Author: Richard H. Adler

“ ...People are uneducated about traumatic brain injury. They don't recognize it when it happens to them or their loved ones, they don't know the extent of the public health problem....

“ This is my dream for people who will sustain a traumatic brain injury:

“ ....At the time the TBI is diagnosed,...the injured person receives information about the consequences of traumatic brain injury and sources of education and support.

“....All traumatic brain injuries will be counted, including mild TBIs. The Centers for Disease Control and Prevention will develop a methodology to count even me, a person with TBI who was not admitted to hospital or died.

“ ...Without accurate data, how can we begin to address the problem?...”

Presented by a survivor of traumatic brain injury to the Congressional Brain Injury Task Force June 27, 2001

A traumatic brain injury (TBI) is defined as 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 neurology severity of such an injury 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. A TBI can result in short or long-term problems with independent function.

Traumatic Brain Injury (TBI) is an important public health problem in the United States. Problems that result from TBI, such as those of thinking and memory, are often not visible, and because awareness about TBI among the general public is limited, it is frequently referred to as the “silent epidemic.”

The Centers for Disease Control estimates that over one million Americans sustain a traumatic brain injury each year. A result of the magnitude of this silent epidemic is that survivors and their families face heavy burdens in their efforts to obtain competent medical assistance from providers who have a keen understanding of the evaluation and treatment of traumatic brain injury.

Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalization and Death, a 2004 study that was jointly sponsored and prepared by the Centers of Disease Control and the Prevention and the National Center for Injury Prevention and Control, presented significant data on the frequency of traumatic brain injury. The study concluded that:

How many people have TBI?

• Of the 1.4 million who sustain a TBI each year in the United States
  50,000 die;
• 235,000 are hospitalized; and
• 1.1 million are treated and released from an emergency department.¹

What causes TBI?

• The leading causes of TBI are:
• Falls (28%);
• Motor vehicle-traffic crashes (20%);
• Struck by/against (19%); and
• Assaults (11%).¹
• Blasts are a leading cause of TBI for active duty of military personnel in war zones.

Who is at highest risk for TBI?

• Males are about 1.5 times as likely as females to sustain a TBI.¹
• The two age groups at highest risk for TBI are 0 to 4 years olds and 15 to 19 years olds.¹
• Certain military duties (e.g. paratroopers) increase the risk of sustaining a TBI.³
• African Americans have the highest death rate from TBI.¹

What are the costs of TBI?

Direct medical costs and indirect costs such as lost of productivity of TBI totaled
an estimated $56.3 billion in the United States in 1995.⁴

What are the long-term consequences of TBI?

The Centers for Disease Control and Prevention estimates that at least 5.3 million Americans currently have a long-term or lifelong need for help to perform activities of daily living as a result of a TBI.⁵

According to one study, about 40% of those hospitalized with a TBI had at least one unmet need for services one year after their injury. The most frequent unmet needs were:


Improving memory and problem solving;

Managing stress and emotional upsets;

Controlling one's temper; and

Improving one's job skills.⁶

TBI can cause a wide range of functional changes affecting thinking, sensation, language, and/or emotions. It 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.⁷

Complaints of post-concussion symptoms and traumatic brain injury (TBI) are common among populations of auto collision and other trauma victims, particularly during the acute phase of injury. Symptoms frequently involve reports of memory and attention deficit, headaches with and without nausea, double vision, loss of concentration, increase sensitivity to distractions, anger and/or irritability, apathy, etc.

Medical literature and experience suggest that many head injury symptoms seem to lessen with time, and resolve fully within 6-12 months of trauma in many cases. This "presumption of improvement" may be misleading and deter many providers from a comprehensive and rigorous tracking of specific symptoms and pain complaints. Cognitive limitations following head trauma are wide ranging and are not always fully evaluated when early treatment is directed at acute physical pain. When concussive and cognitive symptoms are not well documented effective care suffers.

When treating a patient who presents with head injury or concussive-like symptoms, a simple but comprehensive intake questionnaire may help fully assess the patient's condition. Toward this end, we are enclosing a questionnaire to assist the healthcare provider in further assessing TBI conditions.

If a patient checks off several symptoms in the checklist, consideration needs to be given for a referral to a neurologist1 and/or neuropsychologist. If the condition arises from a traumatic injury, it may also be prudent to have the patient consult with an attorney specializing in head injury cases. Early legal consultation can protect the patient's rights and access to necessary health care providers.

Research has shown that acknowledgment, proper assessment, and treatment can diminish and lessen the effects of post concussion syndrome and closed head injury effects by giving the patient necessary information and insights to address the deficits. Individuals who sustain head injuries may experience an array of symptoms, both short-and-long-term. The important thing is to take head injury seriously and conduct proper assessment of the condition during the acute phase of injury.

1 Langolis JA, Rutland - Brown W, Thomas KE. Traumatic Brain Injury in the United State: Emergency Department Visits, Hospitalizations and Deaths. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2004

2 Defense and Veterans Brain Injury Center (DVBIC). [unpublished]. Washington (DC): U.S. Department of Defense; 2005

3 Ivins BJ, Schwab K, Warden D, Harvey S, Hollien 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.

4 Thurman D. The epidemiology and economics of head Trauma. In: Miller L, Hayes R, editors. Head trauma: basic, preclinical, and clinical directions. New York (NY): Wiley and Sons; 2001.

5 Thurman D, Alverson C, Dunn K, Guerreo J, Sniezek J. Traumatic brain injury in the United States: a public health perspective. Journal of Head Trauma Rehabilitation 1999;14(6):602-15.

6 Corrigan JS, Whiteneck G, Mellick D. Perceived needs following traumatic brain injury. Journal of Head Trauma Rehabilitation 2004;19(3):205-16.

7 National Institute of Neurological Disorders and Stroke. Traumatic brain injury: hope through research. Bethesda (MD): National Institute of Health; 2002 Feb. NIH Publication No. 02-158. Available from: www.ninds.nih.gov/disorders/tbi/details_tbi.htm.

8 It is important to note that some pain medications can exacerbate cognitive deficits in attention, memory and other areas.