Severe TBI

Each year, TBI causes a substantial number of deaths and leads to life-long disability for many Americans. In fact, TBIs contribute to about 30% of all injury deaths in the United States.1 In 2014, there were:

  • approximately 2.5 million TBI-related emergency department visits,
  • approximately than 288,000 hospitalizations, and
  • nearly 57,000 deaths related to TBI.2

The effects of a TBI can vary significantly, depending on the severity. Individuals with a mild TBI generally experience short-term symptoms and feel better within a couple of weeks, whereas individuals with a moderate or severe TBI may have long-term or life-long effects from the injury.

A severe TBI not only impacts the life of an individual and their family, but it also has a large societal and economic toll. The lifetime economic cost of TBI, including direct and indirect medical costs, was estimated to be approximately $76.5 billion (in 2010 dollars). Additionally, the cost of fatal TBIs and TBIs requiring hospitalization, many of which are severe, account for approximately 90% of total TBI medical costs.3,4 Falls are one of the leading causes of TBI-related ED visits, hospitalizations, and deaths, and recent data shows that over half of fall-related TBIs were among the youngest (0-4 years) and oldest age groups (≥75 years).2

Potential Effects of Severe TBI

The long-term effects of a TBI have been described as being similar to the effects of a chronic disease.5 Individuals who experience mild TBI are more likely to recover from their initial injury symptoms, although some individuals experience longer-term effects. Individuals who experience more severe TBI are more likely to have lasting effects from the injury.

A TBI may lead to a wide range of short- or long-term issues6 affecting:

  • Cognitive Function (attention and memory)
  • Motor function (extremity weakness, impaired coordination and balance)
  • Sensation (hearing, vision, impaired perception and touch)
  • Behavior (emotional regulation, depression, anxiety, aggression, impairments in behavioral control, personality changes)

A severe TBI may lead to death, or result in an extended period of unconsciousness (coma) or amnesia. Individuals may experience significant changes in thinking and behavior. Moderate-to-severe TBI may also result in a reduced lifespan.7

The consequences of severe TBI can affect all aspects of an individual’s life,7 including relationships with family and friends, the ability to progress at school or work, doing household tasks, driving, or participating in other daily activities.

Survivor Story: Lt. Col. Tim Maxwell

Lt. Col. Tim Maxwell

They train together. They fight together. So if wounded, why shouldn’t they go through recovery together? This was the question that Lt. Col. Tim Maxwell asked about his fellow marines being discharged from the hospital and left alone to recover from injuries of war.

Read more of this storyCdc-pdf

TBIs in the Military

Blasts are a leading cause of TBI for active duty military personnel in war zones.8 CDC estimates of TBI do not include injuries seen at U.S. Department of Defense or U.S. Veterans Health Administration Hospitals. Visit the Defense and Veterans Brain Injury CenterExternal for more information about TBI in the military for service members, veterans, and families and caregivers.

Research and Prevention

While there is no one size fits all solution, there are interventions and programs that can be effective to help limit the impact of severe TBI. These measures include prevention, early management, and treatment.

CDC’s research and programs work to reduce TBI and its consequences by developing and evaluating clinical guidelines, conducting surveillance, implementing primary prevention and education strategies, and developing evidence-based interventions to save lives and reduce the long-term effects of TBI.

Developing and Evaluating Clinical Guidelines

CDC researchers conducted a study to assess the effectiveness of adopting the Brain Trauma Foundation (BTF) in-hospital guidelines for the treatment of adults with severe traumatic brain injury (TBI). This research indicated widespread adoption of these guidelines could result in:

  • a 50% decrease in deaths;
  • a savings of approximately $288 million in medical and rehabilitation costs; and
  • a savings of approximately $3.8 billion to society.9

Implementing Prevention and Education Strategies

CDC has multiple education and awareness efforts to help improve primary prevention of TBI, as well as those that promote early identification and appropriate care.

  • Fall prevention strategies: Healthcare providers can reduce their older patients’ chances of falling by implementing strategies from the Stopping Elderly Accidents, Deaths, and Injuries, or STEADI, initiative.
  • Motor vehicle safety strategies:

Conducting Surveillance

Surveillance data are critical to help inform prevention strategies, identify modifiable risk and protective factors, and identify trends to let us know whether the problem is getting better or worse (and whether prevention efforts are working).  A report describing the most recent data can be found here.  In addition, CDC is working to improve TBI surveillance through the development of the National Concussion Surveillance System; more information can be found here.

References

  1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. MMWR Surveill Summ 2017;66(No. SS-9):1–16. DOI: http://dx.doi.org/10.15585/mmwr.ss6609a1
  2. Centers for Disease Control and Prevention (2019). Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths—United States, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.
  3. Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006.
  4. Coronado, McGuire, Faul, Sugerman, Pearson. The Epidemiology and Prevention of TBI; 2012
  5. Masel, B. E., & DeWitt, D. S. (2010). Traumatic brain injury: a disease process, not an event. Journal of Neurotrauma, 27(8), 1529-1540.
  6. Harrison-Felix, C., Pretz, C., Hammond, F. M., Cuthbert, J. P., Bell, J., Corrigan, J., Miller, CA & Haarbauer-Krupa, J, (2015). Life Expectancy after Inpatient Rehabilitation for Traumatic Brain Injury in the United States. J Neurotrauma, 32(23), 1893-1901. doi: 10.1089/neu.2014.3353 [doi]
  7. Thurman D, Alverson C, Dunn K, Guerrero J, Sniezek J. Traumatic brain injury in the United States: a public health perspective. J Head Trauma Rehabil 1999;14(6):602-615.
  8. Champion HR, Holcomb JB, Young LA. Injuries from explosions. Journal of Trauma 2009;66(5):1468–1476.
  9. Faul M, Wald MM, Rutland-Brown W, Sullivent EE, Sattin RW. Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing the Brain Trauma Foundation guidelines for the treatment of severe traumatic brain injury. J Trauma. 2007 Dec;63(6):1271-8.