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Traumatic brain injury (tbi) is a leading cause of death and disability in the United States. It is estimated that 2.5 million cases of TBI occur annually, leading to over 2.2 million emergency department (ED) visits, 280,000 hospitalizations, and 52,000 deaths.1,2 Per the Centers for Disease Control and Prevention (CDC), the total annual rate of TBI has increased from 521.0 per 100,000 persons in 2001 to 823.7 per 100,000 persons in 2010. At the same time, the mortality from TBI has decreased slightly from 18.5 per 100,000 persons in 2001 to 17.1 per 100,000 persons in 20103 (Fig. 19–1). Currently, it is estimated that an overall 12.1% to 41% of adults have a history of TBI.47

Figure 19–1

Rates of TBI-related ED visits, hospitalizations and deaths in the United States 2001–2010. (Data from the CDC Traumatic Brain Injury & Concussion: Data and Statisitics. (

It is important to understand a distinction exists in the literature between TBI and concussion due to sports and recreation, despite concussions being a form of mild traumatic brain injury. Aware of this distinction, it is estimated that another 1.6 to 3.8 million mild TBIs or concussions occur annually due to sports and recreation-related injuries alone.8

In this chapter, we will summarize the epidemiology of traumatic brain injury, focusing on the incidence, prevalence, risk factors, causes of injury, and long-term impacts. The primary focus will be on cases of TBI that lead to medical attention in the emergency department or hospital. Additionally, separate sections will investigate the epidemiology of TBI in the military and sports populations.



TBI occurs in persons of all ages, with those that are young and old at highest risk. In the United States, the rate of ED visits for TBI is highest in children under the age of 5 years old at an annual rate of 2193.8 per 100,000 persons in 2009 to 2010, with those between the ages of 15 and 24 years at a distant second at an annual rate of 888.7 per 100,000 persons.9 Hospitalizations are highest for those aged 65 years or older, at a rate of 294.0 per 100,000, and lowest for those under the age of 5 years old, indicating a difference of severity in the injury.9 In the Netherlands, the rate of TBI between 2010 and 2012 was highest in individuals 85 years old or older, at 578.2 per 100,000 person-years; patients between 75 and 84 years old had the next highest incidence, at 307.6 per 100,000 person-years.10


Overall, males are twice as likely to suffer from TBI than females.4,5,11 This difference ...

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