Traumatic Brain Injuries Among
Arizona Residents, 2008

Resources for the development of this report were provided through funding to the
Arizona Department of Health Services from the Centers for Disease and Control and
Prevention, Cooperative Agreement 5U17CE924770-04, Integrated Core Injury
Prevention and Control Program
Permission to quote from or reproduce materials from this publication is granted when
acknowledgment is made.

Prepared by: Alana Shacter, MPH
150 North 18th Avenue, Suite 320
Phoenix, AZ 85007
Injury Prevention Program
Bureau of Women’s and Children’s Health
Arizona Department of Health Services
August 2009

Table of Contents
Executive Summary ...................................................................................................... 2
Introduction ................................................................................................................... 3
Deaths ............................................................................................................................ 4
Firearm-Related TBI Mortality...................................................................................... 6
Fall-Related TBI Mortality ............................................................................................ 7
Non-Fatal Inpatient Hospitalizations ........................................................................... 8
Non-Fatal Motor Vehicle Traffic Crash-Related TBI Inpatient Hospitalizations.......... 11
Non-Fatal Fall-Related TBI Inpatient Hospitalizations ............................................... 12
Non-Fatal Emergency Department Visits .................................................................. 14
Non-Fatal Fall-Related Emergency Department Visits .............................................. 16
Non-Fatal Struck By/Against-Related TBI Emergency Department Visits ................. 17
Data Notes ................................................................................................................... 19
Appendix A. Definitions of Causes........................................................................... 20

1

Executive Summary
Traumatic brain injuries were the cause of death for 1,325 Arizona residents in 2008.
Males ages 85 years and older had the highest rate of TBI deaths with 174.5 deaths per
100,000 residents. TBI death rates were highest among American Indians (30.5 per
100,000 residents) and Non-Hispanic Whites (19.5 per 100,000 residents). Fifty-one
percent of TBI deaths in 2008 were due to unintentional injuries (n=667); 35 percent
were due to suicides (n=466); and 11 percent were due to homicides (n=147). The
most common causes of TBI deaths of any intent were firearms (44 percent, n=585),
falls (23 percent, n=304), and motor vehicle traffic-related injuries (20 percent, n=269).
In 2008, there were 4,949 inpatient hospitalizations due to TBI. Adults 85 years and
older had the highest rates of TBI inpatient hospitalizations. Males 85 years and older
had a rate of 315.1 per 100,000 residents. The rate for females 85 years and older was
358.5 per 100,000 residents. TBI inpatient hospitalization rates were highest among
American Indians (121.7 per 100,000 residents) and Non-Hispanic Whites (77.5 per
100,000 residents). Unintentional injuries accounted for 86 percent of TBI
hospitalizations (n=4,271) and assaults comprised an additional 12 percent (n=603).
Motor vehicle traffic-related injuries were the most common cause of TBI
hospitalizations (40 percent, n=1,956), followed by falls (33 percent, n=1,653).
In 2008, there were 35,755 TBI emergency department visits among Arizona residents.
Almost half of TBI emergency department visits were among children ages 19 and
younger (46 percent, n=16,297), as a result of physical and mental factors that make
children and young adults more susceptible to TBIs and the injuries that may cause
them. TBI emergency department visit rates were highest among children younger than
one year of age. Females younger than one year of age had a rate of 1,747.1 visits per
100,000 residents, and males younger than one year of age had a rate of 1,956.8 visits
per 100,000 residents. The majority of TBI emergency department visits were due to
unintentional injuries (88 percent, n=31,207), and 12 percent were due to assaults
(n=4,371). The leading causes of TBI emergency department visits were falls (48
percent, n=17,258), struck by/against injuries (24 percent, n=8,624), and motor vehicle
traffic-related injuries (14 percent, n=4,959).
The data presented in this report show that TBI is a public health problem that
impacts the lives of thousands of Arizona residents each year. The effects of TBI
can include chronic pain, disability, large medical bills, changes in quality of life, and
premature death. TBI can occur throughout the life span, and the repercussions of
these injuries may be experienced for many years. The consequences of TBI can
extend beyond the injured individuals to their families and communities. With non-fatal
TBI, family members are often required to provide care, which can result in time away
from work, loss of income, and increases in stress. Within a community, the financial
costs of TBI include medical expenses, rehabilitation, lost wages, and lost productivity.
Most TBI injuries are predictable and preventable. Understanding the causes of TBI
is an important step towards educating and empowering communities and implementing
effective prevention strategies.

