Traumatic Brain Injury

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Everyday, men, women and children suffer head injuries. A trip or fall, a car accident, a sports injury – these everyday injuries can range in severity from concussion to coma. Traumatic Brain Injury (TBI) can be fatal or, in survivors, can produce persistent problems that significantly affect the livelihood and well-being of millions around the globe.

  • India has the rather unenviable distinction of having the highest rate of head injury in the world. In India, more than 100,000 lives are lost every year with over 1 million suffering from serious head injuries.
  • In India, 1 out of 6 trauma victims die, while in the United States this figure is 1 out of 200. This seemingly unbreachable gap speaks volumes of the perfected PTC procedures in US and their near absence in India..
  • Half of those who die from TBI do so within the first two hours of injury. It is now known that only a portion of neurological damage occurs at the moment of impact (primary injury); damage progresses during the ensuing minutes, hours and days. The secondary brain injury can result in increased mortality and disability.
  • Consequently, the early and appropriate management of TBI is critical to the survival of these patients. This while being a critical factor in the overall prospects of a patient is yet to be fully appreciated.
  • In 1991, 60,000 people were killed in road traffic accidents (RTA’s), as compared to 24,600 in 1980. This figure is now closing in on 100,000 deaths per year.
  • Ninety-five percent of trauma victims in India do not receive optimal care during the “golden hour” period after an injury is sustained, in which health care administration is critical. The outcome of TBI is drastically correlated to the response of pre-hospital care and rehabilitation. Thirty percent of those who currently die from head injuries could be saved if quality care were available to them sooner.
  • Most road traffic accident victims are in the 20- to 40-year age group, the main bread-earners of the family, putting the whole family below the poverty line in many cases while depriving society of vital drivers of economy as in many cases these are entrepreneurs or professionals.
  • Pedestrians and motorcyclists are the most common victims of road traffic accidents in India.
  • By 2050, India will have the greatest number of automobiles on the planet, overtaking the United States.

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•50 million injured every year
•Estimated deaths – 1.2 million
•Global mortality: 97/1,000,000
•70 percent fatalities (8,500,000) under 45 years of age
•3,300 deaths and 6,600 serious injuries every day
•WHO Research Predicts by 2020:
80 percent increase in developing countries
147 percent increase in road traffic accidents (RTA) deaths in India/Rajasthan

•60 percent of all TBI caused by RTA
•Fatality rate: 70 per 10,000 vehicles
•25 times higher than in developed countries
•Alcohol involvement: 15-20 percent of TBI
•A 38 to 43 percent mortality rate in severe TBI
•One person dies in India every 6 to 10 minutes; will be every 3 minutes by 2020
•Asia is the location of the highest rate of injury for pedestrians and motorcycle operators
•Most of those who are injured in RTA are considered “vulnerable road users”: pedestrians (25 percent of those injured), motorcyclists (17 percent),
four-wheel vehicle operators (15 percent), and pedal cyclists (10 percent).
•Of the victims classified as “severely injured” in RTAs, 76 percent have suffered head injuries.
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What is Consussion?

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.

Health care professionals may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.

Symptoms of concussion usually fall into four categories:

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.

When to Seek Immediate Medical Attention:
Danger Signs in Adults
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. Contact your health care professional or emergency department right away if you have any of the following danger signs after a bump, blow, or jolt to the head or body:
• Headache that gets worse and does not go away.
• Weakness, numbness or decreased coordination.
• Repeated vomiting or nausea.
• Slurred speech.

The people checking on you should take you to an emergency department right away if you:
• Look very drowsy or cannot be awakened.
• Have one pupil (the black part in the middle of the eye) larger than the other.
• Have convulsions or seizures.
• Cannot recognize people or places.
• Are getting more and more confused, restless, or agitated.
• Have unusual behavior.
• Lose consciousness (a brief loss of consciousness should be taken seriously and the person should be carefully monitored).

Danger Signs in Children

Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:
• Have any of the danger signs for adults listed above.
• Will not stop crying and cannot be consoled.
• Will not nurse or eat.

Information courtesy of the United States Centers for Disease Control
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A patient is typically considered comatose when they do not open their eyes and do not respond to stimulation. They should be transported by an ambulance and brought to a major trauma center that follows the BTF Guidelines.

