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Original Investigation
November 2018

Prevalence of Parent-Reported Traumatic Brain Injury in Children and Associated Health Conditions

Author Affiliations
  • 1Division of Unintentional Injury, National Centers for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2School of Public Health, Georgia State University, Atlanta
  • 3Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 4Division of Analysis, Research and Practice Integration, Centers for Disease Control and Prevention, Atlanta, Georgia
JAMA Pediatr. 2018;172(11):1078-1086. doi:10.1001/jamapediatrics.2018.2740
Key Points

Question  What are the national and state estimates of parent-reported, diagnosed traumatic brain injury in children aged 0 to 17 years?

Findings  In this analysis of data from the National Survey of Children’s Health, children were shown to have a lifetime estimate of a parent-reported traumatic brain injury diagnosis of 2.5%. National estimates of the association between traumatic brain injury and other childhood health conditions is reported along with parent report of insurance coverage and perception of insurance adequacy.

Meaning  A large number of children experience traumatic brain injury in the United States, and these children are more likely to have childhood health conditions; insurance type and parent adequacy perception contribute to care seeking and outcomes for children.

Abstract

Importance  Traumatic brain injury (TBI) in children results in a high number of emergency department visits and risk for long-term adverse effects.

Objectives  To estimate lifetime prevalence of TBI in a nationally representative sample of US children and describe the association between TBI and other childhood health conditions.

Design, Setting, and Participants  Data were analyzed from the 2011-2012 National Survey of Children’s Health, a cross-sectional telephone survey of US households with a response rate of 23%. Traumatic brain injury prevalence estimates were stratified by sociodemographic characteristics. The likelihood of reporting specific health conditions was compared between children with and without TBI. Age-adjusted prevalence estimates were computed for each state. Associations between TBI prevalence, insurance type, and parent rating of insurance adequacy were examined. Data analysis was conducted from February 1, 2016, through November 1, 2017.

Main Outcomes and Measures  Lifetime estimate of TBI in children, associated childhood health conditions, and parent report of health insurance type and adequacy.

Results  The lifetime estimate of parent-reported TBI among children was 2.5% (95% CI, 2.3%-2.7%), representing over 1.8 million children nationally. Children with a lifetime history of TBI were more likely to have a variety of health conditions compared with those without a TBI history. Those with the highest prevalence included learning disorders (21.4%; 95% CI, 18.1%-25.2%); attention-deficit/hyperactivity disorder (20.5%; 95% CI, 17.4%-24.0%); speech/language problems (18.6%; 95% CI, 15.8%-21.7%); developmental delay (15.3%; 95% CI, 12.9%-18.1%); bone, joint, or muscle problems (14.2%; 95% CI, 11.6%-17.2%); and anxiety problems (13.2%; 95% CI, 11.0%-16.0%). States with a higher prevalence of childhood TBI were more likely to have a higher proportion of children with private health insurance and higher parent report of adequate insurance. Examples of states with higher prevalence of TBI and higher proportion of private insurance included Maine, Vermont, Pennsylvania, Washington, Montana, Wyoming North Dakota, South Dakota, and Colorado.

Conclusions and Relevance  A large number of US children have experienced a TBI during childhood. Higher TBI prevalence in states with greater levels of private insurance and insurance adequacy may suggest an underrecognition of TBI among children with less access to care. For more comprehensive monitoring, health care professionals should be aware of the increased risk of associated health conditions among children with TBI.

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