2

Introduction
Traumatic brain injury (TBI) is defined as damage to the brain following a sudden blow
to the head or by shaking the head violently. TBI can also be caused by a penetrating
head injury that disrupts brain function. An estimated 1.4 million Americans sustain
these injuries each year, and of these, 50,000 die as a result of the trauma.1 An
additional 80,000 to 90,000 experience permanent disability, and it is estimated that 5.3
million Americans are currently living with a TBI-related disability.2,3 TBI can cause
cognitive function deficits, which can lead to depression and other secondary outcomes
including problems working and performing daily activities such completing homework,
managing personal finances, or driving a vehicle.

Figure 1. Traumatic Brain Injury Pyramid, Arizona 2008

Deaths
1,325
Inpatient
Hospitalizations
4,949
Emergency
Department
Visits
35,755
Injuries treated in physician offices, other
outpatient facilities, at home, or not treated
???

Figure 1 shows a TBI pyramid for Arizona in 2008. This pyramid shows that deaths
represent the smallest proportion of injuries. The proportions increase towards the
foundation of the pyramid, which is comprised of hospital discharges, emergency
department visits, and self-care. Although TBI that do not require medical treatment
may be the most numerous, no existing datasets capture these types of injuries.
1

Langlois JA, Rutland-Brown W, Thomas KE. Traumatic Brain Injury in the United States: Emergency Department
Visits, Hospitalizations and Deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control; 2006
2
Ibid
3
Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in the United States: a public health
perspective. Journal of Head Trauma Rehabilitation 1999;14(6):602–15.

3

Deaths
In 2008, 1,325 Arizona residents died as a result of TBI. The majority of deaths were
among males (74 percent, n=982), while females accounted for 26 percent of TBI
deaths (n=343). The largest percentage of deaths was among individuals ages 65
years and older (34 percent, n=448). Children ages 19 and younger accounted for 10
percent of TBI deaths in 2008 (n=135). Age distributions are shown in Figure 2.

Figure 2. TBI Deaths by Age Group, Arizona 2008
(n=1,325)
0-4 Years
2% (n=25)

5-14 Years
2% (n=30)

15-19 Years
6% (n=80)
20-24 Years
8% (n=101)

65+ Years
34% (n=448)

25-44 Years
22% (n=298)
45-64 Years
26% (n=343)

Males 85 years and older accounted for 72 deaths and had the highest rate of TBI
deaths in 2008 (174.5 per 100,000 residents). For all adults 85 years and older, 72
percent of TBI deaths were due to unintentional falls (n=105). Figure 3 shows the 2008
TBI death rates by age group and sex for Arizona residents.
Figure 3. TBI Mortality Rates per 100,000 by Age Group and Sex,
Arizona 2008
180

174.5

Females (n=343)

160

Males (n=982)

140
120

107.4

100

82.7

81.6

80

59.0

51.8

60

32.3
40
20

19.0

11.7
13.9
5.8 0.7 1.3 0.9 3.6 4.8
6.2
3.2
1.5

12.2

24.5

12.6

0
<1

1-4

5-9

10-14

15-19

20-24

25-44

45-64

65-74

75-84

85+

Age in Years

4

TBI death rates were highest among American Indians (30.5 per 100,000 residents) and
Non-Hispanic Whites (19.5 per 100,000 residents). Figure 4 shows the 2008 ageadjusted TBI death rates by race/ethnicity in Arizona.
Figure 4. Age-Adjusted TBI Mortality Rates per 100,000 by
Race/Ethnicity, Arizona 2008
35

30.5

30
25

20.0

19.5

20

16.8

16.5

12.8

15
10
5
0
American
White, NonIndian (n=93)
Hispanic
(n=910)

Hispanic
(n=255)

African
American
(n=41)

Asian (n=17)

All
race/ethnicities
(n=1,325)

Half of the TBI deaths in 2008 were due to unintentional injuries (51 percent, n=667); 35
percent were due to suicides (n=466); and 11 percent were due to homicides (n=147).
Figure 5 shows TBI deaths by intent during 2008 in Arizona.

