Reprinted with Permission from Auger & Auger
October 1, 2020
Did you know that one person in the United States of America sustains a brain injury every 23 seconds? (Source) Around 50,000 of these individuals will die annually following a Traumatic Brain Injury (TBI). Adolescents, young adults, and the elderly are at the highest risk of sustaining this injury (Source).
While car accidents contribute about 14% of the aggregate TBI cases in the US, they are the leading cause of TBI-related deaths among children and young adults (Source). Thus, more attention needs to be focused on car accidents.
We took some time to gather the latest car accidents and brain injury statistics to show how bad the TBI problem is in the US, who is at the highest risk, the leading causes, the contribution made by car accidents to the problem, and the cost of such injuries to society and individuals.
One thing that is clear from the data available is that car accident and TBI statistics are not updated every year. Thus, we have gathered the latest available numbers to get an idea of the general situation prevailing.
What is a Traumatic Brain Injury?
A Traumatic Brain Injury (TBI) is defined by the National Institute of Neurological Disorders and Stroke as an injury that can be “caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain.” However, the same organization notes that it is not all jolts or blows that result in a TBI (Source).
The injury that happens at the time of impact is called the primary injury. Primary injuries could affect the entire brain or a specific part of it. Due to the impact caused by an accident, the brain can crash into the sides of the skull leading to bleeding, bruising, or slitting of the nerve fibers.
Following the first impact, the brain could go through what is known as delayed trauma. At this stage, known as the secondary injury, the brain swells and pushes against the skull. This can result in a reduction in oxygen flow around the brain. Thus, a secondary injury can be more damaging than the first one.
In terms of severity, TBIs can be classified into two broad categories:
A Mild TBI: The individual is usually awake. The symptoms may include a brief loss of consciousness, confusion, headache, disorientation, and memory loss.
The National Institute of Health (NIH), names two types of TBIs:
A Penetrating TBI: Also referred to as an open TBI, occurs when an object, such as a bullet, shrapnel, or knife, pierces the skull and enters the brain tissue. This type of injury usually damages a part of the brain.
A Non-penetrating TBI: This is sometimes called a blunt TBI. It occurs when an external force is strong enough to move the brain within the skull. Examples include sports injuries, car accidents, falls, or when an object strikes the head.
Why is TBI Data Critical?
When we have information, it becomes easier to determine the causes, develop prevention strategies, decide in terms of research and education strategies, and acquire know-how so we can assist those affected and impacted by a TBI.
Another reason why it is vital to gather car accidents and TBI data is that its impact can be felt many years after the incident. Having the right information about the extended effects can ensure that victims from the car accidents, which lead to a TBI, get the justice and compensation they deserve, even if they are passengers, pedestrians, or cyclists.
Brain Injury Statistics at a Glance
To provide a glimpse of the US’s TBI situation, below are some quick statistics provided by the Brain Injury Alliance of Utah. This non-profit organization provides support and education on matters linked to the prevention and recovery of brain injury (Source):
- Around 1.7 million Americans sustain a TBI every year.
- About 1,365,000 Americans are treated for a TBI and released from an emergency department annually.
- An estimated 5.4 million people in the US live with disabilities associated with a TBI.
- Without support, 75% of persons in the US with a TBI lose their jobs within 90 days of returning to work.
- The lifetime cost for each severe TBI survivor is estimated to be more than $4 million.
- Car accidents, falls, and violence are the most common causes of traumatic brain injury.
- About 80% of all TBI cases are categorized as a mild TBI (Source).
Prevalence in the US
The latest reliable statistics on the prevalence of TBIs provided by the Centers for Disease Control and Prevention (CDC) are from 2014. These figures show that 837,000 incidents involved children (aged 17 or younger). In the same year, traumatic brain injuries resulted in the death of 56,800 people.
Notwithstanding the statistics provided by the CDC above, an article written by Kyle C. Dennis, Ph.D. for the American Speech-Language-Hearing Association says the numbers should be taken with caution. Dennis argues that “there is an ongoing debate over the nature of mild traumatic brain injuries, its diagnosis (or rather it’s over diagnosis), its pathophysiology, its natural history, and even the terminology to describe the condition” (Source).
Dennis says that several authors have argued that a mild traumatic brain injury is often used to describe any cases of unresolved brain injury (Source). For this reason, the numbers may not reflect the actual situation on the ground.
An article published in 2018 by the National Center for Biotechnology Information’s National Library of Medicine reports that 69 million individuals suffer a TBI each year globally. The same article, entitled Estimating the Global Incidence of Traumatic Brain Injury, reports that “the proportion of TBIs resulting from road traffic collisions was the greatest in Africa and Southeast Asia (both 56%) and the lowest in North America (25%).”
The American Speech-Language-Hearing Association notes that many of the mild TBI cases are treated outside the hospital or not treated at all. These figures are not captured in all estimation data; hence, this health problem could be under-estimated (Source).
