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Background Current guidelines recommend healthcare professionals avoid routine use of neuroimaging for diagnosing mild traumatic brain injury (mTBI). Objective This study aimed to examine current use of CT and MRI among children and young adult patients with mTBI and factors that increase likelihood of neuroimaging in this population. Materials and methods Data were analyzed using the 2019 MarketScan commercial claims and encounters database for the commercially insured population for both inpatient and outpatient claims. Descriptive statistics and logistic regression models for patients  ≤24 years of age who received an ICD-10-CM code indicative of a possible mTBI were analyzed. Results Neuroimaging was performed in 16.9% (CT; 95% CI=16.7–17.1) and 0.9% (MRI; 95% CI=0.8–0.9) of mTBI outpatient visits (including emergency department visits) among children (≤18 years old). Neuroimaging was performed in a higher percentage of outpatient visits for patients 19–24 years old (CT=47.1% [95% CI=46.5–47.6] and MRI=1.7% [95% CI=1.5–1.8]), and children aged 15–18 years old (CT=20.9% [95% CI=20.5–21.2] and MRI=1.4% [95% CI=1.3–1.5]). Outpatient visits for males were 1.22 (95% CI=1.10–1.25) times more likely to include CT compared to females, while there were no differences by sex for MRI or among inpatient stays. Urban residents, as compared to rural, were less likely to get CT in outpatient settings (adjusted odds ratio [aOR]=0.55, 95% CI=0.53–0.57). Rural residents demonstrated a larger proportion of inpatient admissions that had a CT. Conclusions Despite recommendations to avoid routine use of neuroimaging for mTBI, neuroimaging remained common practice in 2019.

Background The majority of US children do not meet physical activity recommendations. Schools are an important environment for promoting physical activity in children, yet most school districts do not offer enough physical activity opportunities to meet recommendations. This study aimed to identify school districts across the country that demonstrated exemplary efforts to provide students with many physical activity opportunities and to understand the factors that facilitated their programmatic success. Methods A total of 59 districts were identified as model districts by members of the Physical Activity and Health Innovation Collaborative, an ad hoc activity associated with the Roundtable on Obesity Solutions at the National Academies of Sciences, Engineering, and Medicine. Semi-structured interviews were conducted with consenting stakeholders from 23 school districts to understand physical education and activity efforts and elucidate factors that led to the success of these districts’ physical activity programming. Districts were geographically and socioeconomically diverse and varied in their administrative and funding structure. Results Most districts did not offer the recommended 150 or 225 min of physical activity a week through physical education alone; yet all districts offered a range of programs outside of physical education that provided additional opportunities for students to be physically active. The average number of school-based physical activity programs offered was 5.5, 3.5 and 2.1 for elementary, middle and high schools, respectively. Three overarching and broadly relevant themes were identified that were associated with successfully enhancing physical activity opportunities for students: soliciting and maintaining the support of champions, securing funding and/or tangible support, and fostering bi-directional partnerships between the district and community organizations and programs. Not only were these three themes critical for the development of physical activity opportunities, but they also remained important for the implementation, evaluation and sustainability of programs. These themes also did not differ substantially by the socioeconomic status of districts. Conclusions These findings demonstrate the success of school districts across the nation in providing ample opportunities for physical activity despite considerable variability in socioeconomic status and resources. These results can inform future research and provide actionable evidence for school districts to enhance physical activity opportunities to students.

Insufficient sleep is common among high school students and has been associated with an increased risk for motor vehicle crashes (1), sports injuries (2), and occupational injuries (3). To evaluate the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among U.S. high school students, CDC analyzed data from 50,370 high school students (grades 9-12) who participated in the national Youth Risk Behavior Surveys (YRBSs) in 2007, 2009, 2011, or 2013. The likelihood of each of the five risk behaviors was significantly higher for students who reported sleeping ≤7 hours on an average school night; infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students who reported sleeping ≥10 hours compared with 9 hours on an average school night. Although insufficient sleep directly contributes to injury risk, some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors. Intervention efforts aimed at these behaviors might help reduce injuries resulting from sleepiness, as well as provide opportunities for increasing awareness of the importance of sleep.