Figure 5. TBI Deaths by Intent, Arizona 2008
(n=1,325)
Homicide
11% (n=147)
Suicide
35% (n=466)

Other/unknown
3% (n=45)

Unintentional
51% (n=667)

The most common causes of deaths were firearms (44 percent, n=585), falls (23
percent, n=304), and motor vehicle traffic-related injuries (20 percent, n=269). Causes
of TBI deaths during 2008 in Arizona are shown in Table 1. Descriptions of these
causes are given in Appendix A.

5

Table 1. TBI Deaths by Cause, Arizona 2008
Cause
Number
Percentage
Firearm
585
44%
Fall
304
23%
Motor vehicle traffic
269
20%
Other/unspecified
122
9%
Other land transport
25
2%
Unknown cause
20
2%
Total
1,325
100%

Firearm-Related TBI Mortality
Among the 585 Arizona residents who died as a result of firearm-related TBI, the
majority were male (83 percent, n=484) and 17 percent were female (n=101). Nine
percent of TBI deaths due to firearms were among children 19 years and younger
(n=50). Nine percent of the deaths were among individuals ages 20 to 24 years (n=54);
61 percent were among individuals ages 25 to 64 years (n=358); and 21 percent were
among individuals 65 years and older (n=123).
The highest rate of firearm-related TBI deaths was among White Non-Hispanics
(n=434). This population had a rate of 9.7 deaths per 100,000 residents. The second
highest rate was among African Americans, who accounted for 21 deaths, or 7.7 per
100,000 residents.
The majority of firearm-related TBI deaths were suicides (79 percent, n=460). Eighteen
percent of the deaths were due to homicides (n=106); two percent were of
undetermined intent (n=12); and one percent were due to unintentional injuries (n=7).
Figure 6 shows TBI deaths due to firearms by intent.

Figure 6. TBI Deaths due to Firearms by Intent,
Arizona 2008 (n=585)
Homicide
18% (n=106)

Undetermined
2% (n=12)

Unintentional
1% (n=7)

Suicide
79% (n=460)

6

Fall-Related TBI Mortality
Of the 304 TBI deaths due to falls, 57 percent were among males (n=174) and 43
percent were among females (n=130). All but three of the falls were unintentional.
Three percent of TBI deaths due to falls were among children and young adults ages 24
years and younger (n=9). Sixteen percent of the deaths were among adults ages 25 to
64 years (n=49); and 81 percent were among adults 65 years and older (n=246).
The highest rate of fall-related TBI deaths was among American Indians (7.7 per
100,000 residents; n=16). The second highest rate was among Asians, who accounted
for four deaths, or 5.0 per 100,000 residents. The age-adjusted mortality rate for fallrelated TBI deaths among all races/ethnicities was 4.4 deaths per 100,000 residents.

7

Non-Fatal Inpatient Hospitalizations
In 2008, 4,949 Arizona residents were hospitalized due to TBI. Males comprised 65
percent of total TBI hospitalizations (n=3,230) and females accounted for 35 percent
(n=1,718). One hospitalization was of an individual of unknown sex. Twenty percent of
TBI inpatient hospitalizations were among children ages 19 years and younger
(n=1,024). The age distribution is shown in Figure 7.

Figure 7. TBI Inpatient Hospitalizations by Age Group,
Arizona 2008 (n=4,949)
0-4 Years
5% (n=252)
65+ Years
24% (n=1,175)

5-14 Years
6% (n=309)
15-19 Years
9% (n=463)

20-24 Years
9% (n=455)
45-64 Years
22% (n=1,075)

25-44 Years
25% (n=1,220)

Adults 85 years and older had the highest rates of TBI inpatient hospitalizations in 2008.
Males 85 years and older had a rate of 315.1 per 100,000 residents (n=130), and the
rate for females 85 years and older was 358.5 per 100,000 residents (n=247). For
adults 85 years and older, 90 percent of hospitalizations were due to unintentional falls
(n=339).
In contrast to the pattern observed with TBI deaths, the highest rates of TBI
hospitalizations among children were among infants younger than one year of age. For
infants younger than one year, 58 percent of hospitalizations were due to unintentional
falls (n=74). Figure 8 shows the 2008 TBI inpatient hospitalization rates by age group
and sex for Arizona residents.

