Epidemiology and Injury Prevention

Email
Print

Type Size

 Injury is the fifth overall leading cause of death in the United States, preceded only by heart
disease, cancer, stroke, and chronic respiratory diseases.1
 More than 2.8 million people are hospitalized with injury each year. 2
 More than 180,000 deaths from injury occur each year; meaning, approximately one person dies
from injury every three minutes.2
 Injury is the leading cause of death in persons aged 1-34 years. 3
 Motor vehicle crashes are the leading cause of death for persons aged 5-34, claiming the lives of
more than 30,000 Americans each year.3
 More than 2.3 million adult drivers and passengers are treated in Emergency Departments for
injury each year. 3
 Adult seatbelt use is the most effective way to save lives and reduce injuries in automobile
crashes. 6
 Seatbelt use reduces the likelihood of serious injury in a crash by approximately 50%.6
 Helmet use is the most effective way to save lives and reduce injuries in motorcycle crashes.
 Helmets are estimated to prevent 37% of fatal motorcycle injures.5
 Homicide is the second leading cause of death in 15-24 year olds, and claims more than 8,500
lives each year.3
 Among those age 65 and older, falls are the leading cause of injury related death.3
 Injuries in 2005 accounted for $406 billion in medical and work loss costs.4
Trauma Centers

 A trauma center is a hospital with resources and equipment needed to care for severely injured
patients.
 Trauma centers are designated by state government agencies as Level I to Level IV depending on
the types of resources available.
 CDC-supported research shows a 25% reduction in deaths for severely injured patients who
receive care at a Level I trauma center rather than at a non-trauma center.
 A trauma center may seek additional verification by The American College of Surgeons
Committee on Trauma (ACSCOT), ensuring accredited centers have the resources necessary for
delivering care as outlined in Resources for Optimal Care of the Injured Patient.
 The ACSCOT strives to improve all phases of care of the injured patient through the development
of standards, educational programs and the assessment of patient outcomes.
 A trauma system is an organized, coordinated effort in a defined geographic area that delivers the
full range of care to all injured patients and is integrated with the local public health system.
1. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final data for 2007. National vital
statistics reports; vol 58 no 19. Hyattsville, MD:

National Center for Health Statistics. 2010.

2. Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS).
National hospital discharge survey: 2007 summary. National health statistics reports, no. 29. Atlanta,
GA: NCHS; 2010.

3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
Web-based Injury Statistics Query and Reporting System (WISQARS) [online] (2007) [cited 2011
Mar 4]. Available from URL: http://www.cdc.gov/injury/wisqars.

4.National Highway Traffic Safety Administration. Lives saved in 2009 by restraint use and minimum-
drinking-age laws. Washington, D.C.: US Department of Transportation, National Highway Traffic
Safety Administration: 2010. Publication no. DOT-HS-811-383.

5. http://www.cdc.gov/Features/MotorcycleSafety/

6. Finkelstein EA, Corso PS, Miller TR, Associates. Incidence and economic burden of injuries in
the United States. New York, NY: Oxford University Press; 2006

7.National Highway Traffic Safety Administration. Final regulatory impact analysis amendment to
Federal Motor Vehicle Safety Standard 208. Passenger car front seat occupant protection.
Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration;
1984. Publication no. DOT-HS-806-572.

Author: Jennifer Smith, MD (2011)

Traumatic Brain Injury Rehabilitation
Email

Print

Type Size

Traumatic Brain Injury (TBI) is the third leading cause of death by injury in the United States, with
about 550,000 persons hospitalized each year with TBI, and more than 80,000 persons per year
developing long-term disability. The majority of persons with TBI are male and less than age 30.
Younger age at injury amounts to devastating consequences on social, financial, emotional, and
familial development. Since the advancement of earlier in-field care (i.e., “Jaws of life”), and more
recent neurosurgical guidelines, people are surviving severe TBI more than ever before. This has
implications on rehabilitation of TBI patients given the shear volume of patients and the great variety
of problems. The TBI rehabilitation plan begins with establishing the major impairments specific to
the injury itself.

General impairments in TBI encompass three main groups: Cognitive, physical, and behavioral.
Cognitive deficits are first manifested in problems with communication and comprehension which
have profound impact on the rehabilitation plan of care. Typical cognitive issues that affect all
aspects of both early and late rehabilitation include memory, concentration, and attention deficits.
Diffuse injury, commonly occurring in closed head injuries from acceleration-deceleration
mechanism (like a car collision or fall from a high level), classically results in cognitive-related
language problems. Cognitive related language problems include difficulty solving problems or
learning something new. This is in contrast to the inability to form the words and express oneself
(called aphasia). Physical impairments range from arm, legs, and trunk muscular dysfunction to
speech and swallowing dysfunction. The behavioral impairments of moderate-to-severe TBI include
impulsivity, distractibility, aggression, and agitation as a person with acute TBI recovers.

The patient with moderate-to-severe TBI especially requires a multidisciplinary approach including
members of surgery, physiatry (physical medicine and rehabilitation specialists), psychiatry, nursing,
physical and occupational therapy (PT, OT), speech and language pathology (SLP), social work, and
case management. Due to the enormous complexity of physical, cognitive, and behavioral
dysfunctions, in the setting of potential underlying problems such as alcoholism, mental health
disorders and / or social challenges, regular communication among trauma team members is
paramount to optimizing recovery in both acute care and rehabilitation setting. Admission to the
inpatient rehabilitation center is a major step upward with respect to intensity and frequency of
rehabilitation; however, it should ideally serve as a continuation of TBI rehabilitation as persons go
from “coma to community,” rather than the initiation of rehabilitation.

TBI rehabilitation is incomplete without discussions of prognosis. This is begun in the initial stages of
recovery and continues during acute rehabilitation, depending on the individual patient’s course of
recovery. Rehabilitation plans with the entire team are carved out on the basis of outcome
expectations and goals. All TBI characteristics, including CT and MRI findings, age, Coma scores,
other medical problems, and pre-injury psychosocial aspects, play a significant role in realistic
predictions of future function.
As with all dramatic functional changes encountered after trauma, family involvement and education
cannot be underemphasized as patients proceed through rehabilitation phases. The entire family is
“injured” in acute TBI in many complex ways and is modified by premorbid dynamics among
members or caregivers. During the continuum of rehabilitation, it is essential that the rehabilitation
team direct, educate, and counsel the family. As mentioned, rehabilitation professionals can play a
key role as “interventionalists,” guiding patients and families with realistic prognostication, as well as
ongoing education as patients recover at various stages during recovery and rehabilitation.

As acute care lengths of stay decreases in the general trauma population, too many TBI survivors
are surprisingly not offered specialty TBI rehabilitation units on discharge. For optimal functional
recovery, it is imperative that these patients and their families be referred to these specialized units
prior to transitioning to skilled nursing facilities and home.

Please see the below lists of helpful links for more detailed information.

www.biaa.org

www.tbims.org

www.nabis.org

www.braintrauma.org

Authors: Marc de Moya, MD & Ronald Hirschberg, MD (2011)