According to the , every year in the United States, an estimated 1.7 million people sustain a . Of those cases, roughly 52,000 die, 275,000 are hospitalized, and 1.4 million—nearly 80% of all cases—are treated in an emergency room. There is thought to be millions more that go unreported and untreated. Additionally, TBIs are responsible for about third of all . About 75% of these TBIs are concussions or other forms of mild traumatic brain injury. There is no exact number, but TBIs are thought to cost an estimated $60 billion in combined , like medical bills, and in indirect costs, like loss of productivity, lost wages, and the like.
What is a traumatic brain injury?
In order to be classified as a TBI, the incident must have occurred as a result of an injury, as the name implies. This refers to damage to the brain caused by an external physical force such as a car accident, slipping and hitting your head, or the handlebars of a bicycle piercing the skull. Something that has an internal or genetic cause is not classified as a TBI, such as a stroke or tumor.
TBIs are often confused with the symptom of lost consciousness. One does not have to lose consciousness in order to have a TBI. Plenty of TBI cases, such as , occur every year without the patient ever being “knocked out.” Likewise, some people even have penetrating head wounds and are fully awake the whole time.
The TBI Model Systems is used to establish commonly accepted criteria in identifying the presence and severity of a TBI. This includes:
Damage to brain tissue caused by an external force and at least one of the following:
- A documented loss of consciousness.
- The person cannot recall the actual traumatic event; amnesia.
- The person has a skull fracture, post-traumatic seizure, or an abnormal due to the trauma.
- Causes of TBI
- The leading causes of TBI are:
- Falls (40%)
- Struck by an object (16%)
- Car crashes (14%)
- Assault (11%)
- Other (19%)
How does a TBI occur?
As one can probably conclude, the brain is an extremely important organ. Without it, the other essential organ like the lungs, heart, kidneys, etc. would just be lifeless lumps of tissue. The human head weighs 8 pounds (well, it’s more like 10lbs, thanks, Jerry Mcguire) and of that, the brain makes up about 3.4 pounds. The brain is composed of extremely delicate soft tissue that is suspended within the skull by cerebrospinal fluid.
Because the brain is a soft, pliable tissue, it can be compressed, squeezed, stretched, and pulled. This most often occurs when there is a . Since the brain is suspended in a liquid (similar to the way that a yolk is suspended in an egg and not touching the sides) it can move around. As the skull suddenly speeds up or slows down, the brain continues on in the direction it was moving; it then slams into the wall of the skull. This can occur as a result of a , fall, or any other impact. This violent movement of the brain inside the skull is what causes a TBI.
To better understand this concept, it’s helpful to understand Isaac Newton’s First Law of Motion. We need only focus on the second part of the law, which states:
…An object in motion continues in motion with the same speed and in the same direction unless acted upon by another force.
For illustration purposes, let’s think of a car accident. Let’s say a person is traveling forward in a vehicle at 60 miles per hour. This means that their brain is also traveling forward at 60 mph. When the car suddenly hits another vehicle, the car slows down dramatically in a split second; let’s assume to 0 mph. This means that for a fraction of a second, the brain continues forward in motion at 60 mph until it is acted upon by another force, in this case, the solid skull. When the brain comes in contact with the skull, it has nowhere else to go and slams into it. From this illustration, it’s clear just how devastating a car accident can be on the brain.
Closed vs Open Head Injuries
As mentioned above, a TBI can be both a result of the brain making contact with the skull and a result of a foreign object coming in contact with the brain.
A closed head injury means that neither the skull nor the brain has been penetrated. An open head injury means that the skull and other protective layers are penetrated and exposed to the open-air. For example, a closed injury is one that occurs from hitting one’s head, like on a steering wheel. The skull is not cracked, nor is the brain exposed. An example of an open head injury is a piece of steel penetrating the skull and going in the brain tissue.
can cause bruising to the brain tissue, swelling and pressure, damage to axons and nerves, and tears in blood vessels. This damage can be localized to a specific area of the brain or more widespread affecting the entire brain—known as a diffuse axonal injury.
may sound or appear more dramatic, but the damage tends to be localized to a specific area of the brain. This often means only one part of the brain is affected. However, depending which area that is, these injuries can be very serious and life threatening also.