8

Figure 8. TBI Inpatient Hospitalization Rates per 100,000 by Age
Group and Sex, Arizona 2008
400
358.5

Females (n=1,718)
350

Males (n=3,230)

315.1

300
250
200
157.1

155.2
149.6

145.7

150
98.5

92.5
36.4

50

25.5

44.6

53.2

104.3

99.8

100

45.6

43.1

37.3

90.7

94.5
64.0

30.8

21.4

0
<1

1-4

5-9

10-14

15-19

20-24

25-44

45-64

65-74

75-84

85+

Age in Years
Does not include one individual of unknown sex

TBI inpatient hospitalization rates were highest among American Indians (121.7 per
100,000 residents) and Non-Hispanic Whites (77.5 per 100,000 residents). Figure 9
shows the 2008 age-adjusted TBI inpatient hospitalization rates by race/ethnicity in
Arizona.
Figure 9. Age-Adjusted TBI Inpatient Hospitalizations Rates per
100,000 by Race/Ethnicity, Arizona 2008
140

121.7

120
100

77.5
80

75.3
62.0

56.1

55.0

60
40
20
0
American
White, NonIndian (n=404) Hispanic
(n=3,259)

African
American
(n=157)

Hispanic
(n=927)

Asian (n=68)

All
race/ethnicities
(n=4,949)

134 hospitalizations were other or unknown race/ethnicity

For TBI inpatient hospitalizations, the average length of stay was five days, with the
majority of stays less than five days (65 percent, n=3,200). Length of stay in hospitals

9

due to TBI ranged from less than one full day to 81 days. Figure 10 shows TBI inpatient
hospitalizations by length of stay.
Figure 10. TBI Inpatient Hospitalizations by Length of Stay,
Arizona 2008 (n=4,949)
10-14 Days
7% (n=353)

5-9 Days
20% (n=1,009)

15 Days or More
8% (n=387)

0-4 Days
65% (n=3,200)

TBI inpatient hospitalization charges in 2008 totaled more than $314 million, with 48
percent paid by the Arizona Health Care Cost Containment System
(AHCCCS)/Medicaid and Medicare. This total does not include costs related to
physician care, rehabilitation, lost wages, or long-term costs of disability.
Unintentional injuries accounted for 86 percent of TBI hospitalizations (n=4,271). There
were 34 self-inflicted TBI hospitalizations (one percent) and 603 assaults (12 percent).
Figure 11 shows the TBI inpatient hospitalizations by intent for Arizona in 2008.
Figure 11. TBI Inpatient Hospitalizations by Intent,
Arizona 2008 (n=4,949)
Self-Inflicted
1% (n=34)

Assault
12% (n=603)
Other/unknown
1% (n=41)

Unintentional
86% (n=4,271)

Motor vehicle traffic-related injuries were the most common cause of TBI
hospitalizations (40 percent, n=1,956), followed by falls (33 percent, n=1,653). Table 2
shows causes of TBI inpatient hospitalizations in Arizona during 2008. Descriptions of
these causes are given in Appendix A.

10

Table 2. TBI Inpatient Hospitalizations by Cause,
Arizona 2008
Cause
Number
Percentage
Motor vehicle traffic
1,956
40%
Fall
1,653
33%
Struck by/against
507
10%
Other/unspecified
351
7%
Transport
313
6%
Other pedal cycle
87
2%
Firearm
50
1%
Cut/pierce
32
1%
Total
4,949
100%

