Brain Injury, Traumatic

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Description

  • Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force.
  • Mild TBI (mTBI) is defined by Glasgow Coma Scale (GCS) score 13 to 15 and short-lived neurologic symptoms (loss of consciousness [LOC], posttraumatic amnesia, altered mental status [AMS], or transient neurologic deficit).
  • System(s) affected: neurologic; psychiatric; cardiovascular; endocrine/metabolic; gastrointestinal; pulmonary
  • Synonym(s): head injury, concussion

Epidemiology

Incidence

  • Majority (>70%) of TBIs are mild.
  • 2.87 million ED visits with 288,000 hospitalizations per year in the United States
  • 56,000 TBI-related deaths per year; ~43% of patients who survive will experience long-term disabilities.
  • Young children (ages 0 to 4) and older adults (≥75 years old) have highest incidence (1).

Etiology and Pathophysiology

  • Centers for Disease Control and Prevention (CDC) TBI data in 2017, mechanism of injury of hospitalized patients (male vs. female percentage)
    • Unintentional falls (35.6 vs. 23.9)
    • Motor vehicle crashes (22.5 vs. 10.8)
    • Unintentionally being struck by or against an object (2.3 vs. 0.9)
    • Intentional self-harm (0.8 vs. 0.3)
    • Assault (7.5 vs. 1.7)
    • Children 0 to 17 years
      • Falls (7.7)
      • Motor vehicle crashes (6.8)
  • Contact sports account for 45% of TBI emergency room visits for children related to sports and recreation.
  • Mechanical damage with actuation of complex cellular and molecular cascades that promote cerebral edema, ischemia, and apoptotic cell death

Risk Factors

Alcohol and drug use, prior/recurrent head injury, contact sports, seizure disorderGeriatric Considerations
Subdural hematomas (SDHs) are common after a fall or blow in elderly; symptoms may be subtle and not present until days after trauma.

General Prevention

  • Safety education and fall prevention
  • Seat belts; bicycle and motorcycle helmets
  • Banning certain types of contact in sports that carry increased risk of concussion

Geriatric Considerations
Learning about individual fall risk can help prevent injuries resulting in TBI for adults ≥75 years old.Pediatric Considerations

  • Incidence is high in children age 0 to 4 due to falls and developing motor skills. Risk also increases in adolescence due to sports and motor vehicle accidents.
  • Child abuse: Consider if dropped or fell <4 feet (e.g., off bed, couch), suspicious history, significant injury present, injury inconsistent with developmental age (e.g., rolling off bed in an infant), or any retinal hemorrhages.

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