![]() ![]() 18 One illustrative example involves cyclists. ![]() ![]() 17 Individuals who consume more than five drinks in a sitting are more than three times as likely to suffer a trauma. 16 Binge drinking is a major risk factor for trauma, particularly brain trauma. Most studies estimate that between 30% and 50% of patients treated for TBI were intoxicated at the time of injury, with even greater intoxication estimates for patients injured in motor vehicle accidents and assaults. TBI has long been closely associated with acute alcohol intoxication. 13, 14 Thus, the total cost, comprising health care dollars, loss of productivity, and quality of life, associated with TBI in the United States is substantial, with estimates of lifetime cost (in 2009 dollars) ranging from more than $75 billion to more than $200 billion. Additionally, survivors of TBI can suffer from cognitive issues and are more likely to be unemployed, socially isolated, and incarcerated. 12 The long-term sequelae of TBI can include psychiatric and neurological dysfunction, as well as a whole host of nonneurological diseases. What is becoming clear, is that even relatively mild TBI can have far-reaching consequences that last well beyond the initial symptoms. 10 During the first 12 years of these conflicts, nearly 250,000 service members were diagnosed with TBI, 11 although the difficulties associated with reporting, identifying, and diagnosing head injuries indicate that this number likely is underestimated. 9 Additionally, TBI was declared the signature injury among military personnel involved in the protracted conflicts in Iraq and Afghanistan (Operations Enduring Freedom, Iraqi Freedom, and New Dawn). 8 Even among those patients seen by medical personnel, the lack of definitive diagnostic tools, or even consensus on a definition, means that a substantial proportion of TBIs go undiagnosed. 4, 5 Although these recent events, which include the emerging understanding of the role of TBI in later neurodegeneration and the recognition of the high incidence of TBI among amateur and public athletes, as well as military personnel, represent tragedies with real human cost, they have also helped focus public attention on an ongoing public health crisis.Īnnually, about 2.8 million civilians in the United States receive medical treatment for TBI, but the true incidence of TBI is actually far higher, as many TBI patients are never seen by health care providers 6, 7 (although rates of emergency department visits are rising, likely due to increasing public awareness of the seriousness of TBI). Public understanding of TBI is currently undergoing a shift due, in part, to recent events that have focused public and media attention on the issue. 3 Consequently, TBI is a highly heterogeneous injury state resulting in a patient population with markedly different injuries, comorbidities, and predicted outcomes. 2 Further, the injuries can be divided into those that cause focal or penetrating damage to local brain regions versus those that result in more diffuse damage. 1 The extent of neurological damage is determined by an evolving pathophysiology over the hours and days following the injury, during which time brain swelling, increased intracranial pressure, and reduced cerebral blood flow contribute to the development of cognitive and functional deficits. The duration and severity of dysfunction may range from “mild” TBI (concussion), which may involve a brief period of loss of consciousness and a transient neurological impairment with rapid recovery, to “severe” TBI, involving an extended period of loss of consciousness and permanent brain damage. Traumatic brain injury (TBI) is characterized by neurological dysfunction caused by a bump, blow, or penetrating injury to the brain. ![]()
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