Definition of Traumatic Brain Injury
The Centers for Disease Control and Prevention (CDC) defines TBI as “craniocerebral trauma associated with neurological or neuropsychological abnormalities, skull fracture, intracranial lesions or death”. Injury leads all causes of death for Americans under age 44. One-third of injury-related deaths are associated with TBI. Approximately 230,000 hospitalizations occur per year as a result of TBI. Nearly 2 percent of the population of the United States lives with TBI-related disabilities.
A recently published analysis of epidemiological studies of TBI in the United States found the combined incidence of hospitalized and fatal TBIs to be 101 per 100,000. Rates among men were approximately twice those of women (though death rates for males are 3.4 times as high as they are for females). Rates were highest among adolescents and young adults as well as seniors (bi-modal distribution). The estimated annual rate of mild TBI, treated only in hospital emergency rooms or out-patient settings, was 540 per 100,000.
The most frequent causes of TBI differ based upon gender and age at injury. Firearms and motor vehicle collisions are the leading causes of TBI in those under 75 years of age, and falls are the leading cause for those 75 and older. Further, firearms-related TBI occur 6 times more frequently among males than females. A CDC-supported analysis of TBI occurring in 7 states in 1994 revealed that the median age at time of injury for those with TBI requiring hospitalization or leading to death was 32 years and that transportation-related causes of TBI accounted for 49% of these injuries.
Improvements in acute brain injury management have led to reduced mortality rates, which have fallen from the 50% range in the 1970s to the 30% range in the 1990s for severe TBI. Optimal acute care requires healthcare systems which offer not only outstanding pre-hospital care, emergency care, surgical and critical care, but also specialists skilled at recognizing and intervening when secondary complications (such as seizures, dysautonomia, hydrocephalus, deep venous thrombosis, pneumonia and urinary tract infection arise). The complexity of care needs experienced by patients with TBI demands state-of-the-art care with multiple capabilities. Optimal care requires a comprehensive center that offers access to a broad range of expertise in multiple areas of medical and rehabilitative care. In addition to high quality rehabilitation care, the patient should have continued access to the collaborative efforts of a multitude of specialty services (including physiatry, neurology, neurosurgery, orthopedics, internal medicine, plastic surgery, and ophthalmology) to effectively address long-term medical care issues as they arise.