Primary versus secondary injuries
Primary injuries result from the immediate trauma of the accident or incident causing the injury. When treating a TBI, doctors are trying to the primary injury, while trying to prevent a secondary injury. Secondary injuries occur because of damage or complications from the primary injuries in the hours, days, weeks after.
Some examples of primary injuries include:
Concussion – caused by the brain being moved around violently, tearing nerves, blood vessels, and releasing chemicals.
Skull fracture – not all skull fractures cause brain damage, but a fracture can cause a TBI if the skulls are depressed into the brain or a piece of skull breaks off into the brain.
Contusion – bruising (bleeding) on or in the brain.
Diffuse axonal Injury – stretching and possible tearing of the neurons (brain nerve cells) and axons (fibers that transfer information). The tearing of the nerve tissue disrupts the brain’s regular communication and chemical processes which can produce temporary or permanent brain damage, coma, or death.
Penetration injury – a foreign object enters the skull and makes contact with the brain. This can be localized, like a sharp piece of metal entering and staying in one place, or like a bullet which may take one path or bounce around the skull.
Some examples of secondary injuries include:
Intracranial hemorrhage – bleeding inside the skull because of torn blood vessels.
Brain swelling – is your body’s response to damage, but can be further damaging in the brain, as the skull greatly limits where the excess swelling can go. Brain swelling can restrict needed fluids, blood, and oxygen.
Increased intracranial pressure – this is related to the , but more specifically references the pressure that builds inside the skull. As the pressure becomes greater, damage to other areas becomes more likely.
Measuring the severity of TBI
TBI severity is commonly classified as mild, moderate, or severe. Diagnosing the severity of a brain injury is not exact, since brain injuries themselves are not. However, a few things are often taken into account, like, how long a person was unconsciousness, their ranking on a coma rating scale, how severe their memory loss is (amnesia), and brain imaging results.
-Brief loss of consciousness, usually a few seconds or minutes
-Normal brain scan results
-Loss of consciousness for 1 – 24 hours
-Amnesia for 1 – 24 hours after the TBI
-Abnormal brain can results
-Loss of consciousness or coma for more than 24 hours
-Amnesia for more than 24 hours after the TBI
-Abnormal brain scan results
Severe TBI may be further sub-categorized as follows:
Vegetative State – a state in which an individual is not in a coma, but is not aware of the environment
Minimally Responsive State – a state in which a person with a severe TBI is no longer in a coma or vegetative state, but inconsistently interacts with and responds to their environment.
As mentioned above, a scale—called The Glasgow Coma Scale—is used to measure the extent of a coma. Three things are used to do this: eye opening, movement, and verbal response. Basically, it is assessed if the patient can do the following on their own: open their eyes, move body parts, and respond to questions verbally.
Another factor in severity is post-traumatic amnesia. After a traumatic brain injury, patients will often forget the event, some period of time before the event, and some period of time after the event. Severity can be gauged by using the duration of this memory loss as an indicator. The longer the memory is lost, the more severe.
Finally, imaging devices are used to help determine the severity of a TBI. The two most common types of imaging used to scan the brain are . These detailed images of the brain structure can identify many different kinds of brain injuries. However, not all can be detected this way, which is why other symptoms are taken into account.
Dolman Law Group
A traumatic brain injury could be a mild concussion which heals in a few days or could be a life-threatening, . When someone does suffer a moderate or severe TBI, the results can be damaging to the patient’s and their family’s life. They may require extensive medical treatment, , or in-home care. This will be hard enough without considering the cost; there is no need for the victim and their family to take on the financial responsibility of a TBI that was caused by negligence.
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