Organization), the classification scheme was expanded to capture greater 

detail on diagnoses and conditions needed in morbidity data. Notably, injury codes in ICD–10–CM constitute 

about 60% of all codes, compared with about 15% in ICD–9–CM.7

 Overall, ICD–10–CM contains almost five 

times the number of codes found in ICD–9–CM8

 and will potentially provide more detailed information on 

clinical care for billing and public health surveillance. Due to the 2015 data year containing both ICD–9–CM 

and ICD–10–CM, the 2015 data year is not presented in this updated report. 

Early research focused on the effects of the transition from ICD–9–CM to ICD–10–CM reported a notable 

increase in time for medical coding and decreased medical coder productivity, especially for inpatient 

coding.9

 These changes are of great concern, especially for external cause of injury (ECOI) coding. These 

codes are generally not required for health care provider billing and reimbursement, and increased ICD– 

10–CM time demands could discourage coders from entering ECOI codes for injury-related clinical care. 

As medical coders become accustomed to ICD–10–CM coding, ECOI completeness for inpatient coding is 

expected to increase. In Kentucky hospital discharge data, the drop in ECOI completeness lasted only during 

the first month after ICD–10–CM implementation.10 

CDC'S NEW TBI MORBIDITY SURVEILLANCE DEFINITION 

A new surveillance definition for TBI morbidity was necessary due to the transition from ICD–9–CM to ICD– 

10–CM. In 2016, CDC proposed an ICD–10–CM TBI morbidity surveillance definition that included specific 

S and T diagnosis codes based on the General Equivalence Mappings (GEMs) of the diagnosis codes used 

in the ICD–9–CM TBI morbidity surveillance definition.8

 The proposed code set for the TBI morbidity 

surveillance definition was incorporated into CDC’s proposed ICD–10–CM injury diagnosis matrix†

.

8

 State 

health department representatives in four states assessed the positive predictive value (PPV) for ICD–10– 

CM codes 1) intracranial injury (S06) or 2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) without other 

proposed TBI codes in randomly sampled emergency department (ED) and shock trauma records.11 Findings 

of this multisite study revealed the PPV for the intracranial injury codes ranged from 70% to 88% for “high” 

certainty of TBI. This finding meant the records included documentation of 1) head imaging positive for 

TBI; 2) loss of consciousness, or confusion or memory problems after an injury event; or 3) three or more 

signs or symptoms indicative of TBI. Furthermore, the PPV for skull fracture codes ranged from 54% to 

nearly 78% for “high” certainty of TBI among study sites in four states. This early study showed that among 

different settings in these four states, ICD–10–CM codes for intracranial injury and skull fracture displayed 

a high PPV for capturing “high” certainty TBIs in ED billing datasets. 

†

Proposed ICD–10–CM codes included in the TBI morbidity surveillance definition described in “Methods” section. 6 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

Notably, the CDC’s proposed ICD–10–CM TBI morbidity surveillance definition excluded the diagnosis code 

S09.90 (unspecified injury of head),8

 although the previous ICD–9–CM TBI morbidity surveillance definition 

included its complementary ICD–9–CM diagnosis code (959.01).12 During the ICD–9–CM coding era, multiple 

studies reported that the S09.90 codes represented a significant proportion of TBI morbidity records 

identified in their samples.13-15 However, only 25% of cases assigned the diagnosis code ICD–9–CM 959.01 

(unspecified injury to the head) met the clinical definition of TBI in a prospective cohort study.14 Given the 

concerns over the validity of the ICD–9–CM 959.01 (unspecified injury to the head) code, four states and CDC 

reviewed sampled ED medical records containing it’s complementary ICD–10–CM code (S09.90), without 

other proposed TBI codes, for evidence of TBI based on medical documentation.16 Findings of this multisite 

study displayed varying PPV ranging from 36% to 52%, varying by state, for medium or high evidence of TBI, 

while 48% to 64% of records, varying by state, contained low or no evidence of a TBI.16 Overall, this initial 

study indicated that exclusion of the S09.90 code in surveillance estimates may result in many missed TBI 

cases, while inclusion may result in many false positives. Although the multisite study focused on ED medical 

records solely assigned S09.90 (unspecified injury of head), findings of this study informed the decision 

to exclude the S09.90 diagnosis code from the surveillance case definition for TBI-related hospitalizations 

estimated in this report. Overall, this decision was based on the same concerns over the validity of the 

S09.90 code for identifying TBI cases in hospitalization data. 

7 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

Preliminary data analysis of the 2016 HCUP Nationwide Emergency Department Sample (NEDS) data 

revealed that, when ICD–10–CM code S09.90 was included in the analysis, age-adjusted rates of TBI-related 

ED visits were 792 per 100,000 population.§

 Subsequently, when ICD–10–CM code S09.90 was removed 

from the analysis (leaving only the ICD–10–CM codes included in the proposed surveillance definition), 

age-adjusted rates of TBI-related ED visits decreased to 264 per 100,000 population. Due to the large 

proportion of ED medical encounters coded as S09.90 and concerns over the possibility of including many 

false positives, ED visits for the 2016 and 2017 data years are not presented. Additionally, due to differences 

in surveillance definitions for TBI morbidity, numbers and rates of TBI-related hospitalizations in this report 

should not be compared to previous reports. 

CHANGES IN THE IDENTIFICATION AND CLASSIFICATION OF TBI-RELATED HOSPITALIZATIONS 

AND DEATHS^^

For the 2016 and 2017 data, TBIs diagnosed in the hospital were included if the health record listed an ICD– 

10–CM injury diagnosis code in the primary diagnosis field and an ICD–10–CM TBI code in any diagnosis 

field. This represents a change in the inclusion criteria used to estimate 2014 TBI-related hospitalizations, 

as the inclusion criteria for those estimates did not require a primary diagnosis of injury. However, requiring 

these codes is in line with CDC’s and the Council of State and Territorial Epidemiologists’ recommendations 

of restricting analysis of hospitalizations to those with injuries severe enough to be the primary reason 

for hospitalization.17 

In previous versions of this report, falls of undetermined intent requiring hospitalization were included in the 

unintentional falls category.2,12 However, in this report, falls of undetermined intent were not included with 

unintentional falls. ICD–10–CM coding guidance instructs that undetermined intent is to be used only in 

cases where the documentation specifies that the intent cannot be determined. 

Deaths were included as TBI-related if any multiple-cause-of-death codes listed in the death record 

indicated a TBI-related diagnosis and the single underlying cause of death was listed as an injury. This 

methodology represents a change in the calculation of TBI-related deaths from previous CDC reports, 

which did not require that an injury be listed as the underlying cause of death. 

§

Preliminary data analysis utilized HCUPnet (https://hcupnet.ahrq.gov/#setup), a free online query system based on data from HCUP. 

^^Note: Identification and classification of TBI morbidity and mortality are described in the “Methods” section. 8 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

9 

 

 

METHODS 

TBI-related nonfatal hospitalization (i.e., inpatient stays) estimates were obtained from the 2016 and 

2017 HCUP’s NIS files. The NIS produces a stratified sample of approximately 20% of U.S. hospital 

discharges and is sponsored by the Agency for Healthcare Research and Quality. The NIS contains data 

on approximately 7 million unweighted records.3

 Records were included if the primary diagnosis was an 

injury (codes included in the appendix) and if a proposed TBI-related ICD–10–CM code6

 was present in 

any diagnosis field. The following TBI-related ICD–10–CM codes correspond to the preliminary TBI case 

definition developed by NCIPC and National Center for Health Statistics (NCHS)8

: S02.0. S02.1, S02.8, 

S02.91, S04.02, S04.03, S04.04, S06, S07.1, T74.4. For this analysis, the injury mechanism/intent 

categories of interest were motor vehicle traffic crashes, unintentional falls, unintentional struck by or 

against an object, other or unspecified unintentional injury, suicide/intentional self-harm injury, homicide/ 

assault, and other/unknown (codes included in the appendix). The Center for Medicare and Medicaid 

Services (CMS) coding guideline specifies that all transport accident categories assume accidental intent.18 

The injury mechanism/intent categories were based on the first valid external cause of injury because a 

record could potentially have multiple external cause of injury codes (methods and codes included in the 

methodological appendix). 

TBI-related deaths were obtained from the 2016 and 2017 NVSS multiple-cause-of-death files. NVSS is a 

partnership between the NCHS and state/local jurisdictions that results in the compilation of records of 

all deaths in the United States.4

 Deaths were included if they had an injury underlying cause of death (see 

codes in the methodological appendix) and a TBI-related ICD–10 code8

 in one of the multiple-cause-ofdeath fields. The following TBI-related ICD–10 codes correspond to the established TBI death surveillance 

definition:2

 S01, S02.0, S02.1, S02.3, S02.7-S02.9, S04.0, S06, S07.0, S07.1, S07.8, S07.9, S09.7-S09.9, 

T90.1, T90.2, T90.4, T90.5, T90.8, T90.9. The injury mechanism/intent categories for deaths were the 

same as for hospitalizations and were based on the underlying cause of death field (codes included in the 

methodological appendix). 

