A traumatic brain injury (TBI) is caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal 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.

TBIs contribute to a substantial number of deaths and cases of permanent disability annually.

Of the 1.4 million who sustain a TBI each year in the United States:

• 50,000 die
• 235,000 are hospitalized
• 1.1 million are treated and released from an emergency department

Among children ages 0 to 14 years, TBI results in an estimated:

• 2,685 deaths
• 37,000 hospitalizations
• 435,000 emergency department visits annually

The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.  TBIs contribute to a substantial number of deaths and cases of permanent disability annually.

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Causes

A traumatic brain injury (TBI) is caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.

The leading causes of TBI are:

• Falls (28%)
• Motor vehicle-traffic crashes (20%)
• Struck by/against events (19%)
• Assaults (11%)

Falls

• Falls are the leading cause of TBI; rates are highest for children ages 0 to 4 years and adults ages 75 years and older.

Motor Vehicle-Traffic Crashes

• Motor vehicle-traffic causes result in the greatest number of TBI-related hospitalizations.
• The rate of motor vehicle-traffic-related TBI is highest among adolescents ages 15 to 19 years.

Struck By/Against Events

• Struck by/against events, which include colliding with a moving or stationary object, are the third leading cause of TBI.
• An estimated 300,000 sports and recreationrelated TBIs of mild to moderate severity occur in the United States each year.

Assaults

• Firearm use is the leading cause of death related to TBI.
• Nine out of 10 people with a firearm-related TBI die.
• Nearly two thirds of firearm-related TBIs are classified as suicidal in intent.

Blasts are a leading cause of TBI for active duty military personnel in war zones.

For more information on TBI and mass casualty events, go to: ww.bt.cdc.gov/masstrauma/injuryfactsheets.asp

To learn more about the Defense and Veterans Brain Injury Center’s (DVBIC) efforts to prevent, treat, and provide education on TBI to active duty military, their dependents, and veterans, go to: ww.dvbic.org.

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Signs and Symptoms

The signs and symptoms of a traumatic brain injury (TBI) can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed as people may look fine even though they may act or feel differently. The following are some common signs and symptoms of a TBI:

• Headaches or neck pain that do not go away
• Difficulty remembering, concentrating, or making decisions
• Slowness in thinking, speaking, acting, or reading
• Getting lost or easily confused
• Feeling tired all of the time, having no energy or motivation
• Mood changes (feeling sad or angry for no reason)
• Changes in sleep patterns (sleeping a lot more or having a hard time sleeping)
• Light-headedness, dizziness, or loss of balance
• Urge to vomit (nausea)
• Increased sensitivity to lights, sounds, or distractions
• Blurred vision or eyes that tire easily
• Loss of sense of smell or taste

Ringing in the ears

Children with a brain injury can have the same symptoms as adults, but it is often harder for them to let others know how they feel. Call your child’s doctor if they have had a blow to the head and you notice any of these symptoms:

• Tiredness or listlessness
• Irritability or crankiness (will not stop crying or cannot be consoled)
• Changes in eating (will not eat or nurse)
• Changes in sleep patterns
• Changes in the way the child plays
• Changes in performance at school
• Lack of interest in favorite toys or activities
• Loss of new skills, such as toilet training
• Loss of balance or unsteady walking
• Vomiting

If you think you or someone you know has a TBI, contact your health care provider. Your health care provider can refer you to a neurologist, neuropsychologist, neurosurgeon, or specialist in rehabilitation (such as a speech pathologist). Getting help soon after the injury by trained specialists may speed recovery.

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Outcomes

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.

TBI can cause a wide range of functional changes affecting thinking, sensation, language, or emotions.

• Thinking (i.e., memory and reasoning)
• Sensation (i.e., touch, taste, and smell)
• Language (i.e., communication, expression, and understanding)
• Emotion (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).

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.

The severity of a traumatic brain injury (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.

About 75% of TBIs that occur each year are concussions or other forms of mild TBI. An estimated 15% of persons who sustain a mild brain injury continue to experience negative consequences one year after injury.

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.

The following general tips can aid in recovery:

• Get lots of rest. Don't rush back to daily activities such as work or school.
• Avoid doing anything that could cause another blow or jolt to the head.
• Ask your doctor when it's safe to drive a car, ride a bike, or use heavy equipment, because your ability to react may be slower after a brain injury.
• Take only the drugs your doctor has approved, and don't drink alcohol until your doctor says it's OK.
• Write things down if you have a hard time remembering.
• If your brain injury was severe, you may need therapy to learn skills that were lost, such as speaking, walking, or reading. Your doctor can help arrange rehabilitation services.

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Prevention

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).

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.

3. Never driving while under the influence of alcohol or drugs.

4. Wearing a helmet and making sure your children wear helmets when:

• Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
• Playing a contact sport, such as football, ice hockey, or boxing;
• Using in-line skates or riding a skateboard;
• Batting and running bases in baseball or softball;
• Riding a horse; or
• Skiing or snowboarding

5. Making living areas safer for seniors:

• Removing tripping hazards such as throw rugs and clutter in walkways.
• Using nonslip mats in the bathtub and on shower floors.
• Installing grab bars next to the toilet and in the tub or shower.
• Installing handrails on both sides of stairways.
• Improving lighting throughout the home; and
• Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.

6. Making living areas safer for children:

• Installing window guards to keep young children from falling out of open windows.
• 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.

There are many opportunities to raise awareness in your community about TBI. Below are some times of the year that may be opportune for drawing attention to a particular issue:

• The week of Valentine’s Day is National Child Passenger Safety Week.
• March is Brain Injury Awareness Month.
• The fourth week of April is National Playground Safety Week.
• December is National Drunk and Drugged Driving Prevention Month.

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Schools are a great place to incorporate prevention efforts. The National SAFE KIDS campaign website and the National Program for Playground Safety website have plans for teachers and have student handouts about playground, motor vehicle, and sports and recreation safety.

• National SAFE KIDS Campaign Website
• National Program for Playground Safety Website

The ThinkFirst National Injury Prevention Foundation also offers TBI prevention and educational programs for young people.

• ThinkFirst National Injury Prevention Foundation

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