A TBI is caused by a bump, blow, or jolt to the head that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild” (i.e., a brief change in mental status or consciousness) to “severe” (i.e., an extended period of unconsciousness or memory loss after the injury).

TBI: Get the Facts

Overview

Traumatic brain injury (TBI) is a major cause of death and disability in the United States. TBIs contribute to about 30% of all injury deaths.1 Every day, 153 people in the United States die from injuries that include TBI.1 Those who survive a TBI can face effects that last a few days, or the rest of their lives. Effects of TBI can include impaired thinking or memory, movement, sensation (e.g., vision or hearing), or emotional functioning (e.g., personality changes, depression).  These issues not only affect individuals but can have lasting effects on families and communities.

What is a TBI?

A TBI is caused by a bump, blow, or jolt to the head that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild” (i.e., a brief change in mental status or consciousness) to “severe” (i.e., an extended period of unconsciousness or memory loss after the injury).  Most TBIs that occur each year are mild, commonly called concussions.2

How big is the problem?

  • In 2013,1 about 2.8 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States.
    • TBI contributed to the deaths of nearly 50,000 people.
    • TBI was a diagnosis in more than 282,000 hospitalizations and 2.5 million ED visits.  These consisted of TBI alone or TBI in combination with other injuries.
  • Over the span of six years (2007–2013), while rates of TBI-related ED visits increased by 47%, hospitalization rates decreased by 2.5% and death rates decreased by 5%.
  • In 2012, an estimated 329,290 children (age 19 or younger) were treated in U.S. EDs for sports and recreation-related injuries that included a diagnosis of concussion or TBI.3
    • From 2001 to 2012, the rate of ED visits for sports and recreation-related injuries with a diagnosis of concussion or TBI, alone or in combination with other injuries, more than doubled among children (age 19 or younger).3

What are the leading causes of TBI?

  • In 2013,1 falls were the leading cause of TBI. Falls accounted for 47% of all TBI-related ED visits, hospitalizations, and deaths in the United States. Falls disproportionately affect the youngest and oldest age groups:
    • More than half (54%) of TBI-related ED visits hospitalizations, and deaths among children 0 to 14 years were caused by falls.
    • Nearly 4 in 5 (79%) TBI-related ED visits, hospitalizations, and deaths in adults aged 65 and older were caused by falls.
  • Being struck by or against an object was the second leading cause of TBI, accounting for about 15% of TBI-related ED visits, hospitalizations, and deaths in the United States in 2013.
    • Over 1 in 5 (22%) TBI-related ED visits, hospitalizations, and deaths in children less than 15 years of age were caused by being struck by or against an object.
  • Among all age groups, motor vehicle crashes were the third overall leading cause of TBI-related ED visits, hospitalizations, and deaths (14%). When looking at just TBI-related deaths, motor vehicle crashes were the third leading cause (19%) in 2013.
  • Intentional self-harm was the second leading cause of TBI-related deaths (33%) in 2013.

Risk factors for TBI

Among TBI-related deaths in 2013:1

  • Rates were highest for persons 75 years of age and older.
  • The leading cause of TBI-related death varied by age.
    • Falls were the leading cause of death for persons 65 years of age or older.
    • Intentional self-harm was the leading cause of death for persons 25-64 years of age.
    • Motor vehicle crashes were the leading cause of death for persons 5-24 years of age.
    • Assaults were the leading cause of death for children ages 0-4 years.

Among non-fatal TBI-related injuries in 2013:1

  • Hospitalization rates were highest among persons 75 years of age and older.
  • Rates of ED visits were highest for persons 75 years of age and older and children 0-4 years of age.
  • Falls were the leading cause of TBI-related ED visits for all but one age group.
    • Being struck by or against an object was the leading cause of TBI-related ED visits for persons 15 to 24 years of age.
  • The leading cause of TBI-related hospitalizations varied by age:
    • Falls were the leading cause among children 0-14 years of age and adults 45 years of age and older.
    • Motor vehicle crashes were the leading cause of hospitalizations for adolescents and persons 15-44 years of age.

