Traumatic Brain Injury Statistics

Brain injury can also result from a nearby blast or explosion, as is the case in many combat veterans and first responders (firefighters, police officers, paramedics, and other emergency personnel).

Additionally, any object that penetrates the brain tissue, such as a bullet or shattered piece of skull or other material, can cause a TBI. This differs from an acquired brain injury (ABI); ABI is an injury to the brain caused by a stroke, chemical or toxic poisoning, damage to the brain as a result of pressure from a tumor, lack of oxygen to the brain as in near drowning, or infectious diseases like meningitis.

A TBI can result from an open or closed head injury. In a closed head injury, damage is often unseen except for the typical bump or bruise on the head. Don’t be fooled, however; while there may be no outward sign that the brain has been harmed, a severe jarring or blow to the head can bruise the brain tissue and tear delicate blood vessels inside, especially in those areas where the inside surface of the skull is rough or uneven.

Rapid movement of the brain (think whiplash) can also lead to shearing of the white matter (axons) in the brain – these are the parts of the nerve cells (neurons) that connect cells to one another in the brain and throughout the spinal cord and body. This shearing of delicate brain tissue may be missed on MRI or CT as it is not detected on most imaging technology; the symptoms become obvious over time, however, as the effects the injury has on individual functioning can be widespread.

An open head injury is more obvious of course: an open head injury is especially serious when there is a penetrating head injury (meaning an object had penetrated the skull and entered the brain). These injuries tend to be focal as they affect a specific area of the brain.

Scope of the Problem

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TBI-related emergency department visits, hospitalizations, and deaths increased by 53%. In fact, the CDC (2014) found that TBI was a contributing factor to a third of all injury-related deaths in the United States.

Such injuries can include impairments related to thinking, memory, movement, sensation, vision, hearing, or emotional functioning (e.g., personality changes, depression, anxiety). These issues not only affect individuals but also can have lasting effects on families, caregivers, healthcare providers, and communities.

While most TBIs are considered mild and will be diagnosed as concussions, the Center for Disease Control and Prevention (CDC) estimates that 155 people die from traumatic brain injuries every day. Those who do survive can face the effects of their injuries that last from a few days to the rest of their lives.

https://www.brainline.org/slideshow/infographic-leading-causes-traumatic-brain-injury

Cost of Brain Injury

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An estimated 1 out of every 6 Americans live with a TBI related disability – that’s approximately 5.3 million people. The economic cost of TBI to society is estimated at $76,5 billion, including $11.5 billion in direct medical and nearly $65 billion in indirect costs, including lost wages, productivity, and non-medical costs.

The costs of TBI include more than the monumental medical costs resulting from the injury itself. Costs associated with ongoing physical and occupational therapy, caregiver costs, not to mention the pain and suffering involved in trying to recover from a TBI. Too many costs involved simply cannot be estimated.

Could it be a Traumatic Brain Injury?

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An alarming number of those who sustain concussion and go to health care providers are not properly diagnosed, and if they are do not receive the follow up care they should.

Symptoms of TBI may not always present themselves right away, so don’t be fooled. If you have had a blow to the head, or even a severe jolt as in a whiplash type movement, watch for signs of possible TBI. While all brain injuries are unique, the type and extent of the injury to the brain will determine the symptoms.

TBIs, ranging from mild to severe, are typically categorized as one of the following:

Concussion

A concussion is considered a minor brain injury. It results from a bump or blow to the head, or by sudden changes in movement, as in whiplash. Even though typically considered mild compared to other TBI types, a concussion can still cause substantial difficulties or impairment and can take months or even years to heal. The symptoms of concussion can include:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion or feeling as if in a fog
• Difficulty/slowness in responding to questions
• Amnesia surrounding the traumatic event
• Dizziness or "seeing stars"
• Ringing in the ears
• Nausea
• Vomiting
• Slurred speech
• Delayed response to questions
• Appearing dazed
• Fatigue
• Concentration and memory complaints
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems and depression
• Disorders of taste and smell

Contusion

A contusion is a bruise to the brain tissue, caused by breaking of small blood vessels inside the brain. Like bruising on the skin, the leaking blood vessels can cause swelling; if this happens, all kinds of problems can result, depending upon where it is located and the extent of the damage. A large contusion may require surgery. Symptoms of contusion, depending upon severity, could include:

• Confusion
• Tiredness
• Emotional changes
• Agitation
• Memory loss
• Changes in cognition, personality, ability to process information
• Attention problems
• Emotional disturbances
• Difficulty with motor coordination
• Numbness
• Loss of ability to understand or express speech

Penetrating Brain Injury

A penetrating brain injury occurs when an object actually pierces through the skull into the brain tissue. Such injuries may result from a bullet, a knife or other sharp object, or bone and fragments from the object that hit the skull. Depending upon the extent of the damage and location of the injury, symptoms of a penetrating TBI could include:

• Heavy bleeding from the head
• Bleeding from the ears
• Problems breathing
• Seizure
• Loss of bowel and bladder function
• Loss of movement or feeding in the limbs
• Loss of consciousness
• Coma may occur after the injury

Diffuse Axonal Injury

This type of diffuse axonal injury (DAI) results when the head is moved with such violent force that the axons (nerve tissue connected to brain cells) are sheared or torn inside the brain. This occurs with Shaken Baby Syndrome, or by rotational forces such as someone in auto accident might experience. This type of damage disrupts the brain’s ability to communicate to other parts of the brain and body and can result in widespread brain damage that may or may not be permanent, depending upon where the shearing occurs and to what extent. Coma is also a possible result of DAI, and in some cases, it is fatal. Again, DAI symptoms depend upon the location and extent of the damage to the brain, and could include:

• Disorientation or confusion
• Headache
• Nausea or vomiting
• Drowsiness or fatigue
• Trouble sleeping
• Sleeping longer than normal
• Loss of balance or dizziness

Levels of Brain Injury

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The level of a TBI is measured using a scoring system. The Glasgow Coma Scale (GCS) is the most common one used and describes the level of consciousness a person is displaying after a head injury. The scale measures eye opening response, verbal response, and motor response and is scored as follows:

Scores from each category and summed and brain injuries are then classified as mild, moderate, or severe. (In children, the Pediatric Glasgow Coma Scale (PGCS) is used as they are evaluated a bit differently.)

Scores from each category and summed and brain injuries are then classified as mild, moderate, or severe. (In children, the Pediatric Glasgow Coma Scale (PGCS) is used as they are evaluated a bit differently.)

Mild injury – A GCS or 13-15. A mild TBI occurs when loss of consciousness (if it occurs at all) lasts for a few seconds or minutes. The person may only appear to be confused or disoriented. With mild TBIs, tests or scans may show no injury to the brain, although this is not always the case, so patients and caretakers must remain vigilant following a TBI. Doctors will only diagnose TBI when there is a change in function or mental status at or immediately following the injury; if this is the case, concussion will be the diagnosis.

Moderate injury – A GCS of 9-12. A moderate TBI is if the patient loses consciousness for several minutes to several hours. Confusion can last from days to weeks. With a moderate TBI, other complications (cognitive, physiological, behavioral impairments) can last for months and could be permanent. Often, follow up treatment programs/therapy will be needed to address these complications.

Severe brain injury – A GCS of 8 or less. Severe TBIs often result open head injuries or ones where the skull has been crushed. Penetrating wounds to the skull and brain can also cause this type of TBI, but closed head injuries can also result in a severe TBI. This level of injury to the brain is life-threatening and patients seldom return to the life that they had before the injury as a wide range of functional changes result, affecting cognition (thinking), sensation, language, and emotions.

Living with Concussion

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While medical providers may describe a concussion in terms of “only” a mild brain injury, that is because they are not typically life threatening, not because it is something to be ignored. Symptoms may not show up immediately, and some of the signs of concussion can be subtle. Subjective complaints of sleep disturbances, for example, have been reported in 70% of TBI outpatients (Brain Trauma Foundation, 2022; Chesnut et al., 1999).

Members of the armed forces are particularly plagued by concussion as these account for the majority of TBIs reported by military personnel. Using 2013 data, some 83% reported some type of brain trauma, and even if more than one type of brain injury was sustained, only the most severe went on his or her record.

It is important to understand that even “mild” head injuries (concussions) such as those sustained in service, on the job, in sports, or other activities, can result in cumulative neurological and cognitive deficits over time. Research shows that those who sustained TBI are increased risk for developing more serious problems later on, including Alzheimer’s and Parkinson’s disease. Additionally, it is estimated the risk of experiencing stroke after TBI is 10 times greater in TBI patients than in those who never sustained a TBI.

Repeated concussions, especially when they occur one after another within a short period of time, can be catastrophic and/or fatal. That’s because the effect of any type of trauma to the brain, even once the symptoms seem to go away, can still be there. The initial swelling, bruising, and tearing of blood vessels that cause the initial confusion, headache, visual disturbance, nausea, and other symptoms, can take weeks, months, or even years to heal – especially if the brain is continually reinjured again and again.

These types of injuries typically occur in athletes, especially football players. Young athletes and children who play sports are especially vulnerable as their young brains are still developing. In fact, the brain is not fully developed until around 25 years of age, so taking care of your child or teen’s brain at this stage is vital. As TBI is a leading cause of death and disability in teens and you children, every parent and coach should know the signs of concussion.

Some of the more serious danger signs of concussion, while uncommon and rare, can result:

• One pupil larger than the other
• Drowsiness or inability to wake up
• A headache that gets worse and does not go away
• Slurred speech, weakness, numbness, or decreased coordination
• Repeated vomiting or nausea, convulsions, or seizures
• Unusual behavior, increased confusion, restlessness, or agitation
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.