Rates were calculated using bridged race population estimates obtained from NCHS as the denominator.19 

While deaths are a complete census of all occurrences, confidence intervals were presented to account 

for random variation.20 Hospitalizations were weighted to provide national estimates, and confidence 

intervals were calculated using complex survey procedures in SAS 9.4.21 For estimates, NIS suppression 

rules included no cells with counts <11 and at least two hospitals must contribute to each cell. Numbers, 

estimates, rates, and confidence intervals were presented by age group, by age group and mechanism/ 

intent, and by sex and mechanism/intent. Rates based on <20 counts were suppressed. Age-adjusted 

rates were standardized to the 2000 U.S. population.22 All rates were compared between 2016 and 2017 by 

examining nonoverlapping confidence intervals. T-tests were used to analyze between-group differences 

for rates of TBI-related hospitalizations and deaths. Only selected comparisons were tested for statistical 

significance. A similar approach was used to compare male and female rates. 
RESULTS

Traumatic Brain Injury-related 

Hospitalizations and Deaths by Age 

Group, Sex, and Mechanism of Injury

— United States, 2016 and 2017
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

LIST OF FIGURES§ AND TABLES 

TRAUMATIC BRAIN INJURY (TBI)-RELATED HOSPITALIZATIONS AND DEATHS 

FIGURE 1A 

Estimated number of traumatic brain injury-related hospitalizations and 

deaths by age group — United States, 2016 and 2017 

FIGURE 1B 

Estimated rate of traumatic brain injury-related hospitalizations and deaths 

by age group — United States, 2016 and 2017 

TBI-RELATED HOSPITALIZATIONS 

FIGURE 2A 

Estimated number of traumatic brain injury-related hospitalizations by sex 

and mechanism of injury — United States, 2016 and 2017 

FIGURE 2B 

Estimated age-adjusted rate of traumatic brain injury-related hospitalizations 

by sex and mechanism of injury — United States, 2016 and 2017 

TABLE 1 

Estimated number and rate of traumatic brain injury-related hospitalizations 

by age group and mechanism of injury — United States, 2016 and 2017 

TBI-RELATED DEATHS 

FIGURE 3A 

Number of traumatic brain injury-related deaths by sex and mechanism of 

injury — United States, 2016 and 2017 

FIGURE 3B 

Age-adjusted rate of traumatic brain injury-related deaths by sex and 

mechanism of injury — United States, 2016 and 2017 

TABLE 2 

Number and rate of traumatic brain injury-related deaths by age group and 

mechanism of injury — United States, 2016 and 2017 

§

Note: All data presented in the figures are presented in tabular form in the Appendix. 11 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 1A1 

Estimated number of traumatic brain injury-related (TBI) hospitalizations†

and deaths by age group — United States, 2016 and 2017 

Key Findings 

• Approximately 227,000 TBI-related hospitalizations occurred in 2016, and the count decreased 

to almost 224,000 in 2017. 

• Adults aged ≥75 years accounted for the highest proportion of all TBI-related hospitalizations 

in both 2016 and 2017 (28.5%, N= 64,610 and 30.3%, N= 67,875, respectively) among all the 

age groups analyzed. 

• Individuals aged 65-74 years had the second highest number of TBI-related hospitalizations 

in 2016 (N= 29,990) and 2017 (N= 30,430). 

• Approximately 59,000 TBI-related deaths occurred in 2016, while counts of this health event 

increased to over 61,000 in 2017. 

• Adults aged ≥75 years accounted for the highest proportion of all TBI-related deaths in both 

2016 and 2017 (26.1%, N= 15,561 and 26.6%, N= 16,284, respectively) among all the age 

groups analyzed. 

SOURCES: For hospitalizations, Healthcare Cost and Utilization Project’s National Inpatient Sample; for deaths, CDC’s 

National Vital Statistics System. 

1

Estimated counts of TBI-related hospitalizations presented in tabular form in Supplemental Table 1. 

†

In-hospital deaths and patients who transferred from another hospital were excluded. 12 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 1B1 

Estimated rate* of traumatic brain injury-related (TBI) hospitalizations†

and deaths by age group — United States, 2016 and 2017 

Key Findings 

• Rates of TBI-related hospitalizations per 100,000 population were highest among adults 

aged ≥75 years (313.4 in 2016 and 320.8 in 2017), those aged 65-74 years (104.8 in 2016 

and 102.7 in 2017), and individuals aged 55-64 years (67.7 in 2016 and 67.5 2017). 

• Similarly, rates of TBI-related deaths per 100,000 population were highest among adults 

aged ≥75 years (75.5 in 2016 and 77.0 in 2017), those aged 65-74 years (24.2 in 2016 

and 24.3 in 2017), and individuals aged 55-64 years (19.1 in 2016 and 19.5 in 2017). 

SOURCES: For hospitalizations, Healthcare Cost and Utilization Project’s National Inpatient Sample; for deaths, CDC’s 

National Vital Statistics System. 

1

Estimated rates of TBI-related hospitalizations are presented in tabular form in Supplemental Table 1. 

*

Per 100,000 population. 

†

In-hospital deaths and patients who transferred from another hospital were excluded. 13 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 2A1 

Estimated number of traumatic brain injury-related (TBI) hospitalizations† 

by sex and mechanism of injury — United States, 2016 and 2017 

 

Key Findings 

In 2016, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related hospitalization, males had higher counts when compared with 

females. Males had higher counts of: 

• unintentional falls (58,290 versus 50,035); 

• motor vehicle crashes (37,705 versus 19,065); 

• unintentionally being struck by or against an object (3,990 versus 2,190); 

• intentional self-harm (955 versus 380); and 

• assault (12,900 versus 2,700). 

SOURCE: Healthcare Cost and Utilization Project’s National Inpatient Sample 

1

Estimated counts of TBI-related hospitalizations are presented in tabular form in Supplemental Table 2. 

†

In-hospital deaths and patients who transferred from another hospital were excluded. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. 

¶

Includes undetermined intent, legal intervention, war, intentional self-harm for age <10 years, and cases without information 

about cause of injury. 14 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 2A1 (cont’d) 

Estimated number of traumatic brain injury-related (TBI) hospitalizations† 

by sex and mechanism of injury — United States, 2016 and 2017 

Key Findings (cont’d) 

In 2017, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related hospitalization, males had higher counts when compared with 

females. Males had higher counts of: 

• unintentional falls (58,640 versus 51,125); 

• motor vehicle crashes (36,665 versus 18,050); 

• unintentionally being struck by or against an object (3,675 versus 1,660); 

• intentional self-harm (1,040 versus 420); and 

• assault (11,965 versus 2,625). 

In 2016 and 2017, unintentional falls were the leading mechanism of injury contributing to a 

TBI-related hospitalization among both men and women. 

15 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 2B1 

Estimated age-adjusted rate†† of traumatic brain injury-related (TBI) hospitalizations†

by sex and mechanism of injury — United States, 2016 and 2017 

 

 

Key Findings 

In 2016, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related hospitalization, males had significantly higher age-adjusted rates 

compared with females (t-tests p-value <0.05). Males had higher age-adjusted rates of: 

• unintentional falls (36.2 versus 24.0, per 100,000 population); 

• motor vehicle crashes (23.3 versus 11.4; twofold higher); 

• unintentionally being struck by or against an object (2.5 versus 1.2; twofold higher), 

• intentional self-harm (0.7 versus 0.3; twofold higher), and 

• assault (8.1 versus 1.7; more than fourfold higher). 

SOURCE: Healthcare Cost and Utilization Project’s National Inpatient Sample 

1

Estimated rates of TBI-related hospitalizations are presented in tabular form in Supplemental Table 2. 

††Hospitalizations with missing age were excluded. Rates age-adjusted to the NCHS 2000 U.S. standard population. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. Rates for TBI-related hospitalizations 

due to intentional self-harm were age-adjusted to the population 10 years and older. 

¶

Includes undetermined intent, legal intervention, war, intentional self-harm for age <10 years, and cases without information about 

cause of injury. 16 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 2B1 (cont’d) 

Estimated age-adjusted rate†† of traumatic brain injury-related (TBI) hospitalizations† 

by sex and mechanism of injury — United States, 2016 and 2017 

Key Findings (cont’d) 

In 2017 among the major unintentional and intentional principal mechanism categories examined that 

contributed to a TBI-related hospitalization, males had significantly (t-tests p-value <0.05) 

higher age-adjusted rates compared with females. Males had higher age-adjusted rates of: 

• unintentional falls (35.6 versus 23.9, per 100,000 population); 

• motor vehicle crashes (22.5 versus 10.8; more than twofold higher); 

• unintentionally being struck by or against an object (2.3 versus 0.9; more than twofold higher); 

• intentional self-harm (0.8 versus 0.3; twofold higher); and 

• assault (7.5 versus 1.7; more than fourfold higher). 