Non-Fatal Motor Vehicle Traffic Crash-Related TBI Inpatient Hospitalizations
Of the 1,956 TBI hospitalizations due to motor vehicle traffic crashes, 64 percent were
among males (n=1,258) and 36 percent were among females (n=698). Almost all of the
crashes were unintentional (n=1,952). Twenty-two percent of TBI hospitalizations due
to motor vehicle traffic crashes were among children 19 years and younger (n=425); 13
percent were among individuals ages 20 to 24 years (n=256); 56 percent were among
individuals 25 to 64 years (n=1,089); and 10 percent were among adults 65 years and
older (n=186).
American Indians had the highest rate of TBI hospitalizations for motor vehicle traffic
crashes (45.1 per 100,000 residents; n=157). With 32.9 hospitalizations per 100,000
residents, Non-Hispanic Whites had the second highest rate (n=1,279).
The majority of TBI inpatient hospitalizations due to motor vehicle traffic collisions were
among occupants of motor vehicles (64 percent, n=1,258). Nineteen percent were
motorcyclists (n=362); 11 percent were pedestrians (n=209); and four percent were
pedal cyclists (n=82). Two percent were other/unspecified (n=45). Figure 12 shows
TBI inpatient hospitalizations due to motor vehicle traffic crashes by injured person.

11

Figure 12. TBI Inpatient Hospitalizations due to
Motor Vehicle Traffic Crashes by Injured Person
(All Intents), Arizona 2008 (n=1,956)
Motorcyclist
19% (n=362)

Pedalcyclist
4% (n=82)

Pedestrian
11% (n=209)
Other/unspecified
2% (n=45)

Motor Vehicle
Occupant
64% (n=1,258)

Non-Fatal Fall-Related TBI Inpatient Hospitalizations
There were 1,653 inpatient hospitalizations due to fall-related TBI. Fifty-five percent
were among males (n=912) and 45 percent were among females (n=741). Sixteen
percent of the hospitalizations were among children 19 years and younger (n=258).
Almost all of these falls were unintentional (n=1,646), but seven were self-inflicted or
from assaults or undetermined intents.
Asians had the highest rate of fall-related TBI hospitalizations with 26.6 per 100,000
residents (n=27). The second highest rate was among Non-Hispanic Whites (24.9 per
100,000 residents; n=1,231).
In more than one quarter of fall-related hospitalizations, the hospital discharge database
did not contain any specific information about the events contributing to these falls (25
percent, n=421). The most frequently specified contributing events were slipping,
tripping, or stumbling (30 percent, n=489) and falls from wheelchairs, beds, or other
furniture (10 percent, n=169). Figure 13 shows TBI inpatient hospitalizations due to falls
by contributing event.

12

Figure 13. TBI Inpatient Hospitalizations due to Falls by
Contributing Event (All Intents), Arizona 2008 (n=1,653)

From recreational
equipment or in sports
3% (n=51)

Fall resulting in striking
an object
5% (n=79)

Suicide attempt,
assault, or
undetermined intent
0% (n=7)
From or out of building
3% (n=55)
Slipping, tripping, or
stumbling
30% (n=489)

From stairs/ladders
10% (n=158)
From
wheelchair/furniture
10% (n=169)
Other/unspecified
31% (n=514)

Other fall from one
level to another
8% (n=131)

13

Non-Fatal Emergency Department Visits
In 2008, there were 35,755 TBI emergency department visits among Arizona residents.
Males accounted for more than half of TBI emergency department visits (56 percent,
n=20,129), while females accounted for 44 percent of visits (n=15,626). Forty-six
percent of TBI emergency department visits were among children ages 19 years and
younger (n=16,297). Emergency department visits by age group are shown in Figure
14.

Figure 14. TBI Emergency Department Visits by
Age Group, Arizona 2008 (n=35,755)
0-4 Years
20% (n=7,128)

65+ Years
14% (n=4,878)
45-64 Years
13% (n=4,779)

5-14 Years
15% (n=5,399)
25-44 Years
19% (n=6,913)

20-24 Years
8% (n=2,888)

15-19 Years
11% (n=3,770)

TBI emergency department visit rates were highest among children younger than one
year of age. There were 851 emergency department visits among females younger
than one year of age (a rate of 1,747.1 per 100,000 residents), and 984 visits among
males younger than one year of age (a rate of 1,956.8 per 100,000 residents). For all
children younger than one year of age, 86 percent of TBI emergency department visits
were due to unintentional falls (n=1,569). For adults 85 years and older, 93 percent of
visits were due to unintentional falls (n=1,407). Figure 15 shows the 2008 TBI
emergency department visit rates per 100,000 Arizona residents.

