5-Minute Clinical Consult
Brain Injury, Traumatic
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Basics
Description
- Traumatic brain injury (TBI) is defined as an alteration in brain function or other evidence of brain pathology, caused by an external force.
- System(s) affected: neurologic; psychiatric; cardiovascular; endocrine/metabolic; gastrointestinal
- Synonym(s): head injury, concussion
Epidemiology
Incidence- 69 million individuals worldwide are estimated to sustain a TBI each year.
- 2.5 million ED visits and 288,000 hospitalizations per year
- 56,800 deaths per year; ~30% of all injury-related deaths
- Incidence in males twice that of females with 4-fold risk of fatal trauma
Prevalence
- Predominant age: 0 to 4 years, 15 to 19 years, and >65 years
- Predominant gender: male > female (2:1)
Etiology and Pathophysiology
- Falls (40%)
- Motor vehicle accidents (14%)
- Assault (10%)
- Child abuse (24% of TBI age ≤2 years)
- Recreational activities (21% of pediatric TBI, peak seasons spring/summer; peak ages 10 to 14 years)
- Primary insult: direct mechanical damage
- Secondary insult: 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 disorder, attention deficit hyperactivity disorder, male sex
Geriatric Considerations
Subdural hematomas are common after a fall or blow in elderly; symptoms may be subtle and not present until days after trauma. Many elderly patients are on antiplatelet or anticoagulation therapy.
General Prevention
- Safety education and fall prevention
- Seat belts; bicycle and motorcycle helmets
- Protective headgear for contact sports
Pediatric Considerations
Child abuse: Consider if dropped or fell <4 feet (e.g., off bed, couch), suspicious history, significant injury present, or any retinal hemorrhages.
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
- Traumatic brain injury (TBI) is defined as an alteration in brain function or other evidence of brain pathology, caused by an external force.
- System(s) affected: neurologic; psychiatric; cardiovascular; endocrine/metabolic; gastrointestinal
- Synonym(s): head injury, concussion
Epidemiology
Incidence- 69 million individuals worldwide are estimated to sustain a TBI each year.
- 2.5 million ED visits and 288,000 hospitalizations per year
- 56,800 deaths per year; ~30% of all injury-related deaths
- Incidence in males twice that of females with 4-fold risk of fatal trauma
Prevalence
- Predominant age: 0 to 4 years, 15 to 19 years, and >65 years
- Predominant gender: male > female (2:1)
Etiology and Pathophysiology
- Falls (40%)
- Motor vehicle accidents (14%)
- Assault (10%)
- Child abuse (24% of TBI age ≤2 years)
- Recreational activities (21% of pediatric TBI, peak seasons spring/summer; peak ages 10 to 14 years)
- Primary insult: direct mechanical damage
- Secondary insult: 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 disorder, attention deficit hyperactivity disorder, male sex
Geriatric Considerations
Subdural hematomas are common after a fall or blow in elderly; symptoms may be subtle and not present until days after trauma. Many elderly patients are on antiplatelet or anticoagulation therapy.
General Prevention
- Safety education and fall prevention
- Seat belts; bicycle and motorcycle helmets
- Protective headgear for contact sports
Pediatric Considerations
Child abuse: Consider if dropped or fell <4 feet (e.g., off bed, couch), suspicious history, significant injury present, or any retinal hemorrhages.
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