17 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

TABLE 1 – Estimated number and rate* of traumatic brain injury-related (TBI) hospitalizations† by age group and mechanism of injury — United States, 2016 and 2017 

AGE 

GROUP 

(YRS) 

Motor vehicle 

traffic crashes Unintentional falls‡

Unintentionally struck 

by or against an object 

Other or unspecified 

unintentional injury Intentional self-harm§ Assault Other¶

YEAR NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) 

0-17 2016 5,485 7.4 (6.5 - 8.4) 6,085 8.3 (7.0 - 9.5) 1,350 1.8 (1.5 - 2.2) 3,120 4.2 (3.6 - 4.8) § § 1,515 2.1 (1.7 - 2.4) 1,895 2.6 (1.8 - 3.4) 

2017 5,015 6.8 (5.9 - 7.7) 5,680 7.7 (6.5 - 8.9) 1,005 1.4 (1.1 - 1.6) 2,880 3.9 (3.3 - 4.5) § § 1,545 2.1 (1.7 - 2.5) 1,405 1.9 (1.3 - 2.5) 

0-4 

2016 840 4.2 (3.3 - 5.2) 3,525 17.7 (14.7 - 20.7) 390 2.0 (1.5 - 2.5) 835 4.2 (3.3 - 5.1) § § 1,070 5.4 (4.1 - 6.6) 735 3.7 (2.3 - 5.0) 

2017 740 3.7 (2.9 - 4.5) 3,330 16.7 (13.7 - 19.8) 345 1.7 (1.2 - 2.3) 585 2.9 (2.3 - 3.6) § § 1,025 5.2 (3.8 - 6.5) 475 2.4 (1.5 - 3.3) 

5-9 

2016 910 4.5 (3.5 - 5.4) 985 4.8 (3.8 - 5.9) 275 1.3 (0.9 - 1.8) 405 2.0 (1.5 - 2.5) § § 30 0.1 (0.0 - 0.3) 340 1.7 (0.9 - 2.4) 

2017 945 4.7 (3.7 - 5.6) 985 4.9 (3.9 - 5.8) 215 1.1 (0.7 - 1.4) 440 2.2 (1.6 - 2.7) § § 50 0.2 (0.1 - 0.4) 230 1.1 (0.6 - 1.7) 

10-14 

2016 1,245 6.0 (5.0 - 7.1) 880 4.3 (3.4 - 5.2) 375 1.8 (1.3 - 2.3) 770 3.7 (2.9 - 4.6) 20 0.1 (0.0 - 0.2) 85 0.4 (0.2 - 0.6) 450 2.2 (1.4 - 3.0) 

2017 1,210 5.8 (4.8 - 6.9) 715 3.4 (2.7 - 4.2) 200 1.0 (0.7 - 1.3)& 895 4.3 (3.4 - 5.2) 35 0.2 (0.0 - 0.3) 110 0.5 (0.3 - 0.8) 295 1.4 (0.9 - 1.9) 

15-24 

2016 12,695 29.2 (26.4 - 32.0) 2,860 6.6 (5.9 - 7.3) 750 1.7 (1.4 - 2.0) 3,805 8.7 (7.8 - 9.7) 305 0.7 (0.5 - 0.9) 2,290 5.3 (4.6 - 5.9) 1,610 3.7 (2.8 - 4.6) 

2017 11,290 26.2 (23.7 - 28.6) 2,715 6.3 (5.6 - 7.0) 610 1.4 (1.2 - 1.7) 3,255 7.5 (6.7 - 8.3) 320 0.7 (0.5 - 0.9) 2,200 5.1 (4.4 - 5.8) 1,625 3.8 (2.9 - 4.6) 

25-34 

2016 10,965 24.5 (22.0 - 27.0) 3,315 7.4 (6.7 - 8.1) 470 1.1 (0.8 - 1.3) 3,175 7.1 (6.4 - 7.8) 315 0.7 (0.5 - 0.9) 3,800 8.5 (7.5 - 9.5) 1,670 3.7 (2.8 - 4.7) 

2017 10,220 22.6 (20.4 - 24.7) 3,170 7.0 (6.3 - 7.7) 490 1.1 (0.9 - 1.3) 2,790 6.2 (5.5 - 6.8) 330 0.7 (0.5 - 0.9) 3,295 7.3 (6.4 - 8.1) 1,660 3.7 (2.8 - 4.6) 

35-44 

2016 7,140 17.6 (15.9 - 19.4) 4,090 10.1 (9.2 - 11.0) 445 1.1 (0.9 - 1.3) 2,345 5.8 (5.1 - 6.5) 190 0.5 (0.3 - 0.6) 2,815 7.0 (6.1 - 7.8) 1,420 3.5 (2.8 - 4.2) 

2017 7,185 17.6 (15.8 - 19.4) 3,475 8.5 (7.7 - 9.4) 385 0.9 (0.7 - 1.2) 2,265 5.6 (4.9 - 6.2) 225 0.6 (0.4 - 0.7) 2,540 6.2 (5.5 - 7.0) 1,610 3.9 (3.2 - 4.7) 

45-54 

2016 7,775 18.2 (16.3 - 20.1) 7,650 17.9 (16.6 - 19.2) 560 1.3 (1.1 - 1.6) 2,865 6.7 (6.0 - 7.4) 245 0.6 (0.4 - 0.7) 2,695 6.3 (5.6 - 7.1) 1,965 4.6 (3.6 - 5.6) 

2017 7,525 17.8 (16.1 - 19.5) 6,910 16.3 (15.1 - 17.6) 545 1.3 (1.0 - 1.6) 2,750 6.5 (5.8 - 7.2) 260 0.6 (0.4 - 0.8) 2,665 6.3 (5.6 - 7.0) 1,985 4.7 (3.8 - 5.6) 

55-64 

2016 7,255 17.5 (15.8 - 19.2) 13,080 31.6 (29.5 - 33.6) 630 1.5 (1.2 - 1.8) 2,865 6.9 (6.2 - 7.7) 160 0.4 (0.2 - 0.5) 1,865 4.5 (3.9 - 5.1) 2,190 5.3 (4.3 - 6.3) 

2017 6,915 16.5 (15.0 - 18.1) 13,600 32.5 (30.5 - 34.4) 610 1.5 (1.2 - 1.7) 2,575 6.1 (5.5 - 6.8) 185 0.4 (0.3 - 0.6) 1,820 4.3 (3.8 - 4.9) 2,585 6.2 (5.1 - 7.2) 

65-74 

2016 4,615 16.1 (14.5 - 17.7) 19,225 67.2 (63.4 - 70.9) 855 3.0 (2.5 - 3.5) 1,945 6.8 (6.0 - 7.6) 55 0.2 (0.1 - 0.3) 675 2.4 (1.9 - 2.8) 2,620 9.2 (7.7 - 10.7) 

2017 4,965 16.8 (15.2 - 18.3) 19,670 66.4 (62.7 - 70.1) 745 2.5 (2.1 - 3.0) 1,720 5.8 (5.1 - 6.5) 60 0.2 (0.1 - 0.3) 630 2.1 (1.7 - 2.5) 2,640 8.9 (7.5 - 10.3) 

75+ 

2016 3,340 16.2 (14.4 - 18.0) 52,750 255.9 (243.3 - 268.4) 1,430 6.9 (6.0 - 7.8) 1,565 7.6 (6.6 - 8.6) 45 0.2 (0.1 - 0.4) 265 1.3 (0.9 - 1.6) 5,215 25.3 (21.8 - 28.8) 

2017 3,730 17.6 (15.7 - 19.5) 55,200 260.9 (248.3 - 273.4) 1,190 5.6 (4.9 - 6.4) 1,475 7.0 (6.1 - 7.9) 45 0.2 (0.1 - 0.4) 255 1.2 (0.9 - 1.5) 5,980 28.3 (24.1 - 32.5) 

Total††

2016 56,780 17.6 (16.1 - 19.1) 108,365 33.5 (32.0 - 35.1) 6,180 1.9 (1.8 - 2.1) 20,575 6.4 (5.9 - 6.8) 1,335 0.5 (0.4 - 0.5) 15,600 4.8 (4.4 - 5.3) 18,220 5.6 (4.8 - 6.5) 

2017 54,725 16.8 (15.5 - 18.2) 109,775 33.8 (32.2 - 35.3) 5,335 1.6 (1.5 - 1.8)& 18,750 5.8 (5.4 - 6.2) 1,460 0.5 (0.4 - 0.6) 14,590 4.5 (4.1 - 4.9) 19,085 5.9 (5.0 - 6.7) 

Adjusted††

2016 56,780 17.3 (16.7 - 17.9) 108,360 29.8 (29.1 - 30.5) 6,180 1.8 (1.7 - 2.0) 20,575 6.2 (6.0 - 6.5) 1,335 0.5 (0.4 - 0.5) 15,590 4.9 (4.6 - 5.1) 18,215 5.3 (4.9 - 5.6) 

2017 54,725 16.6 (16.0 - 17.1) 109,770 29.4 (28.7 - 30.1) 5,335 1.6 (1.5 - 1.7)& 18,750 5.7 (5.4 - 5.9)& 1,460 0.5 (0.5 - 0.6) 14,590 4.5 (4.3 - 4.8) 19,085 5.4 (5.1 - 5.8) 

18 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

 TABLE 1 (cont’d) – Estimated number and rate*

 of traumatic brain injury-related (TBI) deaths by age group and mechanism of injury — United States, 2016 and 2017 

Key Findings 

• Children ages 0-17 years accounted for approximately 8.6% of all 

TBI-related hospitalizations in 2016 and 7.8% in 2017. 

