Brain Injury, Traumatic

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  • Traumatic brain injury (TBI) is defined as an alteration in brain function or other evidence of brain pathology, caused by an external force.
  • System(s) affected: neurologic; psychiatric; cardiovascular; endocrine/metabolic; gastrointestinal
  • Synonym(s): head injury, concussion


  • 2.2 million ED visits and 280,000 hospitalizations per year
  • 50,000 deaths per year; ~30% of all injury-related deaths
  • Incidence in males twice that of females with 4-fold risk of fatal trauma

  • Predominant age: 0 to 4 years, 15 to 19 years, and >65 years
  • Predominant gender: male > female (2:1)

Etiology and Pathophysiology

  • Falls (40%)
  • Motor vehicle accidents (14%)
  • Assault (10%)
  • Child abuse (24% of TBI age ≤2 years)
  • Recreational activities (21% of pediatric TBI, peak seasons spring/summer; peak ages 10 to 14 years)
  • Primary insult: direct mechanical damage
  • Secondary insult: actuation of complex cellular and molecular cascades that promote cerebral edema, ischemia, and apoptotic cell death

Risk Factors

Alcohol and drug use, prior/recurrent head injury, contact sports, seizure disorder, ADHD, male sex, luteal phase of female menstrual cycle

Geriatric Considerations
Subdural hematomas are common after a fall or blow in elderly; symptoms may be subtle and not present until days after trauma. Many elderly patients are on antiplatelet or anticoagulation therapy.

General Prevention

  • Safety education
  • Seat belts; bicycle and motorcycle helmets
  • Protective headgear for contact sports

Pediatric Considerations
Child abuse: Consider if dropped or fell <4 feet (e.g., off bed, couch), suspicious history, significant injury present, or any retinal hemorrhages.

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