Brain Injury, Traumatic
Basics
Description
- Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force.
- System(s) affected: neurologic; psychiatric; cardiovascular; endocrine/metabolic; gastrointestinal; pulmonary
- Synonym(s): head injury, concussion
Epidemiology
Incidence
- 801,700 ED visits and 326,600 hospitalizations per year in the United States
- 61,000 deaths per year; ~30% of all injury-related deaths
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 aged 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 disorder, ADHD, male sex
Geriatric Considerations
Subdural hematomas (SDH) 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
- 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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Citation
Domino, Frank J., et al., editors. "Brain Injury, Traumatic." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688576/all/Brain_Injury_Traumatic.
Brain Injury, Traumatic. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688576/all/Brain_Injury_Traumatic. Accessed August 31, 2024.
Brain Injury, Traumatic. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688576/all/Brain_Injury_Traumatic
Brain Injury, Traumatic [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2024 August 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688576/all/Brain_Injury_Traumatic.
* Article titles in AMA citation format should be in sentence-case
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