Brain Injury Newsroom

Impact of Traumatic Brain Injury

Injury is the leading cause of mortality among Americans under 45 years of age; TBI is responsible for the majority of these deaths. An estimated 56,000 lives are lost in the United States each year to TBI. Motor vehicle accidents, followed by gunshot injuries and falls, are the leading causes of injuries resulting in death from TBI. Males are 3.4 times as likely as females to die of TBI. About 50 percent of people who sustain TBI are intoxicated at the time of injury.

In a recent analysis based on hospital discharge data and vital statistics, the annual incidence of TBI in the United States was estimated to be 102.8 per 100,000. In males, the incidence peaks between the ages of 15 and 24 (248.3 per 100,000) and again above 75 years of age (243.4 per 100,000). The incidence in females peaks in the same age groups, but the absolute rates are lower (101.6 and 154.9, respectively). These rates underestimate the true incidence of head trauma because patients with milder symptoms at the time of injury are usually not hospitalized.

About three-quarters of traumatic brain injuries that require hospitalization are nonfatal. Each year, about 80,000 survivors of TBI will incur some disability or require increased medical care. Direct medical costs for TBI treatment have been estimated at $48.3 billion per year, including the costs of hospitalization for acute care and various rehabilitation services.

In the years 1988 to 1992, reports of average length of stay (LOS) for the initial admission for inpatient rehabilitation range from 40 to 165 days. In one multicenter study (the Model Systems study), the average rehabilitation LOS was 61 days, and the average charge was $64,648 exclusive of physician fees. Total charges averaged $154,256. In more recent studies performed in the early 1990s, rehabilitation LOS and charges were lower, ranging from 19 days and $24,000 for patients with milder injuries to 27 days and $38,000 for those with severe injuries. In the Medicare population in 1994, mean charges for patients admitted for brain injury (excluding stroke) were $42,056.

To focus attention on important questions, the life of an adult survivor of TBI was characterized by the developers of the report in terms of five phases. The first phase is pre-injury. Medical treatment is divided into two phases: the acute (or immediate) treatment phase and the intensive treatment phase, lasting days to weeks. The rehabilitation phase may last months to years. The survivor phase implies the remaining life of the person with TBI and involves continual development and adjustment. This division into phases clarifies the three challenges to assessing the efficacy of rehabilitation discussed above. For each phase, patient populations, interventions, and outcome measures were identified, and the literature was reviewed to answer key questions identified by technical experts