depar depar depar depar department of health and human ser tment of health and human ser tment of health and human ser tment of health and human ser tment of health and human services vices vices vices vices Introduction Approximately 1.5 million Americans sustain a traumatic brain injury (TBI) each year (1). According to a recent estimate , of those injured, approximately one quarter million are hospitalized and survive (1), which is more than 20 times the number of hospitalizations each year for spinal cord injury (2), another key disabling injury. Unlike spinal cord injury, however, TBI is frequently referred to as the silent epidemic (3) because the problems that result from TBI (e.g., impaired memory) often are not visible. One year after discharge, approximately one third of adults hospitalized with TBI still need help from another person to perform daily activities (4). Estimated lifetime costs of TBI in the United States totaled approximately $56.3 billion in 1995 (5). In 1989, a task force convened by the U.S. Department of Health and Human Services recommended the establishment of TBI as a category in public health reporting systems (6). In response, CDC published Guidelines for Surveillance of Central Nervous System (CNS) Injury (7) and funded four states to Abstract Problem/Condition: Previous studies indicate that each year in the United States, approximately 1.5 million Ameri-cans sustain a traumatic brain injury (TBI). Of those injured, approximately one quarter million are hospitalized. Approximately one third of adults hospitalized with TBI still need help with daily activities 1 year after their discharge. Description of the System: Data are from 14 states that participated in an ongoing CDC-funded TBI surveillance system. State health departments used CDC guidelines to identify TBI cases from hospital discharge data or from other statewide injury data systems. Supplementary information was abstracted from medical records. Results: The overall age-adjusted TBI-related live hospital discharge rate was 69.7/100,000 population. Rates were highest for American Indians and Alaska Natives (75.3/100,000) and Blacks (74.4/100,000). The age-adjusted rate for males was approximately twice as high as for females (91.9 versus 47.7/100,000 respectively). For both sexes, the rates were highest among those aged 15–19 years and >65 years. Motor-vehicle crashes, falls, and assaults were the leading causes of injury for TBI-related discharges (27.9, 22.5, and 7.3/100,000 respectively). TBI-related discharge rates for falls were highest among those aged >65 years (82.3/100,000). Black males and American Indian/Alaska Native males had …