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The lifetime prevalence of traumatic brain injury (TBI) among children age <17 years was an estimated 2.5%, based on parents' reports of healthcare professionals' diagnoses, an analysis of national survey data found.

This represents more than 1.8 million children nationally. Unlike previous estimates, it likely includes TBIs that were treated in settings other than emergency departments (EDs), reported Juliet Haarbauer-Krupa, PhD, of the CDC in Atlanta, and colleagues in .

Across the country, estimates of TBI ranged from an age-adjusted prevalence of 1.2% in Mississippi to 5.3% in Maine, with prevalence higher in states with higher estimates of private health insurance (OR 1.36) or parent-reported adequate insurance (OR 1.16). "This could result in a greater likelihood of seeking healthcare after TBI, which may lead to higher estimates of diagnosed TBIs," Haarbauer-Krupa told MedPage Today.

But it "could also indicate that some childhood TBIs go untreated for lack of health insurance," she observed.

The analysis also found that children with a lifetime history of TBI were more likely to have a variety of health and developmental conditions, compared with children without a history of TBI, including:

• Learning disorders: 21.4%
• Attention deficit-hyperactivity disorder: 20.5%
• Speech/language problems: 18.6%
• Developmental delay: 15.3%
• Bone, joint, or muscle problems: 14.2%
• Anxiety problems: 13.2%

"These findings support further inquiries about a child's TBI and overall health history by healthcare providers to ensure optimal recovery and outcomes after childhood TBI," Haarbauer-Krupa said.

Healthcare professionals need to be vigilant about assessing children with head injuries with validated tools, noted Steve Hicks, MD, PhD, of Penn State College of Medicine in Hershey, who was not involved with the study.

"Assessing symptom burden, cognition, and balance in the context of predisposing risk factors -- such as previous concussion, neurologic or psychiatric disorder, and family or social stressors -- can provide guidance for important return-to-play or return-to-learn decisions," Hicks told MedPage Today. "Open communication with athletic trainers, teachers, and other professionals who are involved in children's daily activities will be critical for improving concussion recognition and management."

For this analysis, the researchers examined the 2011-2012 , a cross-sectional telephone survey of U.S. households with a response rate of 23%. They did not look at medical records and relied on parents reporting whether they had ever being told by a healthcare professional that their child had a brain injury or concussion. The researchers weighted the data to adjust for the low survey response rate.

The study is the first to provide a lifetime estimate of TBI across the developmental age span for children, Haarbauer-Krupa's group noted. Previous national estimates were based on rates or a by a single large pediatric healthcare system.

The findings were based on cross-sectional data; causality between TBI and other health conditions cannot be assessed. The study also did not include children who didn't receive medical care for their injuries. The proposed potentially could obtain more comprehensive prevalence estimates of TBI in children, Haarbauer-Krupa said.