By Rachel Goodman
Traumatic brain injury (TBI) affects millions of Americans each year, but it does not affect all patients in the same way.
TBI can affect children much differently than adults because children’s brains are still in the process of developing. According to the Brain Injury Association of America, a child who sustains a TBI may experience more devastating and longer-lasting effects than an adult with a TBI of the same severity.
TBI is a disruption in normal brain functioning that results from a bump, blow or jolt to the head. The effects of TBI include functional changes that can affect an individual’s thinking, movement, sensation, language ability and emotions.
TBIs can range from “mild” to “severe,” and the effects may last anywhere from a few days to a lifetime. Children younger than age 4, adolescents ages 15-19 and individuals older than 75 are among those most vulnerable to TBI.
In the United States, TBI is a serious public health issue, affecting more than 2.8 million people annually. In 2014, the most current data available, TBIs led to approximately:
- 2.5 million emergency department (ED) visits.
- 288,000 hospitalizations.
- 56,800 deaths.
Of those 2.5 million ED visits, more than 812,000 involved children age 17 or younger.
In addition to the effects on health and well-being, TBI also inflicts an economic burden on individuals, families and states. The Centers for Disease Control and Prevention (CDC) estimates the lifetime cost of TBI, which includes both direct and indirect medical costs (such as loss of work or decreased productivity) to be about $76.5 billion.
A 2007 CDC study suggests that the development and widespread adoption of clinical TBI guidelines in health care settings may help lower this cost. By improving health outcomes among TBI patients, clinical guidelines can reduce the need for prolonged medical care or rehabilitation, thereby reducing the medical costs associated with TBI.
Although TBI can cause lifelong disability and even death, the CDC reports that 75% of all TBIs are mild. Health care providers often describe a concussion as a “mild” brain injury. Given the prevalence of mild TBI (mTBI), especially among children, the CDC has developed an evidence-based, pediatric mTBI guideline for health care professionals.
It is the first evidence-based clinical guideline to date for diagnosing and managing pediatric mTBI in the United States. The CDC Pediatric mTBI Guideline outlines a total of 19 clinical recommendations regarding the diagnosis, prognosis and management of mTBI cases among youth.
Key recommendations of the guideline, as identified by the CDC, include:
- Avoid routinely using CT scans, MRIs, or other forms of imaging to diagnose mTBI.
- Use validated, age-appropriate tools to assess symptoms and diagnose mTBI.
- Assess risk factors that may indicate a prolonged recovery.
- Provide patients with instructions on return to activity customized to their symptoms.
- Counsel patients to return gradually to non-sports activities after no more than two to three days of rest.
The American Academy of Pediatrics and the CDC have also developed an online mTBI training course for physicians based around these key recommendations. The course is meant to equip practitioners with the practical skills necessary to implement the Guideline’s recommendations. The CDC has also created a checklist on mTBI diagnosis and management for health professionals, as well as mTBI factsheets for patients and families.
All 50 states and the District of Columbia have enacted laws to address TBI. Most existing state legislation regarding youth TBI relates to return-to-activity or return-to-play, a topic discussed in the CDC Guideline. For more specific information regarding TBI legislation, visit NCSL’s TBI legislation webpage, which contains a list of TBI-related state laws passed between 2009 and 2014. For more recent TBI legislation, please visit NCSL’s Injury Prevention Legislation Database.
Rachel Goodman is an intern in the NCSL Health Program.