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Traumatic Brain Injury (TBI)

Bicycle - Related TBI


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Traumatic Brain Injury

Scope of Problem Trends
Who Causes

According to the Brain Injury Association of America, traumatic brain injury (TBI) is among the most misdiagnosed, misunderstood, and under-funded public health problems our country faces. But, just what is it? In fact, it has been shown that much of the public is unaware of the impact of TBI (Harris Interactive Inc., 2000), in part due to the fact that many of the consequences are not readily apparent. This combined with the fact that the actual number of TBIs that occur in the United States is not known has led it to being referred to as the “silent epidemic.” (Langlois, Marr, Mitchko; 2005)

TBI is defined as a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. (Facts about TBI) It is a non-degenerative, non-congenital insult to the brain from an external mechanical force resulting in cognitive, emotional, sensory, and motor impairments which can lead to a variety of temporary or permanent disabilities. The number and extent of impairments varies tremendously with the severity of injury, and lead to other consequences.

There may be social consequences, including increased risk of suicide, divorce, chronic unemployment, economic strain, and substance abuse; and enormous economic consequences. The annual cost of acute care and rehabilitation in the United States for new cases of TBI is estimated at $9 to $10 billion. Estimates for average lifetime cost of care for a person with severe TBI range from $600,000 to $1,875,000. As significant as these figures are, they may grossly underestimate the economic burden of TBI to family and society because they do not include lost earnings, costs to social services systems, and the value of the time and foregone earnings of family members who care for persons with TBI. (NIH Consensus Statement; 1998)
The interactions of physical, cognitive, and behavioral sequelae can also interfere with the task of new learning which is a particularly significant consequence for children.

Scope of Problem

This is probably best portrayed by a comparison of annual incidence with other, more familiar health issues. (TBI Incidence fact sheet, BIA)
Annual Incidence
Multiple Sclerosis
Spinal Cord Injuries
Breast Cancer

More statistics:
  • Every 21 seconds, someone in the United States sustains a TBI.
  • Every year: 50,000 people die from such an injury
  • 235,000 are hospitalized,
  • 1.1 million are treated and released from an emergency department (Facts about TBI)
  • Approximately 5.3 million Americans live with TBI-associated long-term disabilities. (CDC; 2001)
  • Our nation spends an estimated $56 billion annually in direct and indirect costs. (Binder, Corrigan, Langlois; 2005)
  • TBI accounts for approximately 40% of all deaths from acute injuries in the United States. (Dawodu; 2003)

And these numbers don’t give the whole picture. What are not included in these counts are those who are not seen in a hospital or emergency department, or those who receive no care.


  • The incidence of hospitalization for TBI has been diminishing over time. In the 80’s, there were 200 per 100,000 hospitalized cases of head injury based on population estimates. In 1995, it had fallen to about 100 per 100,000. (Novack; 2000) This is a bit misleading as it would seem to suggest the incidence of TBI is going down. However, this is hospitalization rate, and over time, milder injuries have no longer been hospitalized, but have been treated in Emergency Departments or physician’s offices.

  • The incidence of mild traumatic brain injury (MTBI) in EDs appears to have increased – almost doubling from 216 per 100,000 in 1991 (Sosin, Sniedzek, Thurman; 1996) to 392 per 100,000 in 1995-1996 (Guerrero, Thurman, Sniezek; 2000). In contrast, MTBI hospitalizations appear to have declined from 130 per 100,000 to 51 per 100,000 between 1980 and 1994 (Thurman, Guerrero; 1999)

  • The TBI-associated death rate declined 22% between 1979 (24.6/100,000) and 1992 (19.3/100,000). (Sosin DM, Sniezek JE, Waxweiler RJ; 1995)

  • At the 2006 2nd Federal Interagency Conference on Traumatic Brain Injury, Dr. Jean Langlois discussed how the death rates from TBI are decreasing because of improvements in care. More people are surviving severe TBI.


  • Males are more than twice as likely as females to experience TBI.

  • The estimated incidence rate is 100/ 100,000 persons. The highest incidence is among persons 15 to 24 years of age and 75 years and older, with an additional less striking peak in incidence in children ages 5 and younger. (NIH Consensus Statement; 1998)

  • People over 75 years old have the highest rate of TBI. About 191 out of every 100,000 people in that age group have a TBI each year; the most common cause is falls.

  • People age 15-24 have the next highest rate of TBI, with 145 out of every 100,000 persons sustaining a TBI in a given year. The most common cause of TBI for that age group is transportation.

  • Among children under 5 years old, 82 out of 100,000 have a TBI each year, and most of those injuries are caused by falls and motor vehicle crashes


  • Approximately 50 percent of TBIs are the result of motor vehicle, bicycle, or pedestrian-vehicle incidents.
  • Falls are the second most frequent cause of TBI among the frail elderly and the very young.
  • Violence-related incidents account for approximately 20 percent of TBI. These incidents are almost equally divided into firearm and non-firearm assaults. The highest incidence for TBI due to firearms is among people ages 15 to 24.
  • Although sports and recreation related injuries account for 3 percent of hospitalized persons with TBI, approximately 90 percent of sports-related TBIs are mild and may go unreported, thus leading to the underestimate of the actual incidence rate of sports-related TBI.
    (NIH Consensus Statement; 1998)
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