• In 2016 and 2017, unintentional falls accounted for the highest ageadjusted rate (29.8 and 29.4 per 100,000 population, respectively) 

and proportion (47.7%; N=108,360 and 49.1% (weighted estimate); 

n=109,770, respectively) of all TBI-related hospitalizations in the 

United States. During both 2016 and 2017, rates for TBI-related 

hospitalizations attributable to unintentional falls were highest 

among adults aged ≥75 years (255.9 and 260.9, respectively), 

65-74 years (67.2 and 66.4, respectively), and 55-64 years (31.6 

and 32.5, respectively). 

• Motor vehicle crashes were the second leading cause of TBI-related 

hospitalizations, with an age-adjusted rate of 17.3 in 2016 and 16.6 

in 2017 and accounted for approximately 25% of all TBI-related 

hospitalizations in both data years. Age groups with the highest rate 

of motor vehicle crashes leading to a TBI-related hospitalization were 

15-24 years (29.2 in 2016 and 26.2 in 2017) and 25-34 years (24.5 in 

2016 and 22.6 in 2017). 

• The most common principal mechanisms of injury for TBI-related 

hospitalizations among children aged 0-17 (analyzed separately) 

were unintentional falls (rates of 8.3 in 2016 and 7.7 in 2017) and 

motor vehicle crashes (7.4 in 2016 and 6.8 in 2017). 

• The age-adjusted rate of TBI-related hospitalization for each 

mechanism of injury remained steady between 2016 and 2017, 

except unintentionally struck by or against an object and other or 

unspecified unintentional injury which decreased significantly by 

11% and 8%, respectively, from one year to the next. 

SOURCE: Healthcare Cost and Utilization Project’s National Inpatient Sample 

Abbreviations: CI = confidence interval. 

*Per 100,000 population 

†

In-hospital deaths and patients who transferred from another hospital were excluded. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. Rates for TBI-related hospitalizations due to intentional self-harm were age-adjusted 

to the population 10 years and older. 

¶

Includes undetermined intent, legal intervention, war, intentional self-harm for age <10 years, and cases without information about cause of injury. 

&Rate significantly different compared to 2016, t-tests p-value <0.05. 

††Hospitalizations with missing age were included. 

‡‡Hospitalizations with missing age were excluded. Rates age-adjusted to the NCHS 2000 U.S. standard population. 19 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 3A5 

Number of traumatic brain injury-related (TBI) deaths by sex and 

mechanism of injury — United States, 2016 and 2017 

 

 

Key Findings 

In 2016, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related death, males had higher counts when compared with females. 

Males had higher counts of: 

• unintentional falls (9,601 versus 7,095); 

• motor vehicle crashes (8,357 versus 3,184); 

• unintentionally being struck by or against an object (298 versus 38); 

• suicide (17,382 versus 2,757); and 

• homicide (4,280 versus 1,586). 

SOURCE: CDC’s National Vital Statistics System 

5

Counts of TBI-related deaths are presented in tabular form in Supplemental Table 3. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. 

¶

Includes undetermined intent, legal intervention, war, and intentional self-harm for age <10 years. 20 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 3A5 (cont’d) 

Number of traumatic brain injury-related (TBI) deaths by sex and 

mechanism of injury — United States, 2016 and 2017 

Key Findings (cont’d) 

In 2017, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related death, males had higher counts when compared with females. 

Males had higher counts of: 

• unintentional falls (10,180 versus 7,228); 

• motor vehicle crashes (8,036 versus 3,062); 

• unintentionally being struck by or against an object (291 versus 55); 

• suicide (18,436 versus 2,789); and 

• homicide (4,316 versus 1,665). 

In 2016 and 2017, suicide was the leading mechanism of injury contributing to a TBI-related death 

among males; during the same time period unintentional falls were the leading cause of TBI-related 

death among females. 

21 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 3B6 

Age-adjusted rate†† of traumatic brain injury-related (TBI) deaths 

by sex and mechanism of injury — United States, 2016 and 2017 

 

 

Key Findings 

In 2016, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related death, males had significantly (t-tests p-value <0.05) higher 

age-adjusted rates compared with females. Males had higher age-adjusted rates of: 

• unintentional falls (6.1 versus 3.2, per 100,000 population); 

• motor vehicle crashes (5.2 versus 1.9; more than twofold higher); 

• suicide (12.3 versus 1.9; more than sixfold higher); and 

• homicide (2.7 versus 1.0; more than twofold higher). 

SOURCE: CDC’s National Vital Statistics System

 6Rates of TBI-related deaths are presented in tabular form in Supplemental Table 3. 

††Deaths with missing age were excluded. Rates age-adjusted to the NCHS 2000 U.S. standard population. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. Rates for deaths due to suicide 

were age-adjusted to the population 10 years and older. 

¶

Includes undetermined intent, legal intervention, war, and intentional self-harm for age <10 years. 22 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

FIGURE 3B6 (cont’d) 

Age-adjusted rate†† of traumatic brain injury-related (TBI) deaths 

by sex and mechanism of injury — United States, 2016 and 2017 

Key Findings (cont’d) 

In 2017, among the major unintentional and intentional principal mechanism categories examined 

that contributed to a TBI-related death, males had significantly (t-tests p-value <0.05) higher 

age-adjusted rates compared with females. Males had higher age-adjusted rates of: 

• unintentional falls (6.3 versus 3.2 per 100,000 population); 

• motor vehicle crashes (4.9 versus 1.8; more than twofold higher); 

• suicide (13.0 versus 1.9; more than sixfold higher); and 

• homicide (2.7 versus 1.0; more than twofold higher). 

Suicide accounted for the highest age-adjusted rate (12.3 in 2016 and 13.0 in 2017) of TBI-related 

deaths among men. 

Among women, unintentional falls accounted for the highest age-adjusted rate (3.2 in both years) 

of TBI-related deaths. 

23 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

TABLE 2 – Number and rate* of traumatic brain injury-related (TBI) deaths by age group and mechanism of injury — United States, 2016 and 2017 

AGE 

GROUP 

(YRS) 

Motor vehicle 

traffic crashes Unintentional falls‡

Unintentionally struck 

by or against an object 

Other or unspecified 

unintentional injury Suicide§ Homicide Other¶

YEAR NO. RATE (95% CI)¤ NO. RATE (95% CI)¤ NO. RATE (95% CI)¤ NO. RATE (95% CI)¤ NO. RATE (95% CI)¤ NO. RATE (95% CI)¤ NO. RATE (95% CI)¤

0-17 2016 981 1.3 (1.2 - 1.4) 46 0.1 (0.0 - 0.1) 36 0.0 (0.0 - 0.1) 324 0.4 (0.4 - 0.5) § § 638 0.9 (0.8 - 0.9) 57 0.1 (0.1 - 0.1) 

2017 940 1.3 (1.2 - 1.4) 54 0.1 (0.1 - 0.1) 36 0.0 (0.0 - 0.1) 308 0.4 (0.4 - 0.5) § § 665 0.9 (0.8 - 1.0) 92 0.1 (0.1 - 0.2) 

0-4 

2016 213 1.1 (0.9 - 1.2) 17 †† 18 †† 129 0.6 (0.5 - 0.8) § § 303 1.5 (1.3 - 1.7) 28 0.1 (0.1 - 0.2) 

2017 231 1.2 (1.0 - 1.3) 19 †† 17 †† 126 0.6 (0.5 - 0.7) § § 312 1.6 (1.4 - 1.7) 45 0.2 (0.2 - 0.3) 

5-9 

2016 179 0.9 (0.7 - 1.0) †† †† 13 †† 51 0.2 (0.2 - 0.3) § § 56 0.3 (0.2 - 0.4) †† ††

2017 134 0.7 (0.5 - 0.8) †† †† †† †† 46 0.2 (0.2 - 0.3) § § 69 0.3 (0.3 - 0.4) †† ††

10-14 

2016 183 0.9 (0.8 - 1.0) 11 †† †† †† 80 0.4 (0.3 - 0.5) 157 0.8 (0.6 - 0.9) 67 0.3 (0.3 - 0.4) †† ††

2017 181 0.9 (0.7 - 1.0) 11 †† †† †† 70 0.3 (0.3 - 0.4) 178 0.9 (0.7 - 1.0) 64 0.3 (0.2 - 0.4) †† ††

15-24 

2016 2,449 5.6 (5.4 - 5.9) 96 0.2 (0.2 - 0.3) 20 0.0 (0.0 - 0.1) 312 0.7 (0.6 - 0.8) 2,542 5.8 (5.6 - 6.1) 1,405 3.2 (3.1 - 3.4) 95 0.2 (0.2 - 0.3) 

2017 2,266 5.2 (5.0 - 5.5) 109 0.3 (0.2 - 0.3) 18 †† 292 0.7 (0.6 - 0.8) 2,846 6.6 (6.4 - 6.8)& 1,379 3.2 (3.0 - 3.4) 120 0.3 (0.2 - 0.3) 

25-34 

2016 2,260 5.1 (4.8 - 5.3) 191 0.4 (0.4 - 0.5) 40 0.1 (0.1 - 0.1) 335 0.7 (0.7 - 0.8) 3,125 7.0 (6.7 - 7.2) 1,401 3.1 (3.0 - 3.3) 143 0.3 (0.3 - 0.4) 

