Traumatic Brain Injury
Did You Know?
According to the Centers for Disease Control and Prevention (CDC), at least 5.3 million individuals in the United States have a permanent disability as a result of TBI.1 Advances in emergency medicine, faster response time from the scene of injury to the emergency department, and highly trained and skilled responders have all contributed to increased survival rates for individuals who are severely injured. As an increasing number of individuals with TBI survive severe injuries, families and other advocates look to the State and Federal government for assistance with the medical, rehabilitation, long-term care, and other needs associated with brain injury.
The CDC defines a TBI as an injury to the head arising from blunt or penetrating trauma or from acceleration-deceleration forces.2 The injury is not of a degenerative or congenital nature. The severity of injury can range from mild (a brief change in mental status or consciousness), to severe (an extended period of unconsciousness or prolonged amnesia after the injury). Regardless of severity, the consequences are often devastating. The term TBI does not include brain dysfunction caused by congenital or degenerative disorders, nor birth trauma, but may include brain injuries caused by anoxia due to trauma.
According to the CDC, each year an estimated 1.4 million individuals in the United States sustain a TBI. Of those injured, 1.1 million have injuries serious enough to require treatment in hospital emergency departments. Annually, more than 235,000 people are hospitalized and 50,000 people die as a result of their injuries. An estimated 80-90,000 Americans with TBI experience permanent impairs their physical, cognitive, and psychosocial functioning which in turn impacts their ability to return to home, school, and work.
Approximately 475,000 children ages birth to 14 receive a TBI with emergency department visits counting for more than 90 percent of the TBIs in this age group. The risk for incurring a TBI is highest among adolescents, young adults, and persons over the age of 75, with the risk among males twice the risk among females. African Americans have the highest death and hospitalization rates from TBI.3 The reasons for these disparities are not well known. Transportation incidents, primarily motor vehicle crashes, are the leading cause of TBI-related hospitalizations, whereas falls are the leading cause of all TBIs. The injury rates for falls are highest among children ages birth to four years and adults age 75 or older. The injury rates for both motor vehicle and assault-related TBI are highest among adolescents ages 15 to 19.3
Drug and alcohol abuse also has been associated with TBI as both a contributing factor to the injury and as a complicating factor in rehabilitation.4 Individuals who sustain one concussion or mild brain injury are more apt to experience additional concussions, and the cumulative effect of repeated concussions, as is frequently seen in sports-related TBI, increases the likelihood of long-term neurological damage and learning disability.5
Whether the injury is the result of a car crash, a slip and fall, assault, or sports activity, the economic consequences of TBI can be enormous. In the United States, the average lifetime cost of care for a person with a severe injury ranges from $600,000 to $1,875,000.6 This does not include lost earnings of the injured person or family caregivers. The total cost of TBI to the nation is estimated at $56.3 billion annually. 7
Many factors contribute to the consequences of TBI including the location and severity of injury, pre-injury personality, age, and so forth. Symptoms of brain injury may appear immediately after the injury occurs or may not appear for days or weeks following the injury. It is usually difficult to predict the outcome of a brain injury as a patient's prognosis may not be known for many months or even years. The long-term effects and impact of brain injuries can be subtle and difficult to diagnose and substantiate; and yet serious brain injuries can be devastating, producing permanent mental and physical disability.
Individuals who survive their injuries may experience physical impairments such as seizures, fatigue, balance problems, hearing loss, and changes in vision or speech. Ambulation is a significant challenge for many individuals based on loss of gross and fine motor control. Cognitive, or thinking, impairments are common and include memory loss, concentration difficulty, organizational problems, poor judgment, and the inability to perform multiple tasks at the same time.
Individuals with TBI may also experience behavioral impairments such as failure to recognize deficits, impulsivity, sexual dysfunction and an inability to initiate or complete tasks without reminders. These impairments are the result of the neurological damage the individual has sustained and are distinct from the anxiety, depression, and substance abuse that may accompany the injury.
Beginning with the onset of injury and continuing through acute care, rehabilitation, and community integration, individuals with brain injury may require immediate treatment and individualized services and supports that may be lifelong and changing over time. The resulting disability associated with a TBI generally impacts an individual's ability to return to home, school or work, and community. Community-based services and supports such as housing, transportation, personal care assistance, tutoring, job coaching, caregiver respite and other assistance and accommodations may be needed to avoid unnecessary placement in long-term care settings and to ensure independence, to ease stress on peer and family relationships, and to enhance performance in school and at work. These services and supports may come from multiple private, local, State and Federal programs and assistance.
Families and friends are generally the caretakers of individuals with TBI who require long-term care. The February 1998 General Accounting Office Report, TBI Programs Supporting Long-Term Services in Selected States (HEHS-98-55), concludes, "As families exhaust their resources, the public sector pays for a greater share of the services received."8 That is, when ongoing needs surpass families' capacities for providing care, nursing home or community care costs can quickly exceed financial resources.
Click here to order a copy of our latest "Guide to State Government Brain Injury Policies, Funding and Services" to learn more about TBI definitions and State systems components.
1.Thurman, D, Alverson, C, Dunn, K, Guerrero, J, Sniezek, J. Traumatic Brain Injury in the United States: A Public Health Perspective. Journal of Head Trauma Rehabilitation, 14(6):602-15, 1999.
2. Thurman, D, Sniezek J, Johnson D, Greenspan A, Smith S. Guidelines for Surveillance of Central Nervous System Injury. Atlanta: Author, 1994.
3. Langlois, JA, Rutland-Brown, W, Thomas, KE. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. October 2004.
4. Corrigan, J. Substance Abuse as a Mediating Factor in Outcome From Traumatic Brain Injury. Archives of Physical Medicine Rehabilitation, 76 (4):302-309, 1995.
5. Kelly, J and Savage, R. Sports and Return to School Issues Following Concussion. Brain Injury Source, 3(3):34-37, 1999.
6. Report of the NIH Consensus Development Conference on the Rehabilitation of Persons with Traumatic Brain Injury. National Institutes of Health, National Institutes of Child Health and Development, Bethesda, MD: 1999.
7. Thurman, D. The Epidemiology and Economics of Head Trauma. In Miller, L. and Hayes, R. eds. Head Trauma: Basic, Preclinical and Clinical Directions. New York: Wiley and Sons. 2001.
8. General Accounting Office. Traumatic Brain Injury: Programs Supporting Long-Term Services in Selected States (GAO/HEHS Publication No. 98-55). Washington, DC: US Government Printing Office.
Products
- Traumatic Brain Injury Facts: An Overview (Fact Sheet)
- El Trauma Cerebral (Spanish: Traumatic Brain Injury Facts: An Overview) (Fact Sheet)