14

Figure 15. TBI Emergency Department Visit Rates per 100,000 by
Age Group and Sex, Arizona 2008
1,747.1
2,000

1,956.8

Females (n=15,626)

1,800

Males (n=20,129)
1,600

1,108.8

1,548.8

1,511.4

1,400
1,200

1,066.3

1,000

905.6
759.3

800

692.8
552.3

600

451.7
368.8
385.4 321.9
385.9
347.3
318.1
302.0
300.0 269.4

395.1

400

477.3

200
0
<1

1-4

5-9

10-14

15-19

20-24

25-44

45-64

65-74

75-84

85+

Age in Years

TBI emergency department visit rates were highest among Non-Hispanic Whites (611.5
per 100,000 residents) and African Americans (561.6 per 100,000 residents). Figure 16
shows the 2008 age-adjusted TBI emergency department visit rates by race/ethnicity in
Arizona.
Figure 16. Age-Adjusted TBI Emergency Department Visit
Rates per 100,000 by Race/Ethnicity, Arizona 2008
700

611.5

561.6

600

538.4

500

438.1

394.9

400

311.4

300
200
100
0
White, NonHispanic
(n=22,826)

African
American
(n=1,542)

Hispanic
(n=8,845)

American
Indian
(n=1,357)

Asian (n=508)

All
race/ethnicities
(n=35,755)

677 emergency department visits were by individuals of other or unknown race/ethnicity

TBI emergency department charges in 2008 totaled more than $139 million, with 37
percent paid by the Arizona Health Care Cost Containment System

15

(AHCCCS)/Medicaid and Medicare. This total does not include costs related to
physician care, rehabilitation, lost wages, or long-term costs of disability.
The majority of TBI emergency department visits were attributed to unintentional injuries
(88 percent, n=31,207), and 12 percent were assaults (n=4,371). Figure 17 shows TBI
emergency department visits by intent during 2008 in Arizona.

Figure 17. TBI Emergency Department Visits by Intent,
Arizona 2008 (n=35,755)
Self-Inflicted
0% (n=51)

Assault
12% (n=4,371)
Other/unknown
0% (n=126)

Unintentional
88% (n=31,207)

The leading causes of TBI emergency department visits were falls (48 percent,
n=17,258), struck by/against injuries (24 percent, n=8,624), and motor vehicle trafficrelated injuries (14 percent, n=4,959). Table 3 shows TBI emergency department visits
by cause for Arizona in 2008. Descriptions of these causes are given in Appendix A.

Table 3. TBI Emergency Department Visits by Cause,
Arizona 2008
Cause
Number
Percentage
Fall
17,258
48%
Struck by/against
8,624
24%
Motor vehicle traffic
4,959
14%
Other/unspecified
2,489
7%
Transport
1,176
3%
Other pedal cycle
1,037
3%
Cut/pierce
212
1%
Total
35,755
100%

Non-Fatal Fall-Related Emergency Department Visits
There were 17,258 emergency department visits due to fall-related TBI. Forty-nine
percent were among males (n=8523,) and 51 percent were among females (n=8,735).

16

Nearly all of these falls were unintentional (n=17,249). Fifty percent of TBI emergency
department visits due to falls were among individuals 19 years and younger (n=8,665).
Sixteen percent of the falls did not have contributing event information specified in the
hospital discharge database (n=2,841). The most frequently specified contributing
events to fall-related TBI were slipping, tripping, or stumbling (30 percent, n=5,176) and
falls from furniture or wheelchairs (18 percent, n=3,101). Figure 18 shows TBI
emergency department visits due to falls by contributing event.

