Evaluating the HRSA Traumatic Brain Injury Program (2006) / Chapter Skim
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2 Epidemiology and Consequences of Traumatic Brain Injury - An Invisible Disability
2 Epidemiology and Consequences of Traumatic Brain Injury - An Invisible Disability
Pages 33-57
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From page 33... ...
. As background for the committee's assessment of the impact of the TBI Program administered by the Health Resources and Services Administration (HRSA)
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106-310, 2000) .1 EPIDEMIOLOGY OF TBI TBI Incidence and Prevalence Estimates In the immediate aftermath of TBI, a person may have a skull fracture, intracranial lesion, decreased level of consciousness for a period of time, or limited memory for events immediately preceding or following the onset of the brain injury, and other neurological or neuropsychological abnormalities.
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. Available estimates of the incidence and prevalence of TBI are undercounts because most TBI surveillance systems draw only from hospital and emergency department records;2 however, people who have sustained a TBI may not be immediately evaluated at an emergency department, may not be hospitalized, or may not receive medical attention at all (Sosin et al., 1996; NIH, 1998; Schootman and Fuortes, 2000)
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, and assaults (11 percent) ; these accounted for three-fourths of TBI-related emergency department visits, hospital stays, and deaths (Figure 2-2)
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. Available TBI surveillance data related to TBI-related hospitalizations, emergency department visits, and deaths suggest that the population of individuals who sustain a TBI includes substantial numbers of the very young, the very elderly, as well as adolescents and young adults (Table 2-1)
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Motor vehicle traffic crashes are the predominant TABLE 2-2 Rate of TBI-Related Hospitalizations, Emergency Department Visits, and Death, by Age, U.S., 19952001a Age Group Rate per 100,000 04 1120.7 59 659.3 1014 628.6 1519 814.4 2024 555.5 2534 450.2 3544 374.7 4554 285.2 5564 229.5 6574b 267.4 Over 74 659.1 All ages 506.4 aAge-adjusted to the 2000 U.S. standard population.
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. Several studies also suggest that a history of concussion significantly increases the risk of sustaining another, more severe brain injury (Guskiewicz et al., 2000, 2003; Schulz et al., 2004)
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. Recent studies have found alarming rates of TBI among veterans injured by exposure to improvised explosive devices.
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The Glasgow Coma Scale is commonly used to determine the initial severity of TBI.5 A score of 1315 is described as a mild TBI, 912 as a 5The Glasgow Coma Scale (GCS) is one of several approaches for gauging and documenting the severity of a TBI.
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Her summary: "Current criteria define my injury as mild; the changes in my life are radical." moderate TBI, and 8 as a severe TBI.6 The variables typically considered in determining the initial severity of an acute TBI include decreased level of consciousness, duration of post-traumatic amnesia, skull fracture, bruises or blood clots in the brain, and neurological or neuropsychological dysfunction (Kay et al., 1993)
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Family members trying to meet the needs of the injured person may experience declines in their own emotional and physical health status. There is also evidence that TBI has worrisome and significant costs for society at large -- with particular burdens on an array of public and private systems including physical and behavioral health care delivery systems, schools, disability and welfare programs, and courts and correctional facilities.
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. The sequence and nature of a TBI's emerging symptoms depends on a range of critical factors including the site and severity of the injury; preexisting conditions, such as prior TBIs; behavioral, psychiatric, substance abuse, and learning problems; and a number of mediating variables including age, family income, health insurance, access to appropriate services; and social supports (Gordon et al., in press; Hibbard et al., 1998; Novack et al., 2001; Forducey et al., 2003; Dikmen et al., 2003; Mellick et al., 2003; Breed et al., 2004; Whiteneck et al., 2004a, 2004b)
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. Physical Health The majority of individuals with TBI are mobile and able to care for themselves (Novack, 2000)
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Getting necessary care is also difficult because patients often forget appointments and struggle to articulate effectively and present their problems to providers. Behavioral Competence A substantial literature documents that TBI increases the risk of major depression, general anxiety disorder, obsessive-compulsive disorder, panic
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Data collection and analysis are daunting challenges given the fragmented nature of TBI services and the inflexibility of their disparate data systems, lack of standardized definitions, and multiple public and private service systems. Most of the available research draws from convenience samples, such as persons hospitalized for TBI, medical record reviews, and follow-up interviews with persons with TBI to document levels of impairment and need for assistance (Novack et al., 2001; Whiteneck et al., 2004b)
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The available research suggests, however, that psychosocial, cognitive, and physical impairments dramatically limit some individuals' ability to return to productive activity, whether it is work, school, or other endeavors (Buffington and Malec, 1997)
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. Consequences of TBI for Family Members The emotional and physical health status of the family caregiver can be as compromised as that of the person with TBI (Thomsen, 1984; Hall et al., 1994)
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The sequence and nature of a TBI's emerging symptoms depends on the site and severity of the injury; preexisting conditions, such as prior TBIs; behavioral, psychiatric, substance abuse, and learning problems; and a number of mediating variables including age, family income, health insurance, access to appropriate services, and social supports.
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From page 51... ...
Some people with TBI find it hard to learn new information or interpret the subtle cues and actions of others. A substantial literature documents that TBI increases the risk of major depression, general anxiety disorder, panic disorder, post-traumatic stress disorder, antisocial behavior such as criminality and substance abuse, and suicide.
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2004. Methodological issues and research recommendations for mild traumatic brain injury: The WHO collaboration center task force on mild traumatic brain injury.
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2004. Psychiatric illness following traumatic brain injury in an adult health maintenance organization.
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2004. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Deaths.
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2004. Suicidal behavior and mild traumatic brain injury in major depression.
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2005. Two decades of advances in understanding mild traumatic brain injury.
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2005. Productive work and employment for persons with traumatic brain injury.
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