Related Pages

A Head for the Future. A traumatic brain injury prevention inititative for the military community. Learn more.

Signs and Symptoms

What are the Signs and Symptoms of Concussion?

Most people with a concussion recover well from symptoms experienced at the time of the injury. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one. Some people may also find that it takes longer to recover if they have another concussion.

Symptoms of concussion usually fall into four categories:

Thinking/
Remembering		 Physical Emotional/
Mood		 Sleep
Difficulty thinking clearly Headache

Fuzzy or blurry vision		 Irritability Sleeping more than usual
Feeling slowed down Nausea or vomiting
(early on)

Dizziness		 Sadness Sleep less than usual
Difficulty concentrating Sensitivity to noise or light

Balance problems		 More emotional Trouble falling asleep
Difficulty remembering new information Feeling tired, having no energy Nervousness or anxiety

Some of these symptoms may appear right away. Others may not be noticed for days or months after the injury, or until the person resumes their everyday life. Sometimes, people do not recognize or admit that they are having problems. Others may not understand their problems and how the symptoms they are experiencing impact their daily activities.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be overlooked by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.

See Getting Better, for tips to help aid your recovery after a concussion.

When to Seek Immediate Medical Attention

Danger Signs in Adults

In rare cases, a person with a concussion may form a dangerous blood clot that crowds the brain against the skull. Contact your health care professional or emergency department right away if you experience these danger signs after a bump, blow, or jolt to your head or body:

  • Headache that gets worse and does not go away.
  • Weakness, numbness or decreased coordination.
  • Repeated vomiting or nausea.
  • Slurred speech.

The people checking on you should take you to an emergency department right away if you:

  • Look very drowsy or cannot wake up.
  • Have one pupil (the black part in the middle of the eye) larger than the other.
  • Have convulsions or seizures.
  • Cannot recognize people or places.
  • Are getting more and more confused, restless, or agitated.
  • Have unusual behavior.
  • Lose consciousness.

Danger Signs in Children

Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:

  • Have any of the danger signs for adults listed above.
  • Will not stop crying and are inconsolable.
  • Will not nurse or eat.
CDCTraumatic Brain Injury & ConcussionBasic Information

What are the Potential Effects of TBI?

Chronic Traumatic Encephalopathy (CTE)

CTE is a brain disease that results from changes in the brain. These changes can affect how a person thinks, feels, acts, and moves. Traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts, may lead to CTE.

In April 2013, the National Institutes of Health (NIH) launched a major program to better understand CTE, its causes, and how to diagnose it among living persons. Learn more about NIH research efforts by visiting the NINDS Traumatic Brain Injury Information Page. The Report from the First NIH Consensus Conference to Define the Neuropathological Criteria for the Diagnosis of Chronic Traumatic Encephalopathy has additional information.

The severity of a traumatic brain injury (TBI) may range from “mild” (i.e., a brief change in mental status or consciousness) to “severe” (i.e., an extended period of unconsciousness or amnesia after the injury).

A TBI can cause a wide range of functional short- or long-term changes affecting:

  • Thinking  (i.e., memory and reasoning);
  • Sensation (i.e., sight and balance);
  • Language  (i.e., communication, expression, and understanding); and
  • Emotion  (i.e., depression, anxiety, personality changes, aggression, acting out, and social inappropriateness).1

A TBI can also cause epilepsy and increase the risk for conditions such as Alzheimer’s disease, Parkinson’s disease, and other brain disorders.

About 75% of TBIs that occur each year are concussions or other forms of mild TBI.2

Repeated mild TBIs occurring over an extended period of time can result in cumulative neurological and cognitive deficits. Repeated mild TBIs occurring within a short period of time (i.e., hours, days, or weeks) can be catastrophic or fatal.3

For information on how to prevent TBI and the potentially serious effects from this injury, please visit our TBI Prevention page.

