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NOTE

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*The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense.

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PART 1—TRAUMATIC BRAIN INJURY (TBI)

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INTRODUCTION

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More than 2.5 million incidences of traumatic brain injury (TBI) occur in the United States every year, and approximately 2.2 million of those individuals are treated in emergency departments.1 These visits for TBI of varying severities (mild, moderate, and severe) result in more than 280,000 hospitalizations, 80–90,000 individuals with permanent disabilities, and more than 50,000 deaths, every year.2 In total, it is estimated that 5.3 million individuals in the United States continue to require long-term daily assistance due to a TBI. Worldwide, the reported incidence of TBI varies considerably by country—approximately 50 per 100,000 persons in China, to over 400 per 100,000 persons in Sweden, with Europe averaging 235 incidences per 100,000 persons.3 The variability in incidence and prevalence data across different nations may be attributed to such factors as injury awareness, sensitivity of diagnostic criteria, and reporting mechanisms, as well as cultural differences in vocational and avocational activities, which may expose their populations to greater risk. In total, the annual worldwide incidence of TBI is estimated at more than 10 million, and even this is believed to be a vast underestimation.

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As with most traumas, the severity of anatomic damage associated with TBI can vary greatly. Furthermore, based on the location of damage within the brain, patients may manifest a wide variety of physical, cognitive, behavioral, or emotional symptoms. The resultant heterogeneity of TBI thus creates significant challenges in terms of classifying, characterizing, or selecting effective treatments for patients with brain injury. Although the initial or primary damage to the brain may be unavoidable in the trauma setting, all efforts should be made to help mitigate and prevent secondary injury (e.g., brain swelling, hypo/hypertension, hyperthermia, infection, hypo/hyperglycemia, repeated trauma, etc.). The goal must be to both treat the initial injury and also prevent, as much as possible, the development of secondary complications. As with the entire nervous system, early intervention is often regarded as the most valuable and effective, especially with more severe trauma; thus, early diagnosis of severity and detection of the type of injury is vital.

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CASE 15-1

A 12-year-old girl presents to the emergency department (ED) having suffered a kick to the head during a soccer match approximately 3 hours earlier. According to her parents, she was walking and talking following injury, with no apparent loss of consciousness (LOC), although she described memory loss of a few moments following injury. The on-site athletic trainer also reported that she was confused and disoriented for several minutes before walking off the field and experienced low-level nausea and dizziness, which dissipated within 15–20 minutes. She ...

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