BackgroundThe older adult (65+) population in the USA is increasing and with it the number of medically treated falls. In 2015, healthcare spending attributable to older adult falls was approximately US$50 billion. We aim to update the estimated medical expenditures attributable to older adult non-fatal falls.MethodsGeneralised linear models using 2017, 2019 and 2021 Medicare Current Beneficiary Survey and cost supplement files were used to estimate the association of falls with healthcare expenditures while adjusting for demographic characteristics and health conditions in the model. To portion out the share of total healthcare spending attributable to falls versus not, we adjusted for demographic characteristics and health conditions, including self-reported health status and certain comorbidities associated with increased risk of falling or higher healthcare expenditure. We calculated a fall-attributable fraction of expenditure as total expenditures minus total expenditures with no falls divided by total expenditures. We applied the fall-attributable fraction of expenditure from the regression model to the 2020 total expenditures from the National Health Expenditure Data to calculate total healthcare spending attributable to older adult falls.ResultsIn 2020, healthcare expenditure for non-fatal falls was US$80.0 billion, with the majority paid by Medicare.ConclusionHealthcare spending for non-fatal older adult falls was substantially higher than previously reported estimates. This highlights the growing economic burden attributable to older adult falls and these findings can be used to inform policies on fall prevention efforts in the USA.

ObjectivesFalls are a leading preventable cause of death and injury among older adults (65+). Healthcare spending in the USA on non-fatal falls was estimated at $80 billion in 2020. We aim to estimate healthcare spending on older adult non-fatal falls by state.MethodsHealthcare spending for all adults was derived from the 2020 Centers for Medicare and Medicaid Services (CMS) Health Expenditures by State of Residence files. These data covered three payor types: Medicare, Medicaid and private health insurance (PHI). Using the national 2020 CMS Health Expenditure by Age Group files, the national proportion of healthcare spending for older adults was calculated for each payor type. These national proportions were applied to each state’s healthcare spending data to estimate healthcare spending for older adults in each state, adjusted for the proportion of older adults in each state. To estimate the proportion of older adult healthcare spending attributed to non-fatal falls, these adjusted values were combined with the falls-attributable expenditure factors calculated in Haddad (2024). The final state-level estimates of healthcare spending on non-fatal older adult falls were calculated for each payer type: Medicare, Medicaid and PHI. All estimates were inflated to 2023 dollars.ResultsOverall state-level spending on non-fatal falls ranged between $112.7 million in Alaska to $8.3 billion in Florida. Per-capita spending estimates ranged between $1085 in Utah to $2262 in Wisconsin.ConclusionsMeasuring the cost of non-fatal falls at the state level can help inform regional differences and improve targeted fall prevention efforts.

Objectives. To document the increasing influence of firearm suicide on the incidence of traumatic brain injury (TBI)–related death in the United States. Methods. We used national vital statistics data from 2008 to 2017 to identify TBI-related deaths, overall and by cause, among US residents. National counts stratified by year, sex, and age group (to facilitate age adjustment) were merged with corresponding population estimates to calculate incidence rates. Results. During the 10-year period beginning in 2008, when it became the leading cause of TBI-related death in the United States, firearm suicide accounted for nearly half (48.3%) of the increase in the absolute incidence of TBI-related death when combining all injury categories showing absolute increases. Rates of TBI-related firearm suicide increased among both males and females. Conclusions. Safe storage of firearms among people at risk and training of health care providers and community members to identify and support people who may be thinking of suicide are part of a comprehensive public health approach to suicide prevention. Public Health Implications. States, communities, and health care systems can save lives by prioritizing comprehensive suicide prevention.

