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TBI can cause a host of physical, cognitive, emotional, and behavioral
effects, and outcome can range from complete recovery to permanent disability or death. The 20th century has seen critical developments in diagnosis and treatment which have decreased death rates and improved outcome
- Traumatic brain injury is defined as damage to the brain resulting from
- external mechanical force, such as rapid acceleration or deceleration,
- impact, blast waves, or penetration by a projectile.[2]
- Brain function is temporarily or permanently impaired and structural
- damage may or may not be detectable with current technology
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Head injuries can be classified into mild, moderate, and severe categories.[12] The Glasgow Coma Scale (GCS), the most commonly used system for classifying TBI severity, grades a person's level of consciousness on a scale of 3–15 based on verbal, motor, and eye-opening reactions to stimuli.[14] It is generally agreed that a TBI with a GCS of 13 or above is mild, 9–12 is moderate, and 8 or below is severe.
- The incidence of TBI is increasing globally, largely due to an increase
- in motor vehicle use in low- and middle-income countries.[2] In developing countries, automobile use has increased faster than safety infrastructure could be introduced.[54] In contrast, vehicle safety laws have decreased rates of TBI in high-income countries,[2] which have seen decreases in traffic-related TBI since the 1970s.[46] Each year in the United States about two million people suffer a TBI[13] and about 500,000 are hospitalized.[109] The yearly incidence of TBI is estimated at 180–250 per 100,000 people in the US,[109] 281 per 100,000 in France, 361 per 100,000 in South Africa, 322 per 100,000 in Australia,[7] and 430 per 100,000 in England.[52] In the European Union the yearly aggregate incidence of TBI hospitalizations and fatalities is estimated at 235 per 100,000
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neurological examination, for example checking whether the pupils constrict normally in response to light and assigning a Glasgow Coma Score.[15] Neuroimaging helps in determining the diagnosis and prognosis and in deciding what treatments to give.[64]
The preferred radiologic test in the emergency setting is computed tomography (CT): it is quick, accurate, and widely available.[65] Followup CT scans may be performed later to determine whether the injury has progressed.[2]
Magnetic resonance imaging (MRI) can show more detail than CT, and can add information about expected outcome in the long-term.[1
- ertain facilities are equipped to handle TBI better than others;
- initial measures include transporting patients to an appropriate
- treatment center.[43][74]
- Both during transport and in hospital the primary concerns are ensuring
- proper oxygen supply, maintaining adequate cerebral blood flow, and
- controlling raised intracranial pressure (ICP),[3] since high ICP deprives the brain of badly needed blood flow[75] and can cause deadly brain herniation. Other methods to prevent damage include management of other injuries and prevention of seizures.[1
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Once medically stable, patients may be transferred to a subacute nursing unit of the medical center or to an independent rehabilitation hospital.[73] After discharge from the inpatient rehabilitation treatment unit, care may be given on an outpatient basis. Respite care,
including day centers and leisure facilities for the disabled, offers
time off for caregivers and activities for people with TBI.[86]
People with TBI who cannot live independently or with family may be
cared for in supported living facilities such as group homes.[86]
People who cannot return to regular employment may be given vocational
rehabilitation; this supportive employment matches job demands to the
worker's abilities.[86]
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