Figure 18. TBI Emergency Department Visits due to Falls by
Contributing Event (All Intents), Arizona 2008 (n=17,258)
Fall resulting in striking
an object
12% (n=2,150)

Suicide attempt,
assault, or
undetermined intent
0% (n=9)

From or out of building
1% (n=96)

From recreational
equipment or in sports
6% (n=970)
Slipping, tripping, or
stumbling
30% (n=5,176)

From stairs/ladders
6% (n=1,074)

From
wheelchair/furniture
18% (n=3,101)

Other/unspecified
17% (n=2,996)

Other fall from one level
to another
10% (n=1,686)

Non-Fatal Struck By/Against-Related TBI Emergency Department Visits
Struck by/against injuries include being struck by an object (such as falling furniture),
striking against an object (such as the edge of a bathtub), or being struck by other
people (such as when playing sports). Of the 8,624 TBI emergency department visits
due to struck by/against injuries, 66 percent were among males (n=5,676) and 34
percent were among females (n=2,948). Sixty-eight percent of these injuries were
unintentional (n=5,888), and 31 percent were assaults (n=2,657). Forty-nine percent of
TBI emergency department visits from struck by/against injuries were among individuals
19 years and younger (n=4,264).
The emergency department discharge database did not include information regarding
contributing event for 30 percent of the struck by/against injuries (n=2,471). The most
frequently specified contributing events were assaults in unarmed fights (21 percent,
n=1,845) and blows while playing sports (15 percent, n=1,334). Figure 19 shows TBI
emergency department visits due to struck by/against injuries by contributing event.

17

Figure 19. TBI Emergency Department Visits due to Struck
By/Against Injuries by Contributing Event (All Intents),
Arizona 2008 (n=8,624)
Assault with blunt
object
9% (n=812)

Assaulted in unarmed
fight
21% (n=1,845)

Struck unintentionally
by falling object
8% (n=678)

Legal intervention
1% (n=79)
In sports
15% (n=1,334)

By furniture
4% (n=384)

Other/unspecified
30% (n=2,493)

Against other stationary
objects
12% (n=999)

18

Data Notes
All rates shown were calculated using the 2008 Arizona resident population estimates
published by the Arizona Department of Health Services in Arizona Health Status and
Vital Statistics 2008. Age-adjusted rates were standardized to the 2000 U.S. standard
population using the direct standardization method. Age-adjusted rates have been
presented when possible, as age-adjusting controls for the effects of age differences in
populations (i.e., a large proportion of older adults or young children) and allows for
more accurate rate comparisons.
Mortality data were tabulated from death certificates for Arizona residents who died in
2008. Inpatient hospitalization data were compiled from the 2008 Arizona Hospital
Discharge Database. Emergency department visit data were compiled from the 2008
Arizona Emergency Department Discharge Database.
The discharge databases contain information from private, acute-care facilities in the
state of Arizona, and do not include visits to federal facilities, such as Veterans’ Affairs
Hospitals or Indian Health Services facilities. The discharge databases do not contain
data from urgent care facilities, private physician practices, or medical clinics.
Additionally, discharge data include hospital transfers and readmissions, so a single
injured individual may be counted more than once. These data should be interpreted as
episodes of medical treatment, not individual injuries.
Codes from the International Classification of Diseases, Version 9, clinical modification
(ICD-9-CM) were used for determining TBI cases among hospital and emergency
department data. ICD-10 codes were used for mortality data. The specific codes used
are described in Traumatic Brain Injury in the United States: Emergency Department
Visits, Hospitalizations and Deaths, published in 2006 by the U.S. Centers for Disease
Control and Prevention (CDC). Traumatic brain injury-related inpatient hospitalizations
and emergency department visits resulting from medical misadventures have been
excluded from this report.

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Cause
Fall
Firearm
Unknown cause
Motor vehicle traffic

Other land transport

Other pedal cycle
Other/unspecified
Struck by/against

Transport

Appendix A. Definitions of Causes
Definition
Includes falls from furniture, stairs, playground
equipment, and those that occur while playing sports.
Includes injuries from handguns, shotguns, BB guns,
etc.
Cause not listed.
Includes collisions that occur on public highways and
streets. These collisions may include pedestrians,
pedal cyclists, motorcyclists, and occupants of motor
vehicles.
Includes collisions involving railway transport or allterrain vehicles operating off-road. This cause only
applies to deaths and is not used in hospitalization or
emergency department databases.
Includes injured pedal cyclists struck by pedestrians,
pedal cycles, or non-motorized vehicles.
Unspecified events or other rare events.
Includes being struck by furniture, struck by other
people while playing sports, or hit by objects while
playing sports.
Other non-motorized, off-road vehicle, or rail transport.
This cause only applies to hospitalization and
emergency department databases and is not used on
death certificates.

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