Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. It occurs when a sudden trauma causes damage to the brain either by the force of impact or by piercing the skull and entering brain tissue. An estimated 5.3 million Americans are living with a disability caused by a TBI, and face numerous challenges in their efforts to live a full and productive life. It is the top cause of death and disability in people between the ages of 1 to 44 years.
Brain injuries are most often caused by motor vehicle crashes; sports injuries; assaults; or simple falls, at work or in the home. They cause approximately 52,000 deaths a year and raise the risk of developing Alzheimer disease.
TBI has been defined by Segun Toyin Dawodu, MD, of Albany Medical College in New York, as "…a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness". He does, however, point out that the definition has not been consistent and tends to vary according to specialties or circumstances.
Brain injury can sometimes go unnoticed while a medical team is focused on lifesaving measures, although the use of technology to control breathing with respirators and decrease intracranial pressure has helped reduce mortality from TBIs. TBI is classified as either mild or severe; if loss of consciousness and/or confusion and disorientation last less than 30 minutes, the brain injury is classed as mild.
While the results of magnetic resonance imaging and computed tomography scans are often normal, the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration. These injuries are commonly overlooked. Although this type of TBI is called “mild”, the effect on the family and the injured person can be devastating.
Severe brain injury is associated with loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury of longer than 24 hours. The deficits range from impairment of higher-level cognitive functions to comatose states. Survivors may have limited function of arms or legs, abnormal speech or language, loss of thinking ability, or emotional problems. The range of injuries and degree of recovery vary on an individual basis.
The effects of TBI can be profound. Individuals with severe injuries can be left in long-term unresponsive states. For many people with severe TBI, long-term rehabilitation is often necessary to maximize function and independence. Even with mild TBI, the consequences to a person’s life can be dramatic. Change in brain function can have a dramatic impact on one’s family, job, and social and community interaction.
The World Health Organization states, "Traumatic brain injury usually requires long-term care and therefore incurs economic cost to health systems. For this reason, many countries need to develop surveillance systems and conduct epidemiologic studies to measure the impact of neurotrauma among their people to guide the development of more effective preventive methods. A number of methods have already proven effective, such as the use of motorcycle helmets, head supports in vehicles or on sports equipment." The WHO also warns that low- and middle-income countries in particular face higher risk factors at the same time as having inadequately prepared health systems to manage the consequences.
Prevention efforts focus primarily on common sense measures such as always wearing seat belts in motor vehicles and using appropriate child safety seats. Public health messages aimed at preventing brain injury also focus on the dangers of driving under the influence of alcohol or drugs, and the benefits of wearing a helmet for such activities as riding a bicycle, motorcycle, or scooter; playing contact sports; horseback riding; skiing; snowboarding; or skating.
For people with poor vision or who have difficulty walking, adequate lighting and rails should always be provided on stairways. Bars may be needed on windows to prevent children falling, and obstacles should be cleared from pathways. Guns should be unloaded and kept in a locked cabinet, and ammunition should be stored separately from guns.
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006;21:375-378.
World Health Organization. Neurotrauma. http://www.who.int/violence_injury_prevention/road_traffic/activities/neurotrauma/en/. Accessed September 1, 2015.
Dawodu, ST. Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology. Medscape March 3, 2015. http://emedicine.medscape.com/article/326510-overview#a1. Accessed September 1, 2015.
TraumaticBrain.Injury.com. What are the Effects of TBI? http://www.traumaticbraininjury.com/understanding-tbi/what-are-the-effects-of-tbi/. Accessed September 1, 2015.
Additional Reading (Southern Medical Journal resources on this topic):
Holt GR. Sports concussions and traumatic brain injury. South Med J 2014;107:114.
Terrell TR, Nobles T, Rader B, et al. Sports concussion management: part I. South Med J 2014;107:115-125.