The Problem

A blow or jolt to the head can result in a traumatic brain injury (TBI), which can disrupt the normal function of the brain. The severity of the injury may range from mild, a brief change in mental status or consciousness, to severe, an extended period of unconsciousness (30 minutes or more), prolonged amnesia after the injury, or a penetrating skull injury. Any TBI can result in short- and long-term disabilities (CDC unpublished).

Brain injuries are among the most likely types of injury to cause death or permanent disability.

• Each year in the United States, an estimated
  -1.5 million people sustain a TBI, which is 8 times the number of people diagnosed with breast cancer and 34 times the number of new cases of HIV/AIDS (see graph below);

-50,000 people die from a TBI, which accounts for one-third of all injury deaths; -80,000 to 90,000 people experience the onset of long-term or lifelong disability associated with a TBI.

• Among children ages 0 to 14 years, traumatic brain injury results in an estimated

-3,000 deaths;

-29,000 hospitalizations;

-400,000 emergency department visits (Langlois 2001).

• An estimated 300,000 sports-related brain injuries of mild to moderate severity occur in the United States each year (CDC 1997a).

Consequences

• TBI may cause problems with:

-Cognition—concentration, memory, judgment, and mood;

-Movement abilities—strength, coordination, and balance;

-Sensation—tactile sensation and special senses such as vision;

-Emotion—instability and impulsivity (Thurman 1999).

• At least 5.3 million Americans—2% of the U.S. population—currently live with disabilities resulting from TBI (Thurman 1999) (This estimate is based on the number of people hospitalized with TBI each year and does not include people seen in Emergency Departments who were not admitted to the hospital, those seen in private doctor's offices, and those who do not receive medical care.)

• An estimated 15% of persons who sustain a mild brain injury continue to experience negative consequences one year after injury (Guerrero et al 2000).

• TBI can cause seizure disorders such as epilepsy (Hauser 1993).

• Repeated mild brain injuries occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild brain injuries occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal (CDC 1997a).

Causes

• The leading causes of TBI are vehicle crashes, firearm use, and falls (Thurman 1999).
• Crashes involving motor vehicles, bicycles, pedestrians, and recreational vehicles are the primary causes of TBI (Thurman 2001).
• Firearm use is the leading cause of death related to TBI (CDC 1999).
• Firearms cause about 10% of all TBIs, but they account for 44% of TBI-related deaths (CDC 1999).
• Nine out of 10 people with a firearm-related TBI die (CDC 1999)
• Nearly two-thirds of firearm-related TBIs are classified as suicidal in intent (CDC 1999)

Cost

In the U.S. in 1995, direct and indirect costs of TBI totaled an estimated $56.3 billion (Thurman 2000).

Groups at Risk

• Males are about twice as likely as females to sustain a TBI (CDC 1997b)

• People ages 15 to 24 years and those over age 75 are the two age groups at highest risk for TBI (Thurman 1999).

• African Americans have the highest death rate from TBI (Thurman 1999).

Prevention Strategies

Public health strategies to prevent future TBIs, reduce TBI-related disabilities, and improve outcomes of brain-injured persons include:

• Increasing helmet use during recreation and sports activities (Thurman 1998).

• Preventing falls among children and older adults by modifying the environment to reduce fall hazards and the impact of falls; and where possible, reducing medications with side effects that may contribute to falls (Thurman 2001).

• Enhancing violence-prevention programs designed to decrease the occurrence of self-directed and interpersonal violence (Thurman 2001).

• Improving use of child safety seats and seat belts and reducing alcohol- and drug-impaired driving (Thurman 2001).

• Enhancing trauma care surveillance systems and clinical preventive services  (Pollock 2001).

• Improving data collection for TBI incidence (Thurman 1999).

• Conducting follow-up studies of persons with TBI to assess outcomes and identify service needs (Thurman 2001)

• Educating persons with TBI about steps to ease recovery and about available services (Pickelsimer 2002).