Head Trauma
General Principles
Definition
- Traumatic brain injury (TBI) can occur with head injury due to contact and/or acceleration/deceleration forces.
- Concussion: Trauma-induced alteration in mental status with normal radiographic studies that may or may not involve loss of consciousness.
- Contusion: Trauma-induced lesion consisting of punctate hemorrhages and surrounding edema.
Classification
- Closed head injuries may produce diffuse axonal injury.
- Contusion or hemorrhage can occur at the site of initial impact, “coup injury,” or opposite to the side of impact, “countercoup injury.”
- Penetrating injuries (including depressed skull fracture) or foreign objects cause brain injury directly.
- Secondary increases in intracranial pressure may compromise cerebral perfusion.
Epidemiology
- Head injury is the most common cause of neurologic illness in young people.
- The overall incidence of TBI in the US population is estimated at approximately 750 per 100,000 (i.e., approximately 2.5 million per year with approximately 11% requiring hospitalization).1
- Two-thirds of TBIs are considered “mild,” whereas 20% are severe and 10% are fatal. Note that although designated as “mild,” mild TBI can still translate into significant disability (permanent in 15%).
- Rates of TBI are highest in the very young, adolescents, and the elderly.
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Citation
Bhat, Pavat, et al., editors. "Head Trauma." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. The Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602137/all/Head_Trauma.
Head Trauma. In: Bhat PP, Dretler AA, Gdowski MM, et al, eds. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602137/all/Head_Trauma. Accessed November 29, 2023.
Head Trauma. (2016). In Bhat, P., Dretler, A., Gdowski, M., Ramgopal, R., & Williams, D. (Eds.), Washington Manual of Medical Therapeutics (35th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602137/all/Head_Trauma
Head Trauma [Internet]. In: Bhat PP, Dretler AA, Gdowski MM, Ramgopal RR, Williams DD, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2023 November 29]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602137/all/Head_Trauma.
* Article titles in AMA citation format should be in sentence-case
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ED - Dretler,Alexandra,
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BT - Washington Manual of Medical Therapeutics
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PB - Wolters Kluwer Health
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DB - The Washington Manual
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