Higher TBI Incidences among the Homeless
A University of British Columbia 2019 study focused on 38 studies published between 1995 and 2018 and found that “people who are homeless experience a disproportionately high lifetime prevalence of traumatic brain injury (TBI).” The same article reports that one in every two homeless persons experience a TBI. It also reports that one in every four homeless persons experiences a moderate to severe TBI.
The same British Columbia study found that the lifetime prevalence of moderate and severe traumatic brain injuries amongst homeless people could be ten times higher than that of the statistics of the general population (Source).
Leading Causes of TBI
Falls are the leading cause of traumatic brain injuries in the United States. They are mainly responsible for the majority of traumatic brain injuries among infants, children, and the elderly (Source).
Being struck by, or hitting against an object, is responsible for one in every five TBI-related injuries in children under 15 years old. This includes being hit unintentionally by a person or an object, including falling debris (Source).
Car accidents are the leading cause of TBI-related deaths of children and young adults between the ages of 5-24 (Source).
Financial Costs of TBIs
The costs of a TBI include primary medical care (hospitalization, ambulance transportation service, and emergency room care), lost income and wages (if the patient is unable to work for some time, rendered disabled, or unemployable), and recovery from injury (physical and cognitive rehabilitation).
When it comes to a TBI’s total cost, hospital bills alone do not provide a full picture. For instance, a patient could require therapy, vocational training, medication, legal representation, and adaptive strategies to recover from the effects of a TBI.
According to the American Association for the Surgery of Trauma (AAST), around 1.2 million people die from road accidents every year across the world. The AAST describes itself as an organization “dedicated to the discovery, dissemination, implementation, and evaluation of knowledge related to acute care surgery (trauma, critical surgical care, and general emergency surgery) by fostering research, education, and professional development in an environment of fellowship and collegiality.”
The AAST reports that the estimated annual cost of the five or so million people living with disability from a TBI on the US is around $37.8 billion. The same organization estimates the global annual cost to be about $518 billion globally (Source).
Costs to the Individual
While attention is often paid to the financial costs of car injuries and traumatic brain injuries, the costs to affected individuals could easily be overlooked. The Family Caregiver Alliance provides an idea of some of the costs of traumatic brain injuries to the affected individual:
- Memory challenges, especially short term memory.
- Difficulties with solving problems, following instructions, and the ability to learn new material, or understand abstract concepts.
- Poor judgment.
- Partial, or complete loss, of the ability to read and write, and the ability to communicate.
- Problems with muscle co-ordination, including swallowing.
- Changes in sexual functioning.
- Sleep challenges and seizures.
- The inability to empathize with others, challenges with social skills, and a leaning towards being self-centered, exhibiting aggressive behavior, being easily angered, and dramatic mood swings.
- A high risk of depression.
Males are 1.5 times more likely to sustain a TBI than females, and three times more likely to die from its effects (Source). This higher incidence of traumatic brain injuries among males is especially higher during young adulthood (Source).
But why are males 1.5 times more likely to sustain a TBI when compared to women? According to the Brain Injury Association of America, “the jobs and workplaces of men are associated with more severe injuries.” The same organization also says that females are more likely to report their injuries than males.
Deaths and Permanent Disabilities
According to the CDC, every year in the United States, about 50,000 people die from TBI-related cases. Around 80,000 to 90,000 people get long-term disability as a result of a TBI annually. The yearly 50,000 deaths by brain injury are a third of all deaths caused by any form of trauma (Source).
It is estimated that 5.3 million people are living with a permanent disability in the United States, as a result of a TBI-related incident (Source). Around 13.5 million Americans live with the second most prevalent disability, known as the acquired brain trauma (Source).
TBIs Due to Car Accidents
According to the CDC, in 2014 “motor vehicle crashes were the leading cause of death for persons aged 15-24, 25-34, and older adults aged ≥75 years” (Source).
Specifically, an estimated 200,000 injuries every year result from traffic accidents. Included in this number are accidents that involve pedestrians, trains, and bicycles (Source).
What makes a TBI resulting from car crashes complicated is that it can occur even if an individual has not experienced a direct impact. How is this possible? The physical force emanating from a collision can move the brain without the head bumping onto anything. This is why individuals involved in a car crash always need to be checked by a doctor following the incident.
A Promising Future
According to the CDC, since 1980, the rate of TBI-linked death resulting from transportation crashes has declined. The numbers are reported to have gone down by about 40% since 1980 (Source).
The CDI speculates that several factors can be attributed to this decrease. Some of these include “an increase in wearing a seat belt and child safety seat use, an increase in the number of vehicles equipped with airbags, and a decrease in the incidence of driving while intoxicated.” The CDC adds, “These positive changes should receive continued support” (Source).