CDC’s HEADS UP campaign also includes steps to help protect children and teens from concussion and other serious head and brain injuries—both on and off the sports field. Learn more at HEADS UP’s Brain Injury Safety Tips and Prevention page.

General Tips to Help Aid in Recovery:

  • Get lots of rest. Don’t rush back to daily activities such as work or school.
  • Avoid doing anything that could cause another blow or jolt to the head.
  • Ask your health care professional when it’s safe to drive a car, ride a bike, or use heavy equipment. Your ability to react may be slower after a brain injury.
  • Only take medications your health care provider has approved. Don’t drink alcohol until your health care provider says it’s OK.
  • Write things down if you have a hard time remembering.
  • You may need help to re-learn skills you lost. Your health care professional can help arrange for these services.

Recovery from Concussion

Most children with a concussion feel better within a couple of weeks. However for some, symptoms will last for a month or longer. Concussion symptoms may appear during the normal healing process or as your child gets back to their regular activities. If there are any symptoms that concern you or are getting worse, be sure to seek medical care as soon as possible.

What Steps Should My Child Take to Feel Better?

Making short-term changes to your child’s daily activities can help him or her get back to a regular routine more quickly. As your child begins to feel better, you can slowly remove these changes. Use your child’s symptoms to guide return to normal activities. If your child’s symptoms do not worsen during an activity then this activity is OK for them. If symptoms worsen, your child should cut back on how much he or she can do that activity without experiencing symptoms. It is important to remember that each concussion and each child is unique, so your child’s recovery should be customized based on his or her symptoms.

Recovery Delays

Factors that might delay recovery include your child having:

  • a history of a previous concussion or other brain injury,
  • neurological or mental health disorders,
  • learning difficulties, and/or
  • family and social stressors.

1. Rest

Your child should take it easy the first few days after the injury when symptoms are more severe.

  • Early on, limit physical and thinking/remembering activities to avoid symptoms getting worse.
  • Avoid activities that put your child at risk for another injury to the head and brain.
  • Get a good night’s sleep and take naps during the day as needed.

2. Light Activity

As your child starts to feel better, gradually return to regular (non-strenuous) activities.

  • Find relaxing activities at home. Avoid activities that put your child at risk for another injury to the head and brain.
  • Return to school gradually. If symptoms do not worsen during an activity, then this activity is OK for your child. If symptoms worsen, cut back on that activity until it is tolerated.
  • Get maximum nighttime sleep. (Avoid screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake up schedule.)
  • Reduce daytime naps or return to a regular daytime nap schedule (as appropriate for their age).

3. Moderate Activity

When symptoms are mild and nearly gone, your child can return to most regular activities.

  • Help your child take breaks only if concussion symptoms worsen.
  • Return to a regular school schedule.

4. Back to Regular Activity

Recovery from a concussion is when your child is able to do all of their regular activities without experiencing any symptoms.

Also, be sure to:

  • Schedule a follow up appointment for your child’s doctor or nurse.
  • Ask your child’s doctor or nurse about safe over-the-counter or prescription medications to help with symptoms (e.g., Ibuprofen or acetaminophen for headache).
  • Limit the number of soft drinks or caffeinated items to help your child rest.

Post-Concussive Syndrome

While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children’s or teens’ health care provider if their concussion symptoms do not go away or if they get worse after they return to their regular activities.

If your child or teen has concussion symptoms that last weeks to months after the injury, their medical provider may talk to you about post-concussive syndrome. While rare after only one concussion, post-concussive syndrome is believed to occur most commonly in patients with a history of multiple concussions.

There are many people who can help you and your family as your child or teen recovers. You do not have to do it alone. Keep talking with your medical provider, family members, and loved ones about how your child or teen is feeling. If you do not think he or she is getting better, tell your medical provider.

Severe TBI

Each year, TBIs contribute to a substantial number of deaths and cases of permanent disability. In fact, TBI is a contributing factor to a third (30%) of all injury-related deaths in the United States.1 In 2010, approximately 2.5 million people sustained a traumatic brain injury.2  Individuals with more severe injuries are more likely to require hospitalization. 