2017 2,091 4.6 (4.4 - 4.8)& 201 0.4 (0.4 - 0.5) 34 0.1 (0.1 - 0.1) 362 0.8 (0.7 - 0.9) 3,264 7.2 (7.0 - 7.5) 1,474 3.3 (3.1 - 3.4) 131 0.3 (0.2 - 0.3)&

35-44 

2016 1,519 3.8 (3.6 - 3.9) 327 0.8 (0.7 - 0.9) 40 0.1 (0.1 - 0.1) 366 0.9 (0.8 - 1.0) 2,795 6.9 (6.6 - 7.2) 974 2.4 (2.3 - 2.6) 125 0.3 (0.3 - 0.4) 

2017 1,501 3.7 (3.5 - 3.9) 318 0.8 (0.7 - 0.9) 37 0.1 (0.1 - 0.1) 395 1.0 (0.9 - 1.1) 2,854 7.0 (6.7 - 7.3) 913 2.2 (2.1 - 2.4) 130 0.3 (0.3 - 0.4) 

45-54 

2016 1,562 3.7 (3.5 - 3.8) 798 1.9 (1.7 - 2.0) 49 0.1 (0.1 - 0.2) 539 1.3 (1.2 - 1.4) 3,281 7.7 (7.4 - 7.9) 697 1.6 (1.5 - 1.8) 146 0.3 (0.3 - 0.4) 

2017 1,483 3.5 (3.3 - 3.7) 819 1.9 (1.8 - 2.1) 47 0.1 (0.1 - 0.1) 539 1.3 (1.2 - 1.4) 3,424 8.1 (7.8 - 8.4) 735 1.7 (1.6 - 1.9) 148 0.4 (0.3 - 0.4) 

55-64 

2016 1,419 3.4 (3.2 - 3.6) 1,690 4.1 (3.9 - 4.3) 56 0.1 (0.1 - 0.2) 666 1.6 (1.5 - 1.7) 3,402 8.2 (7.9 - 8.5) 541 1.3 (1.2 - 1.4) 130 0.3 (0.3 - 0.4) 

2017 1,434 3.4 (3.2 - 3.6) 1,712 4.1 (3.9 - 4.3) 71 0.2 (0.1 - 0.2) 685 1.6 (1.5 - 1.8) 3,536 8.4 (8.2 - 8.7) 588 1.4 (1.3 - 1.5) 149 0.4 (0.3 - 0.4) 

65-74 

2016 928 3.2 (3.0 - 3.5) 2,602 9.1 (8.7 - 9.4) 48 0.2 (0.1 - 0.2) 563 2.0 (1.8 - 2.1) 2,468 8.6 (8.3 - 9.0) 234 0.8 (0.7 - 0.9) 68 0.2 (0.2 - 0.3) 

2017 892 3.0 (2.8 - 3.2) 2,758 9.3 (9.0 - 9.7) 54 0.2 (0.1 - 0.2) 581 2.0 (1.8 - 2.1) 2,582 8.7 (8.4 - 9.0) 267 0.9 (0.8 - 1.0) 67 0.2 (0.2 - 0.3) 

75+ 

2016 829 4.0 (3.7 - 4.3) 10,959 53.2 (52.2 - 54.2) 49 0.2 (0.2 - 0.3) 1,105 5.4 (5.0 - 5.7) 2,367 11.5 (11.0 - 11.9) 187 0.9 (0.8 - 1.0) 65 0.3 (0.2 - 0.4) 

2017 885 4.2 (3.9 - 4.5) 11,452 54.1 (53.1 - 55.1) 53 0.3 (0.2 - 0.3) 1,078 5.1 (4.8 - 5.4) 2,541 12.0 (11.5 - 12.5) 179 0.8 (0.7 - 1.0) 96 0.5 (0.4 - 0.6)&

Total††

2016 11,541 3.6 (3.5 - 3.6) 16,696 5.2 (5.1 - 5.2) 336 0.1 (0.1 - 0.1) 4,146 1.3 (1.2 - 1.3) 20,139 7.1 (7.0 - 7.2) 5,866 1.8 (1.8 - 1.9) 816 0.3 (0.2 - 0.3) 

2017 11,098 3.4 (3.3 - 3.5)& 17,408 5.4 (5.3 - 5.4)& 346 0.1 (0.1 - 0.1) 4,175 1.3 (1.2 - 1.3) 21,225 7.4 (7.3 - 7.5)& 5,981 1.8 (1.8 - 1.9) 901 0.3 (0.3 - 0.3) 

Adjusted§§ 

2016 11,541 3.5 (3.5 - 3.6) 16,694 4.4 (4.4 - 4.5) 336 0.1 (0.1 - 0.1) 4,146 1.2 (1.2 - 1.2) 20,137 6.9 (6.8 - 7.0) 5,865 1.8 (1.8 - 1.9) 815 0.2 (0.2 - 0.3) 

2017 11,098 3.4 (3.3 - 3.4)& 17,408 4.5 (4.5 - 4.6)& 346 0.1 (0.1 - 0.1) 4,174 1.2 (1.1 - 1.2) 21,225 7.2 (7.1 - 7.3)& 5,980 1.9 (1.8 - 1.9) 900 0.3 (0.3 - 0.3)&

24 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

TABLE 2 (cont'd) – Number and rate* of traumatic brain injury-related (TBI) deaths by age group and mechanism of injury — United States, 2016 and 2017 

Key Findings: 

• Children ages 0-17 years accounted for approximately 4.5% of all 

TBI-related deaths in both years. 

• Suicide accounted for the highest age-adjusted rate (6.9 [2016] 

and 7.2 [2017] per 100,000 population) and proportion (33.8% 

[2016] and 34.7% [2017]) of all TBI-related deaths in the 

United States. 

• Rates of TBI-related deaths attributable to suicide were highest 

among those aged ≥75 years (11.5 in 2016 and 12.0 in 2017). 

• Unintentional falls were the second leading cause of TBI-related 

deaths, with an age-adjusted rate of 4.4 in 2016 and 4.5 in 2017 

and accounted for approximately 28% of all TBI-related deaths in 

both years. 

• Adults aged ≥75 years had the highest rate of TBI-related deaths 

caused by unintentional falls, with rates of 53.2 in 2016 and 54.1 

in 2017. 

• Motor vehicle crashes were the third most common cause of TBIrelated deaths in both years, with age-adjusted rates of 3.5 and 

3.4 and contributing to 11,541 and 11,098 deaths in 2016 and 

2017, respectively. 

• Rates of TBI-related deaths attributable to motor vehicle crashes 

were highest among those aged 15-24 years (5.6 in 2016) and (5.2 

in 2017). In 2016, the second highest rate was found among those 

25-34 years (5.1), and in 2017, among those aged 25-34 (4.6) and 

adults aged ≥75 years (4.2). 

• From 2016 to 2017, the rate of TBI-related deaths increased 

significantly by 13.8% and 4.3%, respectively, for suicide among 

those aged 15-24 years and overall. The adjusted rate also 

increased significantly for unintentional falls and other mechanism 

of injury category. The rate decreased significantly by 9.8% and 

2.9%, respectively, for motor vehicle crashes among those aged 

25-34 years and overall from 2016 to 2017. 

• The top principal mechanism of injury leading to TBI-related death 

among young children and adolescents aged 0-17 years was motor 

vehicle crashes (1.3) in both 2016 and 2017. 

SOURCE: CDC’s National Vital Statistics System 

Abbreviations: CI = confidence interval. 

*

Per 100,000 population. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. Rates for deaths due to suicide were age-adjusted to the population 10 years and older. 

¶

Includes undetermined intent, legal intervention, war, and intentional self-harm for age <10 years. 

&Rate significantly different compared to 2016, t-tests p-value <0.05. 

‡‡Deaths with missing age were included. 

§§Deaths with missing age were excluded. Rates age-adjusted to the NCHS 2000 U.S. standard population. 25 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

The findings in this report are subject to the following limitations: 

• The analysis presented in this surveillance report did not differentiate by injury severity, although 

some codes included in the CDC’s TBI surveillance definition are indicative of a more severe injury. 

• Findings presented do not include patients who sought care in the emergency department or outside 

of the hospital setting (e.g., primary care, urgent care, specialty care) or individuals who did not seek 

care for their TBI. 

• This report does not include TBIs from Veterans Administration (VA), military, or federal hospitals. 

• The mechanism and intent of injury are unknown for a portion of hospitalizations (7.8% in 2016, 8.3%

 in 2017). As a result, estimates of TBI-related hospitalizations by mechanism of injury and injury intent 

are undercounts. 

• This analysis disaggregated TBI estimates into broad categories of mechanism of injury, which 

limits the specificity of conclusions that can be drawn regarding primary causes of TBI-related 

hospitalizations and deaths. 

Conclusions 

• The oldest age group (≥75 years) had the highest numbers and rates of TBI-related hospitalizations 

and deaths during both 2016 and 2017. 

• Unintentional falls were the leading cause of injury for TBI-related hospitalizations during 2016 and 

2017. Annually, half of TBI-related hospitalizations attributed to falls were among the oldest age group 

(≥75 years), which suggests a need to intensify prevention efforts related to falls, particularly among 

older adults. 

