Traumatic Brain Injury (TBI) is a leading cause of death and disability in the United States. According to the Centers for Disease Control, 30.5% of all injury related deaths in the United State are related to TBI. On an annual basis, approximately 1.7 million Americans sustain a TBI. It is estimated that TBI costs the Untied States $76.5 billion annually in direct and indirect costs. Falls and motor vehicle accidents are leading causes of TBI. Fall related TBI’s are more common among the very young and the very old, but motor vehicle accident related injuries are most common among young adults.
Typically, TBI is subdivided into mild, moderate and severe injuries, based on a TBI victim’s period of unconsciousness, Post Traumatic Amnesia (PTA), and Glasgow Coma Score (GCS). The period of unconsciousness is the time it takes for the patient to start responding to simple commands after they are injured. The PTA roughly corresponds to how long an individual remains confused and disoriented following the injury. The GCS is a fifteen-point scale based on an injured person’s eye opening, verbal response, and motor response to stimulation. These classifications assume that the brain injury has had a generalized diffuse effect on the brain. While this is true of the majority of head injuries, some brain injuries can cause very localized severe injuries to the brain without causing a change in level of alertness or wakefulness.
In this classification, mild traumatic brain injury is defined as head trauma that results in a confused state or a loss of consciousness of less than 30 minutes, an initial Glasgow Coma Scale of 13 – 15, and post traumatic amnesia lasts less than 24 hours.
Moderate traumatic brain injury is a trauma to the head that results in a loss of consciousness of 30 minutes to 24 hours, and an initial Glasgow Coma Scale of 9 – 12. Post traumatic amnesia can last 24 hours to seven days.
Severe traumatic brain injury is a trauma to the head that results in a loss of consciousness of greater than 24 hours, an initial Glasgow Coma Scale of less than 8, and a posttraumatic amnesia period of greater than seven days.
Milder cases of mild TBI may result in very little injury and may not require medical evaluation or treatment. More severe mild injures may need emergency medical evaluation and treatment and may require hospitalization. All moderate and severe TBI requires medical evaluation, treatment and hospitalization. Many of these injuries will require treatment at trauma centers equipped to manage these injuries. Most trauma centers (but not all hospitals) have ready access to CAT scans, neurosurgical, neurological, orthopedic, and medical intensive consultation.
Glenn M. Seliger, MD
Director, Traumatic Brain Injury Rehabilitation Services