Introduction

Traumatic brain injury (TBI) is an insult to the brain caused by an impact (e.g., fall or car accident), or internal damage (e.g., gunshot or surgical intervention). Acquired brain injury is an injury to the brain which is not hereditary, congenital, or degenerative that has occurred after birth and includes anoxia, aneurysms, infections to the brain and strokes.  Although not always visible, brain injuries may cause enduring physical, emotional, intellectual and social changes for the survivor. Long-term effects place an enormous emotional and financial burden on the individual's family and strain medical and other service systems due to high costs and often life-long needs.

Magnitude

• About 1.7 million people will experience a brain injury of some type each year in the United States.
• Each year more people will sustain a traumatic brain injury than will develop Multiple Sclerosis, Spinal Cord Injury, HIV/AIDS, and Breast Cancer combined. 
• Each year 270,000 individuals suffer brain injuries severe enough to require sustained hospitalization, with an estimated 124,000 resulting in a lasting disability.
• Traumatic brain injuries account for an estimated 30.5% of all injury deaths in the United States.

Who Is at Risk?

• In every age group, TBI rates are higher for males than for females. Males aged 0 to 4 years have the highest rates of TBI-related emergency department visits, hospitalizations, and deaths.
• Children aged 0 to 4 years, older adolescents aged 15 to 19 years, and adults aged 65 years and older are most likely to sustain a TBI. 
• Residents in rural areas have a higher rate of both fatal and non-fatal traumatic brain injuries.

Causes of TBI

• Falls cause 35.2% of all traumatic brain injuries.  Motor vehicle crashes account for 17.3%, being struck by or against an object cause 16.5%, and assaults are 11%.  There are 21% of traumatic brain injuries that have an unknown or other cause.
• Assaults produced 10% of TBIs in the general population; they accounted for only 2.9% in children aged 0 to 14 years and 1% in adults aged 65 years old and older.  
• Struck by/against events, which include colliding with a moving or stationary object, were the second leading cause of TBI among children aged 0 to 14 years, with 24.8%. 
• Among all age groups, motor vehicle – traffic was the second leading cause of TBI (17.3%) and resulted in the largest percentage of TBI-related deaths (31.8%).  Rates are highest for adults aged 20 to 24 years.
• In 2008, 11,773 people were killed in alcohol-impaired driving crashes, accounting for nearly one-third (32%) of all traffic-related deaths in the United States.
• While brain injuries due to car accidents have declined from 1984 to 1992, brain injuries resulting from firearms increased 13% during the same period.
• About 5% to 10% of skiing accidents result in head injuries.

Cost of Care

• The direct and indirect costs of traumatic brain injury in the U. S. have been estimated to be $60 billion annually.
• In 1991 survivor costs accounted for $31.7 billion and fatal brain injuries cost another $16.6 billion.
• The lifetime costs for one person surviving a severe TBI can reach in excess of $4 million.
• An estimate of medical and non-medical (e.g., home modifications, vocational rehabilitation, health insurance) per TBI survivor averages $151,587.
• Acute rehabilitation costs for survivors of a severe TBI have been shown to average more than $1,000 per day.
• Medical costs are typically the highest for those who do not survive.

Effects of Traumatic Brain Injury

• Although the largest group of TBI survivors are young adults in their prime working years, many survivors, particularly those with a severe TBI, are unable to return to work.
• Survivors of a severe brain injury are likely to experience prolonged anxiety and depression, and are at a high risk for loss of friendships and social support.
• Approximately 20% of survivors of severe TBI remain unresponsive for at least one month.
• The majority of individuals who survive a period of coma eventually regain consciousness. Data from the Traumatic Coma Data Bank indicate that of 650 patients who experienced a vegetative state after a brain injury, only 14% were released from the hospital in a coma. And of those, about half had regained consciousness after one year's time.

Researchers have found that persons who suffer a severe TBI continue to make gradual improvements in functioning for at least 10 years post-injury.