Changes in the rates of TBI-related hospitalizations vary depending on age.  For persons 44 years of age and younger, TBI-related hospitalizations decreased between the periods of 2001–2002 and 2009–2010.  However, rates for age groups 45–64 years of age and 65 years and older increased between these time periods.  Rates in persons 45–64 years of age increased almost 25% from 60.1 to 79.4 per 100,000.  Rates of TBI-related hospitalizations in persons 65 years of age and older increased more than 50%, from 191.5 to 294.0 per 100,000 during the same period, largely due to a substantial increase (39%) between 2007–2008 and 2009–2010.  In contrast, rates of TBI-related hospitalizations in youth 5–14 years of age fell from 54.5 to 23.1 per 100,000, decreasing by more than 50% during this period.1,2

A severe TBI not only impacts the life of an individual and their family, but it also has a large societal and economic toll. The estimated economic cost of TBI in 2010, including direct and indirect medical costs, is estimated to be approximately $76.5 billion. Additionally, the cost of fatal TBIs and TBIs requiring hospitalization, many of which are severe, account for approximately 90% of the total TBI medical costs.3,4

Lt. Col. Tim Maxwell’s Story

Lt. Col. Tim Maxwell

They train together. They fight together. So if wounded, why shouldn’t they go through recovery together? This was the question that Lt. Col. Tim Maxwell asked about his fellow marines being discharged from the hospital and left alone to recover from injuries of war.

Response

What Should I do If a Concussion Occurs?

People with a concussion need to be seen by a health care professional.  If you think you or someone you know has a concussion, contact your health care professional. Your health care professional can evaluate your concussion and determine if you need to be referred to a neurologist, neuropsychologist, neurosurgeon, or specialist in rehabilitation (such as a speech pathologist) for specialized care. Getting help soon after the injury by trained specialists may improve recovery.

See Signs and Symptoms, to learn about common signs and symptoms that you may experience, and to learn about danger signs and when to seek immediate medical attention.

Concussion in Sports and Recreation

HEADS UP logo

If a concussion occurs during sports- and recreation-related activities, implement the HEADS UP action plan.

Athletes with a concussion should never return to sports or recreation activities the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play.

Get HEADS UP

What to Expect When You See a Health Care Professional

While most people are seen in an emergency department or medical office, some people must stay in the hospital overnight. Your health care professional may do a scan of your brain (such as a CT scan) or other tests. Additional tests might be necessary, such as tests of your learning, memory concentration, and problem solving.  These tests are called “neuropsychological” or “neurocognitive” tests and can help your health care professional identify the effects of a concussion. Even if the concussion doesn’t show up on these tests, you may still have a concussion.

Your health care professional will send you home with important instructions to follow. Be sure to follow all of your health care professional’s instructions carefully.

If you are taking medications—prescription, over-the-counter medicines, or “natural remedies”—or if you drink alcohol or take illicit drugs, tell your health care professional. Also, tell your health care professional if you are taking blood thinners (anticoagulant drugs), such as Coumadin and aspirin, because they can increase the chance of complications.

See Getting Better, for tips to help aid your recovery after a concussion.

Prevention

What Can I do to Help Prevent Traumatic Brain Injury?

There are many ways to reduce the chances of sustaining a traumatic brain injury, including:

  1. Buckling your child in the car using a child safety seat, booster seat, or seat belt (according to the child’s height, weight, and age).

Know the Stages

Birth until age 2-4.

Birth up to age 2. Buckle children in a rear-facing seat until age 2 or when they reach the upper weight or height limit of that seat.

For the best possible protection, infants and toddlers should be buckled in a rear-facing car seat, in the back seat, until they reach the upper weight or height limits of their seat. Check the seat’s owner’s manual and/or labels on the seat for weight and height limits.

