373 - Epidemiology of Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) constitutes a critical public health and socioeconomic problem throughout the world. Health care costs for TBI are high. In the United States alone there are an estimated 3.5 million TBIs, resulting in 2 million emergency department visits, almost 300,000 hospital admissions, and 53,000 deaths annually due to TBI, with associated costs reaching $85.5 billion. TBI can affect people of all ages. Peaks in TBI incidence are evident for 0- to 5-year-olds, 18- to 35-year-olds, and the elderly (>65 years). Males, those in the military, and the incarcerated, and those from minority ethnic groups have a higher risk of injury. In low- and middle-income countries most TBIs are caused by road traffic incidents, whereas in high-income countries most are caused by falls. Other causes can include assault or a direct impact with an object. Injuries can be sustained while traveling, at work, in military service, or through sport and recreational activities, as well as in all aspects of everyday life. Most people recover well from mild injuries, but between 10% and 50% may experience various persistent symptoms and challenges, ranging from fatigue and persistent headaches to disabilities and reduced quality of life. Repeated TBIs are associated with worse outcomes. Mortality rates from more severe injuries are decreasing as a result of combined effects of prevention, improvements in emergency medical systems, trauma organization, and the implementation of guidelines. However, reduced overall mortality results in increased prevalence, which may be associated with increased disability in some survivors. Nevertheless, people who have sustained a TBI have a sevenfold increase in their annual mortality rate, and the mortality rate in patients older than 75 years is increasing. Differences in case ascertainment, coding of TBI, and populations included, as well as paucity of evidence from low-income countries, limit the accuracy of our knowledge on the epidemiology of TBI.