Int J Adolesc Med Health 2015; 27(4): 361–362
Editorial Joav Merrick*
Traumatic brain injury: some good news DOI 10.1515/ijamh-2015-0026
Traumatic brain injury (TBI) can have serious consequences for the person in question; it can result in permanent disabilities or even death and have a devastating impact on the patient’s family (1). TBI happens when a sudden trauma causes damage to the brain. TBI can be mild, moderate, or severe depending upon the level of brain damage. In mild TBI, the person can be conscious or may experience a loss of consciousness for a few seconds or minutes. The person can also experience headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, and behavioral or mood changes, as well as trouble with memory, concentration, attention, or thinking. In moderate or severe TBI, the headache gets worse or does not go away; this may be accompanied by repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. Trauma to children and especially head trauma is a public health concern. A recent study of head injury
in children from Nigeria (2) reported that the age range is from 7 months to 18 years, with a mean of 8.66 years. Road traffic accident comprise 63.15% of the cases, while pedestrian accident seemed to be more frequent among preschool and school children. The most common post-traumatic effect is seizure (15.79%). Good functional outcome is observed in 92.1% of the children observed (2). Another study (3) from the US looked at TBI and mortality. This study looked at persons who lacked command following the time of admission for inpatient TBI rehabilitation. Of the 8084 persons enrolled from 1988 and 2009, 387 from 20 centers met this criteria. Individuals with moderate to severe TBI who received inpatient rehabilitation are 2.2 times more likely to die than individuals in the general population, over four times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia, and 38 times more likely to die of aspiration pneumonia (3). Disability resulting from a TBI depends upon the severity of the injury, the location, the age, and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch,
25
Deaths per 100,000 population
20 0–4 years 5–14 years
15
15–19 years
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
Figure 1: Rate of traumatic brain injury (TBI)-related deaths among persons aged 0–19 years, by age group, in the US during 1999–2010 (4).
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362 Merrick: Traumatic brain injury: some good news taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). More serious head injuries may result in persistent vegetative state or even death. Data from the National Vital Statistics System in the US (4) from 1999 to 2010 shows the rate of traumatic brain injury-related deaths among child and youth aged 0–19 years, by age group (see Figure 1). The good news is that from 1999 to 2010, the rate of TBI deaths among persons aged 15–19 years decreased by nearly half, from 23.0 per 100,000 in 1999 to 11.7 in 2010 (4). Rates also decreased for persons aged 0–4 years, from 5.4 per 100,000 in 1999 to 4.0 in 2010, and for persons aged 5–14 years, from 3.7 per 100,000 in 1999 to 1.8 in 2010 (4). The Center for Disease Control and Prevention (CDC) in Atlanta, Georgia, and their National Center for Injury have good information on prevention of injury for parents, sports coaches, school teachers, and health care providers (5). This is an important consideration and prevention seems to be the way forward. In fact, data from 1999 to 2010 (4) show that prevention programs have had an effect on youth in the 15–19-year-old age group.
References 1. Traumatic brain injury. Accessed on Mar 03, 2015. Available at: http://www.traumaticbraininjury.com/. 2. Nnadi MO, Bankole OB, Fente BG. Epidemiology and treatment outcome of head injury in children: a prospective study. J Pediatr Neurosci 2014;9:237–41. 3. Greenwald BD, Hammond FM, Harrison-Felix C, NakaseRichardson R, Howe LL, Kreider S. Mortality following traumatic brain injury among individuals unable to follow commands at the time of rehabilitation admission: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury model systems study. J Neurotrauma 2015. [Epub ahead of print]. 4. Hedegaard H, Chen L, Warner M. QuickStats: rate of traumatic brain injury (TBI)-related deaths among persons aged 0–19 years, by age group: National Vital Statistics System, United States, 1999–2010. MMWR 2013;62:215. 5. Heads up. Assessed on Mar 03, 2015. Available at: http://www. cdc.gov/HEADSUP/.
