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INTRODUCTION

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ESSENTIALS OF DIAGNOSIS

  • Traumatic brain injury (TBI) may be mild, moderate, or severe.

  • In mild TBI, duration of loss of consciousness (LOC) is <30 minutes, duration of post-traumatic amnesia (PTA) is <1 hour, and Glasgow Coma Scale (GCS) score is 13–15.

  • In moderate TBI, duration of LOC is <24 hours, duration of PTA is between 1 and 7 days, and GCS score is 9–12.

  • In severe TBI, duration of LOC is >24 hours, duration of PTA is >7 days, and GCS score is ≤ 8.

  • Computed tomography (CT) scan of the head is the ­initial imaging modality of choice.

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GENERAL CONSIDERATIONS

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Traumatic brain injury (TBI) is a major cause of morbidity in the United States and the world. A wide range of deficits can be seen, including physical, cognitive, and behavioral problems, and difficulties encountered in one area may hinder the patient’s progress in other areas. TBI is characterized by a change in neurologic functioning and can be classified as mild, moderate, or severe. Because some neuromedical problems seen after TBI are rather specific to the brain injury population, the rehabilitation physician must be familiar with diagnosing and treating these complications. TBI rehabilitation encompasses the spectrum of care from the intensive care unit (ICU) through acute inpatient rehabilitation, and outpatient care that extends to family, community, vocational, and avocational activities. Appropriate rehabilitation improves functional outcome, reduces complications, and enhances the quality of life for individuals with TBI and those in their social network.

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Epidemiology & Demographics

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The Centers for Disease Control and Prevention (CDC) estimates that there are 1.7 million TBIs annually in the United States. Of these, approximately 75% are considered to be mild TBI, or concussions. Despite this fact, brain injury is thought to be a contributing factor in nearly one third of all injury-related deaths. Of the 1.7 million patients with TBIs annually, 80% are treated and released from an emergency department; however, 275,000 are hospitalized. The CDC estimates that 52,000 people die each year from injuries related to head trauma. Currently there is no estimate for the number of brain injuries that occur in which people never present to an emergency department or seek medical care. The CDC estimates the total of direct and indirect costs related to TBI to be $60 billion annually.

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Falls are the leading cause of all TBIs and are responsible for 35% of head injuries in the general population. Falls are an even greater cause of TBI in children and the elderly, accounting for 50% of TBIs in children younger than 14 years and for 61% of TBIs in adults aged 65-plus. Motor vehicle accidents and traffic-related accidents cause 17% of head injuries. Struck by or against events (eg, colliding with a moving or stationary object) cause another 16% of head injuries. Assaults account for 10% of head injuries. Brain injury is more common in males than females across all ages. Additionally, alcohol intoxication is involved in 12% of hospitalizations due to head injury and in nearly 50% of all head injuries. Blast injury is a leading cause of TBI ...

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