TBI Flashcards
TBI defined
•An acquired brain injury
•That disrupts the normal function of the brain
•Any period of loss of or decreased consciousness;
•Any loss of memory for events immediately before (retrograde amnesia) or after the injury (post-traumatic amnesia);
•Neurologic deficits such as muscle weakness, loss of balance and coordination, disruption of vision, change in speech and language, or sensory loss;
•Any alteration in mental state at the time of the injury such as confusion, disorientation, slowed thinking, or difficulty with concentration.
•That can be caused by a bump, blow, or jolt (or blast) to the head or a penetrating head injury
Incidence and prevalence of TBI
•Incidence= number of new TBIs over a particular time period
•Prevalence= number of people living with impact of TBI currently
•Estimated prevalence of TBI-related disability in the US:
•3.2 million-5.3 million
Etiologies of TBI
•The sports and recreation activities associated with most TBI-related ED visits for children
•Bicycling
•Football
•playground activities
•Basketball
•soccer
A brain injury is often the result of…
2 injuries:
-A “primary injury” caused by the initial blow or insult to the brain
-A “secondary injury” relates to disruption of the blood brain barrier, production of reactive oxygen species and resultant oxidative stress, metabolic dysfunction, inflammation and excitotoxicity
Primary injury defined
direct mechanical injury caused by trauma
What a primary injury includes
Includes…
fractures
intracranial hemorrhage
contusion
traumatic axonal injury
After a sudden jolt or bang the result can be…
Primary injuries:
Coup-Contracoup Diffuse Axonal injuries
Coup-Contracoup
Injury at the site of impact and on the opposite side from the movement of the brain against the skull (either front to back or side to side)
causes a contusion (brain is gonna bounce back from original site of injury)
Diffuse Axonal injuries
Delicate nerve tissues rip, tear, and stretch
Secondary injury
■Deterioration that follows the initial trauma
■During the first 24 to 72 hours, brain and body are responding to the insult
Secondary injuries can include…
Can include
-Intracranial hemorrhage
-Raised intracranial pressure
-Brain swelling
-Respiratory or cardiac failure
-Hypotension
-Ischemic brain damage
-Infection
Mild TBI ratings
Normal structural imaging
LOC = 0-30 min
AOC = from a moment up to 24 hr
PTA = 0-1 day
GCS = 13-15
Moderate TBI ratings
Normal or abnormal structural imaging
LOC = 30 min and < 24 hr
AOC = 24 hr severity based on other criteria
PTA = 1 and <7 days
GCS = 9-12
Severe TBI ratings
Normal or abnormal structural imaging
LOC = > 24 hr
PTA > 7 days
GCS = 3-6
Factors influencing outcomes after a TBI
Individual characteristics
•Age
•Young children (<7 ) or older adults have worse outcomes
•Pre-injury functioning
Factors influencing outcomes after a TBI
Social-environmental factors
•SES
•Caregiver and family functioning
•Social support
•Return to social functioning (e.g., RTW, living independently) all influence outer outcome variables
•Access to care
•Insurance as a factor here
Factors influencing outcomes after a TBI
CT findings
•petechial hemorrhages
•obliteration of the 3rd ventricle or basal cisterns
•traumatic subarachnoid hemorrhage
•midline shift
•non-evacuated hematoma
Factors influencing outcomes after a TBI
Comorbidities
Factors associated with poor prognosis, defined as mortality at 14 days and death/severe disability at 6 months after injury.
•Older age
•Lower Glasgow coma score
•Absent pupil reactivity
•Presence of major extracranial injury
