Traumatic Head & Brain Injury

Safety & Health Assessment & Research for Prevention (SHARP) — Research for Safe Work

Public health importance of traumatic head and brain injuries

Traumatic head and brain injuries (THBI) are severe injuries to the brain or head caused by the head striking or being struck by an object. The term is synonymous with, but more descriptive than, traumatic brain injury.

Traumatic head and brain injuries are severe with high morbidity, mortality, and considerable social impact. The US annual incidence rate for THBI varies between 137 and 367 per 100,000 US residents. In 1992, 34% of all injury deaths in the US general population were from THBI. Annual direct costs in 1985, for both occupational and non-occupational THBI were approximately $4 billion. Between 4 and 7% of all THBI are occupational injuries.

From 1990 - 1997, the average annual Washington State state fund workers' compensation claims incidence rate for THBIs hospitalized within 7 days of the injury event was 9 per 100,000 employed workers. The average number of days per claim spent requiring hospital care was 67 while the average number of days lost from work was nearly 400 per claim. The total direct cost to the workers' compensation system was $115 million and the average direct cost of a workers' compensation claim was $135,000. These costs do not include the long-term social costs of changes in living arrangements, social relationships, speech and hearing disabilities, inattentive behavior and loss of social autonomy.

Purpose and operation


The purpose of the system is the identification of patterns and trends that can be used to reduce, through prevention, the occupational risks associated with traumatic head and brain injury.


  • Describe the incidence, prevalence and mortality associated with work-related traumatic head and brain injury.
  • Identify high risk occupations and industries.
  • Identify useful prevention strategies.
  • Generate hypotheses about causative agents and factors.

Planned uses

  • Identifying outbreaks of work-related traumatic head and brain injury.
  • Analyzing risks by occupation and industry.
  • Tracking trends in the incidence, prevalence and mortality associated with work-related traumatic head and brain injury.
  • Sharing information with the public, health care providers, public health professionals, and labor and industry stakeholders.

Case definition

A case is any worker with a reported workers' compensation claim in the state of Washington, who received hospital inpatient treatment within a week of a traumatic head or brain injury coded with ICDCM codes 800, 801, 803, 804, and 850 through 854.

Legal authority

No additional legal authority was needed to implement this surveillance system.

Organizational location

The surveillance system is located within the Safety and Health Assessment and Research for Prevention (SHARP) Program of the Washington State Department of Labor & Industries.

System components

Population under surveillance

The population under surveillance was limited to workers employed in the state of Washington, whose coverage under Workers Compensation is provided by the State Fund.

Time period of data collection

January 1, 1990 through December 31, 1997

Collection and reporting sources

Workers' compensation claims data contained in the Medical Information and Payment System (MIPS) and the Labor & Industries Industrial Insurance System (LINIIS). Providers of medical service use MIPS to submit bills for payment of services rendered under workers' compensation. LINIIS is used to administer eligibility requirements and payment of workers' compensation claims.

Data management

A case listing was created using the unique claimant ID included in MIPS for inpatient hospital records that had the ICD codes in the case definition. The records in LINIIS with this ID were joined to the MIPS records to create the database for the surveillance system.

Data analysis and dissemination

Tables and graphs for describing the occurrence of injuries and costs by occupation and industry were created from the surveillance database. They were incorporated into a report that was disseminated to a variety of stakeholders.

Patient privacy, pata confidentiality, and system security

All records with a personal identifier or could be associated with a personal identifier are considered confidential. These records are used only for surveillance and prevention purposes. Physical access to the building and access to individual computers are controlled as part of the security systems of the Department of Labor & Industries.

Traumatic head and brain injury (THBI) resources developed by the SHARP program


THBI reports are available from SHARP's Publications page.

Links to other Traumatic head and brain injury (THBI) information

External hyperlinks are provided as a public service by the SHARP Program. Neither L&I nor SHARP are responsible for the reliability or accuracy of the information found on other Web sites. (Privacy and Security Policy)

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