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  • History or clinical evidence of trauma

  • Headache, altered mental status, seizure, focal neurologic deficit

  • Signs of transtentorial herniation with progressive mass effect

  • Computed tomography (CT) or magnetic resonance imaging (MRI) showing skull fractures; epidural, subdural, subarachnoid, or intraparenchymal hemorrhage; or cerebral edema

General Considerations

Traumatic brain injury is a major cause of death and disability. The incidence is rising due to increasing motor vehicle accidents in low- and middle-income countries and falls of members of the aging population in high-income countries. Violence is reported to cause closed-head injury in about 7–10% of cases. Penetrating injuries are more common with the more frequent use of firearms, and a greater amount of blast injuries became the result of improved explosive devices used in terrorist and other attacks. More than 1.7 million patients with head injuries are treated annually in US emergency departments, and 21% of these patients are hospitalized. Almost 10% of all deaths in the United States are caused by injury, and about half of traumatic deaths involve the brain. The annual financial burden accounts to US $60 billion.

Brain injuries occur at all ages, but the peak is in young adults between the ages of 15 and 25 years. Head injury is the leading cause of death among people younger than 25 years. Men are affected three to four times as often as women.

Traumatic brain injury can be classified according to the mechanism of injury, clinical severity, structural damage on imaging, and prognosis (Table 14–1).

Table 14–1.Classification of traumatic brain injury.

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