Brain Injuries

A traumatic brain injury (TBI) is a significant blow, shock, or penetrating head injury that disrupts the function of the brain. It is a nondegenerative, noncongenital insult to the brain from an external mechanical force. This may possibly lead to permanent or temporary impairments of cognitive, physical, and psychosocial functions with a diminished or altered level of consciousness. The severity may range from mild or brief change in mental status or consciousness to severe or extended periods of unconsciousness or even amnesia. A TBI can result in short- or long-term brain function problems and contributes to morbidity and fatality in multiple systems trauma throughout the world.

Globally, TBI accounts for a significant amount of trauma and related illness and injury. The effects of poor safety standards in industry, motor vehicle crashes and lack of helmets and seat belt use, conflict- and war-related injury such as explosion/blasts and violence, sports injuries such as boxing and contact sports, increased alcohol and drug consumption, as well as the inability for many of those with head injury to receive prompt and adequate diagnosis and treatment make TBI a major problem for the developing world.

Of the 1.5 million who sustain a TBI each year in the United States, roughly 50,000 die, 235,000 are hospitalized, and about 1.1 million are treated and released from an emergency department. TBI accounts for approximately 40 percent of all deaths from acute injuries in the United States. Globally, the number of patients who receive TBI but do not seek medical attention or simply do not have any access to medical care is unknown and thought to be significant in remote areas, developing nations, and areas currently in conflict.

The leading causes of TBI throughout the world are preventable and vary from country to country. The [Page 296]most common are from falls (both ground level and from height), motor vehicle crashes, blunt trauma, penetrating trauma, and explosion blasts. In areas of political conflict and war, many other mechanisms exist that cause TBI. For example, a concussion is caused by deformity of the deep structures of the brain that can lead to neurological dysfunction. Concussion is considered a mild form of diffuse axonal injury and is a mild form of TBI. Males are about 1.5 times more likely than females to sustain a TBI. The two age groups at highest risk for TBI in the United States are 0 to 4 year olds and 15 to 19 year olds. Military duties increase the risk of sustaining a TBI and many normal soldiers and forced child soldiers throughout Africa and other regions in conflict suffer the most from TBI. In the United States, African Americans have the highest death rate from TBI.

At least 5.3 million Americans have a long-term need for help performing activities of daily life as a result of a traumatic brain injury.

The Glasgow Coma Scale (GCS) defines severity of TBI within 48 hours of injury. GCS is a standardized system used to assess the degree of brain impairment and to identify the seriousness of injury as it relates to outcome. The three determinants in the GCS are eye opening, verbal responses, and motor responses. This standard is accepted globally and aids in predicting long-term negative effects and morbidity. The Centers for Disease Control and Prevention (CDC) estimates that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.

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