Treatment for a coma includes:

Initial Treatment — Treatment begins as soon as the patient is in the ambulance and in the Emergency room and includes resuscitation, stabilization and supportive care. ABC principles are followed from the moment of the TBI- Airway, Breathing and Circulation.

Acute Treatment — The goals are to reduce secondary brain injury and include medical ventilation, brain pressure monitoring and treatment to maintain oxygen and blood flow to the brain.

Surgical Treatment — Surgery is needed in some cases to evacuate blood clots or to decompress the brain.
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Information courtesy of the Brain Trauma Foundation in New York City


What is a Traumatic Brain Injury (TBI)?
Traumatic brain injury (TBI) occurs when a sudden trauma, often a blow or jolt to the head, causes damage to the brain. The severity of TBI can range from mild (a concussion) to severe (coma). A concussion may cause temporary confusion and headache, while a severe TBI can be fatal. Levels of brain trauma are characterized by the following:

What are the Levels of TBI?
Mild (Concussion): A person with a mild TBI, which is also called a concussion, may remain conscious or may experience a loss of consciousness for a few seconds or minutes or perhaps not at all. Typical symptoms can include confusion, memory difficulties, headache and behavioral problems.

Moderate: A person with a moderate TBI is often lethargic with their eyes open to stimulation and may lose consciousness for 20 minutes to six hours. He/she may experience some brain swelling or bleeding causing sleepiness, but is still able to be aroused.

Severe (Coma): A person with a severe TBI is typically in a coma state for more than six hours.

A TBI does not include a stroke, an infection in the brain or a brain tumor.

What is brain trauma?

  • Traumatic Brain Injury (TBI) – head injury and brain trauma are synonymous terms, meaning any brain injury produced by an external force.

Main causes – car crashes, falls, sports and assaults. This is different from stroke, infection, cancer or other processes that can produce brain “injuries.”

What are the severity levels of TBI?

  • Mild – Awake; eyes open. Also called a concussion. Symptoms can include confusion, memory, and attention difficulties, headache, and behavioral problems.
  • Moderate – Lethargic; eyes open to stimulation. Some brain swelling or bleeding causing sleepiness, but still arousal.
  • Severe – Coma; eyes do not open, even with stimulation. Associated with 20-50% death rate or severe disabilities. It is in this category that many lives can be saved by application of BTF’s TBI Guidelines.

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Brain death: an irreversible cessation of measurable brain function.

Cerebrospinal fluid (CSF)
: fluid that bathes and protects the brain and spinal cord.

Closed head injury
: an injury that occurs when the head suddenly and violently hits an object but the object does not break through the skull.
Coma: state of profound unconsciousness caused by disease, injury, or poison.
Computed tomography (CT): a scan that creates a series of cross-sectional X-rays of the head and brain; also called computerized axial tomography or CAT scan.
Concussion: injury to the brain caused by a hard blow or violent shaking, causing a sudden and temporary impairment of brain function, such as a short loss of consciousness or disturbance of vision and equilibrium.
Contusion: distinct area of swollen brain tissue mixed with blood released from broken blood vessels.
Intracerebral hematoma: bleeding within the brain caused by damage to a major blood vessel.
Intracranial pressure: buildup of pressure in the brain as a result of injury.
Magnetic resonance imaging (MRI): a noninvasive diagnostic technique that uses magnetic fields to detect subtle changes in brain tissue.
Neuron: a nerve cell that is one of the main functional cells of the brain and nervous system.
Penetrating head injury: a brain injury in which an object pierces the skull and enters the brain tissue.
Penetrating skull fracture: a brain injury in which an object pierces the skull and injures brain tissue.
Vasospasm: exaggerated, persistent contraction of the walls of a blood vessel.
Vegetative state: a condition in which patients are unconscious and unaware of their surroundings, but continue to have a sleep/wake cycle and have periods of alertness.
Ventriculostomy: a surgical procedure that drains cerebrospinal fluid from the brain by creating an opening in one of the small cavities called ventricle.

 Information courtesy of the Brain Trauma Foundation (BTF) in New York City