• Suicide was the leading cause of TBI-related deaths during 2016 and 2017, accounting for 33.8% and 

34.7%, respectively, of all TBI-related deaths. This mirrors the increase in suicide rates overall in the 

United States,5

 suggesting the need for promotion of programs and practices# with the best available 

evidence for preventing suicide. 

#https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf 26 
APPENDIX
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

 

METHODOLOGICAL APPENDIX 

Hospitalizations 

To minimize double-counting, in-hospital deaths and transfers from another hospital were excluded. An 

injury subset was then created by searching the primary diagnosis field for one of the following codes: 

S00-S99; T07-T34; T36-T50 with a 6th character of 1, 2, 3, or 4; T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, 

T45.9, T47.9, or T49.9 with a 5th character of 1, 2, 3, or 4; T51-T76; T79; O9A.2-O9A.5; T84.04; or M97. 

The codes must have a 7th character of A, B, C, or missing, which reflects initial encounter, active treatment. 

Once the injury subset was created, TBI-related hospitalizations were identified if a record had one of the 

following codes in any diagnosis field. 

CODE(S)* DESCRIPTION 

S02.0, S02.1 Fracture of skull 

S02.8, S02.91 Fracture of other specified skull and facial bones; unspecified fracture 

S04.02, S04.03, 

S04.04 

Injury of optic chiasm; injury of optic tract and pathways; injuries of visual 

cortex 

S06 Intracranial injury 

S07.1 Crushing injury of skull 

T74.4 Shaken infant syndrome 

*

Only include case if the 7th character is “A” or “B” for S02.0, S02.1, S02.8, S02.91 or “A” for S04.02, S04.03, S04.04, S06, S07.1, 

and T74.4, which indicates initial encounter. Cases with a 7th character of “missing” will also be included. 

For classifying hospitalizations by cause, each case was assigned a single cause based on the first valid 

external cause of injury. Because there are multiple fields in which codes with external cause information 

can be found and potentially multiple external cause codes for each case, fields were searched in a specific 

order for external cause information (see table below for specific order). Additionally, separate external 

cause of injury fields were eliminated in the 2017 data, so the search strategy was different for each year. 

With the ICD–10–CM coding scheme, external cause of injury information can be found in both diagnosis 

codes (T codes) and external cause of injury codes (V-Y codes). The potential codes can be found in the 

table below. 

CODE(S)* DESCRIPTION 

V00-V99 Transport accidents 

W00-X58 Other external causes of accidental injury 

X71-X83 Intentional self-harm 

X92-Y09 Assault 

Y21-Y33 Event of undetermined intent 

Y35-Y38 Legal intervention, operations of war, military operations and terrorism 

T14.91 Suicide attempt 

T15-T19 Effects of foreign body entering through natural orifice 

28 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

CODE(S)* DESCRIPTION 

T36-T50 with a 6th 

character of 1, 2, 3, or 4 

Note: Include T36.9, 

T37.9, T39.9, T41.4, 

T42.7, T43.9, T45.9, 

T47.9, and T49.9 with 

a 5th character of 1, 2, 

3, or 4 (Intent information for these codes is 

included in the 5th character and not the 6th) 

Poisoning by drugs, medicaments, and biological substances 

T51-T65 Toxic effects of substances chiefly non-medicinal as to source 

T71 Asphyxiation 

T73 Effects of deprivation 

T74, T76 Adult and child abuse, neglect, and other maltreatment, confirmed or 

suspected 

T75.0-T75.4 Effects of lightning, drowning, and vibration, motion sickness, 

electrocution 

*

Only Include cases if the 7th character of the code is A or missing (reflects initial encounter, active treatment) 

For the 2016 data, these codes were searched for in the following order: diagnosis field 1, external cause 

fields 1-4, then diagnosis fields 2-30. For the 2017 data, diagnosis field 1 was initially searched for T codes, 

then diagnosis fields 2-40 searched for V-Y codes, and finally diagnosis fields 2-40 searched for T codes. 

The first code found was considered the first valid external cause of injury. 

Once the first valid external cause of injury was identified, it was classified into the categories of interest by 

the following codes. These codes correspond to the ICD–10–CM external cause of injury matrix23: 

MECHANISM AND/OR INTENT ICD–10–CM CODES*

Motor vehicle traffic crashes V02-V04 (.1, .9), V09.2, V09.3, V12-V14 (.3-.9), V19.4-V19.6, V19.9, 

V20-V28 (.3-.9), V29.4-V29.9, V30-V79 (.4-.9), V80.3-V80.5, V81.1, 

V82.1, V83-V86(.0-.3), V87.0-V87.8, V89.2 

Unintentional falls V00 with 6th character=1, W00-W15, W16 with 6th character=2, 

W16.42, W16.92, W17, W18.1-W18.3, W19 

Unintentionally struck by/ 

against an object 

V00.0, [V00.1-V00.8] (with 6th character = 2), W18.0, W20, W21, 

W22.01-W22.03, W22.042, W22.09, W22.1, W22.8, W50-W52 

Other or unspecified 

unintentional injury 

All the other codes in the T15-T19, [T36-T65, T71] (with 6th character 

= 1), [T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, T49.9, 

T51.9, T52.9, T53.9, T54.9, T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, 

T60.9, T61.0, T61.1, T61.9, T62.9, T63.9, T64, T65.9] (with 5th character = 1), T71.20, T71.21, T71.29, T71.9, T73, T75.0, T75.2-T75.4, 

V00-V99, W00-W99, X00-X58 ranges 

29 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

Intentional self-harm T14.91, [T36-T65, T71] (with 6th character = 2), [T36.9, T37.9, T39.9, 

T41.4, T42.7, T43.9, T45.9, T47.9, T49.9, T51.9, T52.9, T53.9, T54.9, 

T56.9, T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, 

T62.9, T63.9, T64, T65.9] (with 5th character = 2), X71-X83 

Assault [T36-T65, T71] (with 6th character = 3), [T36.9, T37.9, T39.9, T41.4, 

T42.7, T43.9, T45.9, T47.9, T49.9, T51.9, T52.9, T53.9, T54.9, T56.9, 

T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, 

T63.9, T64, T65.9] (with 5th character = 3), T74, T76, X92-X99, 

Y00-Y09, Y38 

Other [T36-T65, T71] (with 6th character = 4), [T36.9, T37.9, T39.9, T41.4, 

T42.7, T43.9, T45.9, T47.9, T49.9, T51.9, T52.9, T53.9, T54.9, T56.9, 

T57.9, T58.0, T58.1, T58.9, T59.9, T60.9, T61.0, T61.1, T61.9, T62.9, 

T63.9, T64, T65.9] (with 5th character = 4), T75.1, Y21-Y33, Y35-Y37 

*

Only include cases if the 7th character of the code is A or missing (reflects initial encounter, active treatment) 

Suicide/Intentional self-harm in children 

For suicide and intentional self-harm data, deaths and hospitalizations among children <10 years were not 

presented because it is unclear if children <10 are able to form suicidal intent.24 Rates for deaths due to 

suicide and intentional self-harm hospitalizations were age-adjusted to the population 10 years and older. 

Any suicides or intentional self-harm hospitalizations in the 0-9 year age group were moved to the “other/ 

unknown” cause category so that the sum of causes equals the total number of TBI-related hospitalizations 

and deaths. 

Deaths 

Injury-related deaths in U.S. residents were identified if the underlying cause of death was one of the 

following ICD–10 codes: V01-Y36, Y85-Y87, Y89, U01-U03. From this injury subset, TBI-related deaths were 

selected if one of the following ICD–10 codes were in any of the record-axis multiple-cause-of-death fields. 

CODE(S) DESCRIPTION 

S01 Open wound of head 

S02.0, S02.1, S02.3, S02.7-S02.9 Fracture of skull and facial bones 

S04.0 Injury of optic nerve and pathways 

S06 Intracranial injury 

S07.0, S07.1, S07.8, S07.9 Crushing injury of head 

S09.7-S09.9 Other and unspecified injuries of head 

T90.1, T90.2, T90.4, T90.5, T90.8, T90.9 Sequelae of injuries of head 

30 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

To identify the cause of injury, the following codes were searched for in the underlying cause of death field. 