*Corresponding author: Joav Merrick, MD, MMedSci, DMSc, Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, PO Box 1260, IL-91012 Jerusalem, Israel, E-mail: [email protected]
Brought to you by | Lund University Libraries Authenticated Download Date | 10/19/16 12:40 AM
Editorial Joav Merrick*
Traumatic brain injury: some good news DOI 10.1515/ijamh-2015-0026
Traumatic brain injury (TBI) can have serious consequences for the person in question; it can result in permanent disabilities or even death and have a devastating impact on the patient’s family (1). TBI happens when a sudden trauma causes damage to the brain. TBI can be mild, moderate, or severe depending upon the level of brain damage. In mild TBI, the person can be conscious or may experience a loss of consciousness for a few seconds or minutes. The person can also experience headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, and behavioral or mood changes, as well as trouble with memory, concentration, attention, or thinking. In moderate or severe TBI, the headache gets worse or does not go away; this may be accompanied by repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. Trauma to children and especially head trauma is a public health concern. A recent study of head injury
in children from Nigeria (2) reported that the age range is from 7 months to 18 years, with a mean of 8.66 years. Road traffic accident comprise 63.15% of the cases, while pedestrian accident seemed to be more frequent among preschool and school children. The most common post-traumatic effect is seizure (15.79%). Good functional outcome is observed in 92.1% of the children observed (2). Another study (3) from the US looked at TBI and mortality. This study looked at persons who lacked command following the time of admission for inpatient TBI rehabilitation. Of the 8084 persons enrolled from 1988 and 2009, 387 from 20 centers met this criteria. Individuals with moderate to severe TBI who received inpatient rehabilitation are 2.2 times more likely to die than individuals in the general population, over four times more likely to die of circulatory conditions, 44 times more likely to die of pneumonia, and 38 times more likely to die of aspiration pneumonia (3). Disability resulting from a TBI depends upon the severity of the injury, the location, the age, and general health of the individual. Some common disabilities include problems with cognition (thinking, memory, and reasoning), sensory processing (sight, hearing, touch,
25
Deaths per 100,000 population
20 0–4 years 5–14 years
15
15–19 years
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Year
Figure 1: Rate of traumatic brain injury (TBI)-related deaths among persons aged 0–19 years, by age group, in the US during 1999–2010 (4).
Brought to you by | Lund University Libraries Authenticated Download Date | 10/19/16 12:40 AM
362 Merrick: Traumatic brain injury: some good news taste, and smell), communication (expression and understanding), and behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness). More serious head injuries may result in persistent vegetative state or even death. Data from the National Vital Statistics System in the US (4) from 1999 to 2010 shows the rate of traumatic brain injury-related deaths among child and youth aged 0–19 years, by age group (see Figure 1). The good news is that from 1999 to 2010, the rate of TBI deaths among persons aged 15–19 years decreased by nearly half, from 23.0 per 100,000 in 1999 to 11.7 in 2010 (4). Rates also decreased for persons aged 0–4 years, from 5.4 per 100,000 in 1999 to 4.0 in 2010, and for persons aged 5–14 years, from 3.7 per 100,000 in 1999 to 1.8 in 2010 (4). The Center for Disease Control and Prevention (CDC) in Atlanta, Georgia, and their National Center for Injury have good information on prevention of injury for parents, sports coaches, school teachers, and health care providers (5). This is an important consideration and prevention seems to be the way forward. In fact, data from 1999 to 2010 (4) show that prevention programs have had an effect on youth in the 15–19-year-old age group.
References 1. Traumatic brain injury. Accessed on Mar 03, 2015. Available at: http://www.traumaticbraininjury.com/. 2. Nnadi MO, Bankole OB, Fente BG. Epidemiology and treatment outcome of head injury in children: a prospective study. J Pediatr Neurosci 2014;9:237–41. 3. Greenwald BD, Hammond FM, Harrison-Felix C, NakaseRichardson R, Howe LL, Kreider S. Mortality following traumatic brain injury among individuals unable to follow commands at the time of rehabilitation admission: a National Institute on Disability and Rehabilitation Research Traumatic Brain Injury model systems study. J Neurotrauma 2015. [Epub ahead of print]. 4. Hedegaard H, Chen L, Warner M. QuickStats: rate of traumatic brain injury (TBI)-related deaths among persons aged 0–19 years, by age group: National Vital Statistics System, United States, 1999–2010. MMWR 2013;62:215. 5. Heads up. Assessed on Mar 03, 2015. Available at: http://www. cdc.gov/HEADSUP/.
*Corresponding author: Joav Merrick, MD, MMedSci, DMSc, Medical Director, Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, PO Box 1260, IL-91012 Jerusalem, Israel, E-mail: [email protected]
Brought to you by | Lund University Libraries Authenticated Download Date | 10/19/16 12:40 AM