Bullying is a public health concern that results in diminished well-being for children and adolescents. One approach that lawmakers have taken to address bullying is enacting anti-bullying laws, which require school districts to establish bullying prevention policies. In this study, researchers used standard legal epidemiology methods to systematically retrieve and analyze anti-bullying laws in the United States (US). While they found that every US state and the District of Columbia has a school anti-bullying law, there is wide variation in their scope and requirements. Some jurisdictions specified requirements that school districts must implement in their anti-bullying policies, while others deferred policy enactment entirely to school districts. Given the differences in requirements and scoping afforded in anti-bullying laws, understanding the important components included in such policies can help provide policymakers and practitioners with information about bullying prevention strategies across jurisdictions.

Unintentional and violence-related injuries, including suicide, homicide, overdoses, motor vehicle crashes, and falls, were among the top 10 causes of death for all age groups in the United States and caused nearly 27 million nonfatal emergency department (ED) visits in 2019.* CDC estimated the economic cost of injuries that occurred in 2019 by assigning costs for medical care, work loss, value of statistical life, and quality of life losses to injury records from the CDC's Web-based Injury Statistics Query and Reporting System (WISQARS). In 2019, the economic cost of injury was $4.2 trillion, including $327 billion in medical care, $69 billion in work loss, and $3.8 trillion in value of statistical life and quality of life losses. More than one half of this cost ($2.4 trillion) was among working-aged adults (aged 25-64 years). Individual persons, families, organizations, communities, and policymakers can use targeted proven strategies to prevent injuries and violence. Resources for best practices for preventing injuries and violence are available online from CDC's National Center for Injury Prevention and Control. .

IntroductionIn 2021, among all age groups, falls ranked as the third leading cause of unintentional injury death in the USA. Unlike fatal data, which rely on death certificates as the gold standard, there is not a gold standard for non-fatal data. Non-fatal falls data are often based on insurance claims or administrative billing data. The purpose of our study is to compare three claims databases to estimate rates of unintentional fall-related hospitalisations in 2019, the most recent year of available data across the three sources.MethodsThree databases were used to produce incidence rates of fall-related hospitalisations for the year 2019: (1) Merative MarketScan research databases, (2) Centers for Medicare and Medicaid Services (CMS) data and (3) Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. Inpatient falls were identified using International Classification of Diseases, 10th Revision, Clinical Modification codes. Incidence rates per 100 000 people were then produced across all three datasets by payer type. Unadjusted incidence rate ratios were estimated with corresponding 95% CIs.ResultsThere were wide disparities among fall rates between the three datasets by payer type. HCUP had the highest rate of falls among Medicare (1087.6 per 100 000) and commercial enrollees (74.7 per 100 000), while CMS had the highest rates of falls among Medicaid enrollees (148.0 per 100 000).ConclusionsThis study shows wide variation in fall hospitalisation rates based on the claims data used to estimate rates. This study suggests that database selection is an important consideration when determining incidence of non-fatal falls.

BackgroundQuality-adjusted life years (QALYs) provide a means to compare injuries using a common measurement which allows quality of life and duration of life from an injury to be considered. A more comprehensive picture of the economic losses associated with injuries can be found when QALY estimates are combined with medical and work loss costs. This study provides estimates of QALY loss.MethodsQALY loss estimates were assigned to records in the 2018 National Electronic Injury Surveillance System - All Injury Program. QALY estimates by body region and nature of injury were assigned using a combination of previous research methods. Injuries were rated on six dimensions, which identify a set of discrete qualitative impairments. Additionally, a seventh dimension, work-related disability, was included. QALY loss estimates were produced by intent and mechanism, for all emergency department-treated cases, by two disposition groups.ResultsLifetime QALY losses ranged from 0.0004 to 0.388 for treated and released injuries, and from 0.031 to 3.905 for hospitalised injuries. The 1-year monetary value of QALY losses ranged from $136 to $437 000 among both treated and released and hospitalised injuries. The lifetime monetary value of QALY losses for hospitalised injuries ranged from $16 000 to $2.1 million.ConclusionsThese estimates provide information to improve knowledge about the comprehensive economic burden of injuries; direct cost elements that can be measured through financial transactions do not capture the full cost of an injury. Comprehensive assessment of the long-term cost of injuries, including quality of life losses, is critical to accurately estimate the economic burden of injuries.