Welcome to Trauma Tuesday! This will be a continuation of my first POTD on TBIs, but today, we will be talking more about the public health implications of TBIs.
According to the CDC, there were over 210,000 TBI-related hospitalizations and a little under 70,000 TBI-related deaths in 2021 in the United States. In addition to direct health-related statistics, there are many long-term effects of TBIs that have an impact on the individual's quality of life and on society as a whole. For example, patients with a history of TBIs are more likely to have difficulties with finding work and holding down a job, dysregulated behavior that can lead to challenges in social relationships, and substance use disorders.
Additionally, vast health disparities exist on who suffers from a TBI. Statistics show that adults aged 75 years or older, racial/ethnic minorities, veterans, people who are incarcerated, people experiencing homelessness, and victims of domestic violence are both more likely to get a TBI and to suffer worse long-term consequences from it. Many of the people who fall under the above mentioned categories also have more difficulty accessing healthcare, which can put even more barriers in their road to recovery, as some patients require long-term services such as physical/occupational therapy and mental health support.
Given everything I mentioned above, it is tremendously important that we do our best in the acute management of head injuries in the ED. However, perhaps even more important is TBI prevention before the primary injury ever happens. While our time and our resources are limited in the ED, we have the opportunity to do some quick education with our patients and their families on how to prevent (more) TBIs - everything from wearing helmets to assessing the fall risk of a patient who may have mobility issues. While we can't control what happens to our patients outside of the ED, we can at least take a few minutes to talk to them about this topic in hopes of saving them a (potential) lifetime of further complications.
Resources:
https://emcrit.org/ibcc/tbi/#coagulation_management
https://www.emdocs.net/neurotrauma-resuscitation-pearls-pitfalls/
https://www.cdc.gov/traumatic-brain-injury/health-equity/
Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic brain injury in the United States: A public health perspective. J Head Trauma Rehabil. 1999;14(6):602-615. doi:10.1097/00001199-199912000-00009
Peterson AB, Zhou H, Thomas KE. Disparities in traumatic brain injury-related deaths-United States, 2020. J Safety Res. 2022 Dec;83:419-426. doi: 10.1016/j.jsr.2022.10.001. Epub 2022 Oct 18. PMID: 36481035; PMCID: PMC9795830.
Wilson MH. Traumatic brain injury: an underappreciated public health issue. Lancet Public Health. 2016;1(2):e44. doi:10.1016/S2468-2667(16)30022-6