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Traumatic Brain Injury
 The
Problem
A traumatic brain injury (TBI) is caused by a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.
Recent data shows that, on average, approximately 1.4 million people sustain a TBI each year in the United States. Of those:
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50,000 die;
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235,000 are hospitalized; and
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1.1 million are treated and released from an emergency department.1
Among children ages 0 to 14 years, TBI results in an estimated
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2,685 deaths;
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37,000 hospitalizations; and
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435,000 emergency department visits.1
The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.
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Consequences
CDC estimates that at least 5.3 million Americans currently have long-term or lifelong need for help to perform activities of daily living as a result of a TBI.2
TBI can cause a wide range of functional changes affecting thinking, sensation, language, or emotions.
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Thinking (i.e., memory and reasoning);
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Sensation (i.e., touch, taste, and smell);
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Language (i.e., communication, expression, and understanding); and
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Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).3
TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders that become more prevalent with age.3
About 75% of TBIs that occur each year are concussions or other forms of mild TBI.4
Repeated mild TBIs occurring over an extended period of time (i.e., months, years) can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.5
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Causes
The leading causes of TBI are:
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Falls (28%);
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Motor vehicle-traffic crashes (20%);
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Struck by/against events (19%); and
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Assaults (11%).1
Falls
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Falls are the leading cause of TBI; rates are highest for children ages 0 to 4 years and adults ages 75 years and older.1
Motor Vehicle-Traffic Crashes
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Motor vehicle-traffic causes result in the greatest number of TBI-related hospitalizations.1
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The rate of motor vehicle-traffic-related TBI is highest among adolescents ages 15 to 19 years.1
Struck By/Against Events
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Struck by/against events, which include colliding with a moving or stationary object, are the third leading cause of TBI.
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Approximately 1.6 – 3.8 million sports- and recreation-related TBIs occur in the United States each year.6 Most of these are mild TBIs that are not treated in a hospital or emergency department.
Assaults
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Firearm use is the leading cause of death related to TBI.7
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Nine out of 10 people with a firearm-related TBI die.7
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Nearly two thirds of firearm-related TBIs are classified as suicidal in intent.7
Blasts are a leading cause of TBI for active duty military personnel in war zones.8
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Cost
Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $60 billion in the United States in 2000.9
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Groups at
Risk
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Males are about twice as likely as females to sustain a TBI.1
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The two age groups at highest risk for TBI are 0 to 4 year olds and 15 to 19 year olds.1
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Adults age 75 years or older have the highest rates of TBI-related hospitalization and death.1
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Certain military duties (e.g., paratrooper) increase the risk of sustaining a TBI.10
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African Americans have the highest death rate from TBI.1
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TBI hospitalization rates are highest among African Americans and American Indians/Alaska Natives (AI/AN).11
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Prevention
Strategies
There are many ways to reduce the chances of a traumatic brain injury (TBI), including:
1. Wearing a seat belt every time you drive or ride in a motor vehicle.
2. Buckling your child in the car using a child safety seat, booster seat, or seat belt (according to the child's height, weight, and age).
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Children should start using a booster seat when they outgrow their child safety seats (usually when they weigh about 40 pounds). They should continue to ride in a booster seat until the lap/shoulder belts in the car fit properly, typically when they are 4’9” tall.12
3. Never driving while under the influence of alcohol or drugs.
4. Wearing a helmet and making sure your children wear helmets when:
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Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
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Playing a contact sport, such as football, ice hockey, or boxing;
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Using in-line skates or riding a skateboard;
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Batting and running bases in baseball or softball;
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Riding a horse; or
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Skiing or snowboarding.
5. Making living areas safer for seniors, by:
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Removing tripping hazards such as throw rugs and clutter in walkways;
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Using nonslip mats in the bathtub and on shower floors;
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Installing grab bars next to the toilet and in the tub or shower;
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Installing handrails on both sides of stairways;
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Improving lighting throughout the home; and
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Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.13-15
6. Making living areas safer for children, by:
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Installing window guards to keep young children from falling out of open windows; and
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Using safety gates at the top and bottom of stairs when young children are around.
7. Making sure the surface on your child's playground is made of shock-absorbing material, such as hardwood mulch or sand.16
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CDC
Activities
Prevention
Tips and Resources
Related CDC Resources and Publications
References
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Langlois JA, Rutland-Brown W, Thomas KE. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Atlanta (GA):
Centers for Disease Control and Prevention, Nation Center for Injury Prevention and Control; 2006.
- 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 1999;14(6):602–15.
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National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institutes of Health; 2002 Feb. NIH Publication No.: 02-158.
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.
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Centers for Disease Control and Prevention (CDC). Sports-related recurrent brain injuries—United States. Morbidity and Mortality Weekly Reports 1997;46(10):224–7.
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Langlois JA, Rutland-Brown W, Wald M. The epidemiology
and impact of traumatic brain injury: a brief overview. Journal of
Head Trauma Rehabilitation 2006;21(5):375-8.
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Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Traumatic brain injury in the United States—A report to Congress. Atlanta (GA): Centers for Disease Control and Prevention; 1999.
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Defense and Veterans Brain Injury Center (DVBIC). [unpublished]. Washington (DC): US Department of Defense; 2005.
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Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006.
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Ivins BJ, Schwab K, Warden D, Harvey S, Hoilien M, Powell J, et al. Traumatic brain injury in U.S. army paratroopers: prevalence and character. Journal of Trauma Injury, Infection and Critical Care 2003;55(4):617–21.
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Langlois JA, Kegler SR, Butler JA, et al. Traumatic brain injury-related hospital discharges: results from a fourteen state surveillance system, 1997. Morbidity and Mortality Weekly Reports 2003;52,SS-04:1–18.
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Centers for Disease Control and Prevention. Warning on interaction between air bags and rear-facing child restraints. Morbidity and Mortality Weekly Report MMWR 1993;42(No.14):20–2.
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Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: effects of exercise training. Physical Therapy 1993;73(4):254–65.
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Lord SR, Caplan GA, Ward JA. Balance, reaction time, and muscle strength in exercising older women: a pilot study. Archives of Physical and Medical Rehabilitation 1993;74(8):837–9.
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Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age and Aging 1999;28:513–18.
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Mack MG, Sacks JJ, Thompson D. Testing the impact attenuation of loose fill playground surfaces. Injury Prevention 2000;6:141–4.
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