These codes are consistent with the ICD–10 external cause of injury matrix.25 

MECHANISM AND/OR INTENT ICD–10–CM CODES 

Motor vehicle traffic crashes [V02-V04] (.1,.9), V09.2, [V12-V14] (.3-.9), V19 (.4-.6), 

[V20-V28] (.3-.9), [V29-V79] (.4-.9), V80 (.3-.5), V81.1, V82.1, 

[V83-V86] (.0-.3), V87 (.0-.8), V89.2 

Unintentional falls W00-W19 

Unintentionally struck by/ 

against an object 

W20-W22, W50-W52 

Other or unspecified 

unintentional injury 

All the other codes in the V01-X59, Y85-Y86 ranges 

Suicide U03, X60-X84, Y87.0 

Homicide U01-U02, X85-Y09, Y87.1 

Other Y10-Y34, Y87.2, Y89.9, Y35-Y36, Y89 (.0,.1) 

31 
 

TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017 

SUPPLEMENTAL TABLE 1 

Estimated number and rate* of traumatic brain injury-related (TBI) hospitalizations†

and deaths by age group — United States, 2016 and 2017 

AGE 

GROUP 

(YRS) 

Hospitalizations† Deaths 

YEAR NO. RATE*

 (95% CI) NO. RATE* (95% CI) 

0-17 2016 19,530 26.5 (23.3 - 29.7) 2,698 3.7 (3.5 - 3.8) 

2017 17,610 23.9 (21.0 - 26.9) 2,810 3.8 (3.7 - 4.0) 

0-4 

2016 7,395 37.1 (31.4 - 42.8) 708 3.6 (3.3 - 3.8) 

2017 6,500 32.7 (27.2 - 38.1) 750 3.8 (3.5 - 4.0) 

5-9 

2016 2,945 14.4 (12.1 - 16.8) 310 1.5 (1.3 - 1.7) 

2017 2,865 14.1 (11.9 - 16.3) 274 1.3 (1.2 - 1.5) 

10-14 

2016 3,825 18.5 (15.8 - 21.3) 508 2.5 (2.2 - 2.7) 

2017 3,460 16.7 (14.2 - 19.2) 517 2.5 (2.3 - 2.7) 

15-24 

2016 24,315 55.9 (51.3 - 60.5) 6,919 15.9 (15.5 - 16.3) 

2017 22,015 51.0 (47.0 - 55.0) 7,030 16.3 (15.9 - 16.7) 

25-34 

2016 23,710 53.0 (48.7 - 57.3) 7,495 16.8 (16.4 - 17.1) 

2017 21,955 48.5 (44.6 - 52.4) 7,557 16.7 (16.3 - 17.1) 

35-44 

2016 18,445 45.6 (42.0 - 49.1) 6,146 15.2 (14.8 - 15.6) 

2017 17,685 43.4 (40.0 - 46.8) 6,148 15.1 (14.7 - 15.5) 

45-54 

2016 23,755 55.6 (51.6 - 59.6) 7,072 16.5 (16.2 - 16.9) 

2017 22,640 53.6 (49.8 - 57.4) 7,195 17.0 (16.6 - 17.4) 

55-64 

2016 28,045 67.7 (63.3 - 72.1) 7,904 19.1 (18.7 - 19.5) 

2017 28,290 67.5 (63.5 - 71.6) 8,175 19.5 (19.1 - 19.9) 

65-74 

2016 29,990 104.8 (99.2 - 110.4) 6,911 24.2 (23.6 - 24.7) 

2017 30,430 102.7 (97.3 - 108.1) 7,201 24.3 (23.7 - 24.9) 

75+ 

2016 64,610 313.4 (298.5 - 328.4) 15,561 75.5 (74.3 - 76.7) 

2017 67,875 320.8 (305.8 - 335.7) 16,284 77.0 (75.8 - 78.1) 

Total§

2016 227,055 70.3 (66.5 - 74.1) 59,540 18.4 (18.3 - 18.6) 

2017 223,720 68.8 (65.2 - 72.4) 61,134 18.8 (18.7 - 19.0)&

Adjusted¶

2016 227,035 65.7 (64.3 - 67.2) 59,534 17.3 (17.1 - 17.4) 

2017 223,715 63.6 (62.3 - 65.0) 61,131 17.5 (17.4 - 17.7) 

SOURCES: Healthcare Cost and Utilization Project’s National Inpatient Sample and CDC’s National Vital Statistics System. 

Abbreviations: CI = confidence interval. 

*

Per 100,000 population. 

†

In-hospital deaths and patients who transferred from another hospital were excluded. 

§

Cases with missing age were included. Numbers subject to rounding error. 

¶

Cases with missing age were excluded. Rates age-adjusted to NCHS 2000 U.S. standard population. 

&Rate significantly different compared to 2016, t-tests p-value <0.05. 32 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

SUPPLEMENTAL TABLE 2 

Estimated number and rate* of traumatic brain injury-related (TBI) hospitalizations† by sex and mechanism of injury — United States, 2016 and 2017 

SEX YEAR 

Motor vehicle 

traffic crashes Unintentional falls‡

Unintentionally struck 

by or against an object 

Other or unspecified 

unintentional injury Intentional self-harm§ Assault Other¶

NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) 

MALE 

2016 Crude** 37,705 23.7 (21.7 - 25.7) 58,290 36.6 (34.8 - 38.5) 3,990 2.5 (2.3 - 2.7) 14,395 9.0 (8.4 - 9.7) 955 0.7 (0.6 - 0.8) 12,900 8.1 (7.4 - 8.9) 11,205 7.0 (5.9 - 8.2) 

Adjusted†† 37,705 23.3 (22.4 - 24.2) 58,285 36.2 (35.2 - 37.2) 3,990 2.5 (2.3 - 2.7) 14,395 8.9 (8.5 - 9.3) 955 0.7 (0.6 - 0.8) 12,900 8.1 (7.6 - 8.5) 11,200 6.9 (6.5 - 7.4) 

2017 

Crude** 36,665 22.9 (21.0 - 24.8) 58,640 36.6 (34.8 - 38.4) 3,675 2.3 (2.1 - 2.5) 13,175 8.2 (7.6 - 8.8) 1,040 0.7 (0.6 - 0.9) 11,965 7.5 (6.8 - 8.1) 12,085 7.5 (6.4 - 8.7) 

Adjusted†† 36,665 22.5 (21.6 - 23.3) 58,635 35.6 (34.6 - 36.5) 3,675 2.3 (2.1 - 2.4) 13,175 8.1 (7.8 - 8.5) 1,040 0.8 (0.6 - 0.9) 11,965 7.5 (7.0 - 7.9) 12,085 7.4 (6.9 - 7.9) 

FEMALE 

2016 

Crude** 19,065 11.6 (10.6 - 12.7)‡‡ 50,035 30.5 (29.1 - 32.0)‡‡ 2,190 1.3 (1.2 - 1.5)‡‡ 6,160 3.8 (3.4 - 4.1)‡‡ 380 0.3 (0.2 - 0.3)‡‡ 2,700 1.6 (1.5 - 1.8)‡‡ 7,010 4.3 (3.6 - 4.9)‡‡

Adjusted†† 19,065 11.4 (10.9 - 11.9)‡‡ 50,035 24.0 (23.2 - 24.7)‡‡ 2,190 1.2 (1.0 - 1.3)‡‡ 6,160 3.7 (3.4 - 3.9)‡‡ 380 0.3 (0.2 - 0.3)‡‡ 2,690 1.7 (1.6 - 1.9)‡‡ 7,010 3.7 (3.4 - 3.9)‡‡

2017 

Crude** 18,050 10.9 (10.0 - 11.8)‡‡ 51,125 31.0 (29.6 - 32.4)‡‡ 1,660 1.0 (0.9 - 1.1)‡‡ 5,575 3.4 (3.1 - 3.7)‡‡ 420 0.3 (0.2 - 0.4)‡‡ 2,625 1.6 (1.4 - 1.8)‡‡ 6,990 4.2 (3.6 - 4.9)‡‡

Adjusted†† 18,050 10.8 (10.3 - 11.2)‡‡ 51,125 23.9 (23.2 - 24.6)‡‡ 1,660 0.9 (0.8 - 1.0)‡‡ 5,575 3.3 (3.1 - 3.5)‡‡ 420 0.3 (0.2 - 0.4)‡‡ 2,625 1.7 (1.5 - 1.8)‡‡ 6,990 3.6 (3.3 - 3.9)‡‡

SOURCE: Healthcare Cost and Utilization Project’s National Inpatient Sample 

Abbreviations: CI = confidence interval. 

*

Per 100,000 population. 

†

In-hospital deaths and patients who transferred from another hospital were excluded. 

‡

Falls of undetermined intent were not included. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. Rates for TBI-related hospitalizations due to intentional self-harm were age-adjusted to 

the population 10 years and older. 

¶

Includes undetermined intent, legal intervention, war, intentional self-harm for age <10 years, and cases without information about cause of injury. 

**Hospitalizations with missing age were included. 

††Hospitalizations with missing age were excluded. Rates age-adjusted to the NCHS 2000 U.S. standard population. 

&Rate significantly different compared to 2016, t-tests p-value <0.05. 

‡‡Rate significantly different compared to male, t-tests p-value <0.05. 33 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

SUPPLEMENTAL TABLE 3 

Number and rate* of traumatic brain injury-related (TBI) deaths by sex and mechanism of injury — United States, 2016 and 2017 

SEX YEAR 

Motor vehicle 

traffic crashes Unintentional falls‡

Unintentionally struck 

by or against an object 

Other or unspecified 

unintentional injury Suicide§ Homicide Other¶

NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) NO. RATE* (95% CI) 

MALE 

2016 Crude** 8,357 5.3 (5.1 - 5.4) 9,601 6.0 (5.9 - 6.2) 298 0.2 (0.2 - 0.2) 2,992 1.9 (1.8 - 1.9) 17,382 12.6 (12.4 - 12.7) 4,280 2.7 (2.6 - 2.8) 621 0.4 (0.4 - 0.4) 

Adjusted†† 8,357 5.2 (5.0 - 5.3) 9,599 6.1 (6.0 - 6.2) 298 0.2 (0.2 - 0.2) 2,992 1.8 (1.8 - 1.9) 17,380 12.3 (12.2 - 12.5) 4,279 2.7 (2.6 - 2.8) 620 0.4 (0.4 - 0.4) 

2017 

Crude** 8,036 5.0 (4.9 - 5.1) 10,180 6.4 (6.2 - 6.5) 291 0.2 (0.2 - 0.2) 3,012 1.9 (1.8 - 1.9) 18,436 13.2 (13.0 - 13.4) 4,316 2.7 (2.6 - 2.8) 693 0.4 (0.4 - 0.5) 

Adjusted†† 8,036 4.9 (4.8 - 5.0) 10,180 6.3 (6.2 - 6.4) 291 0.2 (0.2 - 0.2) 3,011 1.8 (1.8 - 1.9) 18,436 13.0 (12.8 - 13.2) 4,315 2.7 (2.6 - 2.8) 692 0.4 (0.4 - 0.5) 

FEMALE 

2016 

Crude** 3,184 1.9 (1.9 - 2.0)‡‡ 7,095 4.3 (4.2 - 4.4)‡‡ 38 0.0 (0.0 - 0.0)‡‡ 1,154 0.7 (0.7 - 0.7)‡‡ 2,757 1.9 (1.8 - 2.0)‡‡ 1,586 1.0 (0.9 - 1.0)‡‡ 195 0.1 (0.1 - 0.1)‡‡

Adjusted†† 3,184 1.9 (1.9 - 2.0)‡‡ 7,095 3.2 (3.1 - 3.3)‡‡ 38 0.0 (0.0 - 0.0)‡‡ 1,154 0.6 (0.6 - 0.6)‡‡ 2,757 1.9 (1.8 - 2.0)‡‡ 1,586 1.0 (0.9 - 1.0)‡‡ 195 0.1 (0.1 - 0.1)‡‡

2017 

Crude** 3,062 1.9 (1.8 - 1.9)‡‡ 7,228 4.4 (4.3 - 4.5)‡‡ 55 0.0 (0.0 - 0.0)‡‡ 1,163 0.7 (0.7 - 0.7)‡‡ 2,789 1.9 (1.8 - 2.0)‡‡ 1,665 1.0 (1.0 - 1.1)‡‡ 208 0.1 (0.1 - 0.1)‡‡

Adjusted†† 3,062 1.8 (1.8 - 1.9)‡‡ 7,228 3.2 (3.1 - 3.3)‡‡ 55 0.0 (0.0 - 0.0)‡‡ 1,163 0.6 (0.6 - 0.6)‡‡ 2,789 1.9 (1.8 - 2.0)‡‡ 1,665 1.0 (1.0 - 1.1)‡‡ 208 0.1 (0.1 - 0.1)‡‡

SOURCE: CDC’s National Vital Statistics System 

Abbreviations: CI = confidence interval. 

*

Per 100,000 population. 

‡

 Falls of undetermined intent were not included. They were included in this category in previous versions of this report. 

§

Age <10 years were excluded because determining intent in younger children can be difficult. Rates for TBI-related deaths due to suicide were age-adjusted to the population 10 years and older. 

¶

Includes undetermined intent, legal intervention, war, and intentional self-harm for age <10 years. 

**Deaths with missing age were included. 

††Deaths with missing age were excluded. Rates age-adjusted to the NCHS 2000 U.S. standard population. 

&Rate significantly different compared to 2016, t-tests p-value <0.05. 

‡‡Rate significantly different compared to male, t-tests p-value <0.05. 34 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

35 

REFERENCES 

1. https://www.cdc.gov/traumaticbraininjury/index.html. Accessed July 17, 2020. 

2. Centers for Disease Control and Prevention (2019). Surveillance Report of Traumatic Brain Injuryrelated Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014. Centers for 

Disease Control and Prevention, U.S. Department of Health and Human Services. 

3. Healthcare Cost and Utilization Project. (2017). The Healthcare Cost and Utilization Project Fact Sheet. 

Retrieved from https://www.hcup-us.ahrq.gov/news/exhibit_booth/hcup_fact_sheet.jsp 

4. National Center for Health Statistics. (2016). About the National Vital Statistics System. Retrieved from 

https://www.cdc.gov/nchs/nvss/about_nvss.htm 

5. Stone DM, Simon TR, Fowler KA, et al. Vital Signs: Trends in State Suicide Rates — United States, 

1999–2016 and Circumstances Contributing to Suicide — 27 States, 2015. MMWR Morb Mortal Wkly 

Rep 2018;67:617–624. Centers for Medicare & Medicaid Services. ICD–10. Baltimore, MD. Available 

from: https://www.cms.gov/Medicare/Coding/ICD10 

6. Centers for Medicare & Medicaid Services. ICD–10. Baltimore, MD. Available from: 

https://www.cms.gov/Medicare/Coding/ICD10 

7. Topaz M, Shafran-Topaz L, Bowles K. ICD–9 to ICD–10: evolution, revolution, and current debates in the 

United States. Perspect Health Inf Manag. 2013;10:1d 

8. Hedegaard H, Johnson RL, Warner M, et al. Proposed framework for presenting injury data using the 

International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. National 

health statistics reports; no 89. Hyattsville, MD: National Center for Health Statistics. 2016. 

9. Weems S, Heller P, Fenton S. Results from the veterans health administration ICD–10–CM/PCS coding 

pilot study. Perspect Health Inf Manag. 2015;12:1b. 

10. Slavova, S., Costich, J.F., Luu, H. et al. Interrupted time series design to evaluate the effect of the 

ICD–9–CM to ICD–10–CM coding transition on injury hospitalization trends. Inj. Epidemiol. 5, 36 (2018). 

https://doi.org/10.1186/s40621-018-0165-8 

11. Gabella B, Hathaway J, Hume B, Johnson J, Costich J, Slavova S, Liu A. Multi-site medical record review 

of emergency department visits for traumatic brain injury. Injury Prevention (forthcoming). 

12. Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency 

Department Visits, Hospitalizations and Deaths 2002–2006. 2010. Atlanta (GA): Centers for Disease 

Control and Prevention, National Center for Injury Prevention and Control. 

https://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf 

13. Chan V, Mann RE, Pole JD, Colantonio A. Children and youth with ‘unspecified injury to the head’: 

implications for traumatic brain injury research and surveillance. Emerging Themes in Epidemiology. 

2015 (12:9). DOI 10.1186/s12982-015-0031-x 
TBI SURVEILLANCE REPORT // UNITED STATES 2016 AND 2017

36 

 

14. Bazarian JJ, Veazie P, Mookerjee S, Lerner EB. Accuracy of mild traumatic brain injury case 

ascertainment using ICD–9 codes. Acad Emerg Med. 2006;13(1):31-38. 

15. Shore AD, McCarthy ML, Serpi T, Gertner M. Validity of administrative data for characterizing traumatic 

brain injury related hospitalizations. Brain Inj. 2005;19:613–21. 

16. Peterson AB, Gabella B, Johnson J, Hume B, Liu A, Costich J, et al. Multi-Site Medical Record Review 

of Emergency Department Visits for Unspecified Injury of Head Following the ICD–10–CM Coding 

Transition. ICD–10–CM Injury Epidemiology and Surveillance Methods Supplement. Injury Prevention. 

Accepted. 

17. CSTE ICD–10–CM Injury Surveillance Toolkit 11/19/2019. Toolkit Overview and Purpose. Retrieved 

from https://resources.cste.org/Injury-Surveillance-Methods-Toolkit/. International Classification of 

Diseases 10th Revision [online]. [cited August 6, 2020]. 

18. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2019-ICD10-Coding-Guidelines-.pdf 

19. National Center for Health Statistics. (2020). Bridged-race population estimates—data files and 

documentation. Retrieved from https://www.cdc.gov/nchs/nvss/bridged_race/data_documentation. 

htm (Accessed August 12, 2020). 

20. Kochanek KD, Murphy SL, Xu JQ, Arias E. Deaths: Final data for 2017. National Vital Statistics Reports; 

vol 68 no 9. Hyattsville, MD: National Center for Health Statistics. 2019. 

https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf 

21. Houchens R, Ross D, Elixhauser A. Final Report on Calculating National Inpatient Sample (NIS) 

Variances for Data Years 2012 and Later. 2015. HCUP Methods Series Report # 2015-09 ONLINE. 

December 14, 2015. U.S. Agency for Healthcare Research and Quality. Available: 

http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp 

22. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People 

Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. 

https://www.cdc.gov/nchs/data/statnt/statnt20.pdf 

23. Hedegaard H, Johnson RL, Garnett MF, Thomas KE. The International Classification of Diseases, 10th 

Revision, Clinical Modification (ICD–10–CM) external cause-of-injury framework for categorizing 

mechanism and intent of injury. National Health Statistics Reports; no 136. Hyattsville, MD: National 

Center for Health Statistics. 2019. https://www.cdc.gov/nchs/data/nhsr/nhsr136-508.pdf 

24. Hawton, K., Saunders E.A. K., O’Connor C. R. Self-harm and suicide in adolescents. 2012. The Lancet, 

379 (9834), 2373-2382. 

25. NCHS. ICD–10: External cause-of-injury mortality matrix [online]. Available from: 

https://www.cdc.gov/nchs/injury/injury_tools.htm.