  1. Wearing a seat belt every time you drive or ride in a motor vehicle.
  2. Never driving while under the influence of alcohol or drugs.
  3. Wearing a helmet and making sure your children wear helmets when:
    • Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
    • Playing a contact sport, such as football, ice hockey, or boxing;
    • Using in-line skates or riding a skateboard;
    • Batting and running bases in baseball or softball;
    • Riding a horse; or
    • Skiing or snowboarding.
  4. Making living areas safer for seniors, by:
    • Removing tripping hazards such as throw rugs and clutter in walkways;
    • Using nonslip mats in the bathtub and on shower floors; Installing grab bars next to the toilet and in the tub or shower;
    • Installing handrails on both sides of stairways;
    • Improving lighting throughout the home; and
    • Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.1,2,3
  5. Making living areas safer for children, by:
    • Installing window guards to keep young children from falling out of open windows; and
    • Using safety gates at the top and bottom of stairs when young children are around.
  6. Making sure the surface on your child’s playground is made of shock-absorbing material, such as hardwood mulch or sand.4

TBI Classification Systems

TBI injury severity can be described using several different tools.

The Glasgow Coma Scale (GCS),5 a clinical tool designed to assess coma and impaired consciousness, is one of the most commonly used severity scoring systems. Persons with GCS scores of 3 to 8 are classified with a severe TBI, those with scores of 9 to 12 are classified with a moderate TBI, and those with scores of 13 to 15 are classified with a mild TBI.

Other classification systems include the Abbreviated Injury Scale (AIS), the Trauma Score, and the Abbreviated Trauma Score. Despite their limitations,6 these systems are crucial to understanding the clinical management and the likely outcomes of this injury as the prognosis for milder forms of TBIs is better than for moderate or severe TBIs.7-9

Potential Affects of Severe TBI

A non-fatal severe TBI may result in an extended period of unconsciousness (coma) or amnesia after the injury. For individuals hospitalized after a TBI, almost half (43%) have a related disability one year after the injury.10 A TBI may lead to a wide range of short- or long-term issues affecting:

  • Cognitive Function (e.g., attention and memory)
  • Motor function (e.g., extremity weakness, impaired coordination and balance)
  • Sensation (e.g., hearing, vision, impaired perception and touch)
  • Emotion (e.g., depression, anxiety, aggression, impulse control, personality changes)

Approximately 5.3 million Americans are living with a TBI-related disability and the consequences of severe TBI can affect all aspects of an individual’s life.11 This can include relationships with family and friends, as well as their ability to work or be employed, do household tasks, drive, and/or participate in other activities of daily living.

Fast Facts

Meeting the Challenge of Severe TBI

While there is no one size fits all solution, there are interventions that can be effective to help limit the impact of this injury. These measures include primary prevention, early management, and treatment of severe TBI.

CDC’s research and programs work to reduce severe TBI and its consequences by developing and evaluating clinical guidelines, conducting surveillance, implementing primary prevention and education strategies, and developing evidence-based interventions to save lives and reduce morbidity from this injury.

Developing and Evaluating Clinical Guidelines

CDC researchers conducted a study to assess the effectiveness of adopting the Brain Trauma Foundation (BTF) in-hospital guidelines for the treatment of adults with severe traumatic brain injury (TBI). This research indicated that widespread adoption of these guidelines could result in:

  • a 50% decrease in deaths;
  • a savings of approximately $288 million in medical and rehabilitation costs; and
  • a savings of approximately $3.8 billion—the estimated lifelong savings in annual societal costs for severely injured TBI patients.14

TBIs in the Military

Blasts are a leading cause of TBI for active duty military personnel in war zones.15 CDC estimates of TBI do not include injuries seen at U.S. Department of Defense or U.S. Veterans Health Administration Hospitals. For more information about TBI in the military including an interactive website for service members, veterans, and families and caregivers, please visit: www.dvbic.org.

CDC, in collaboration with 17 organizations, published the Field Triage Guidelines for the Injured Patient.16 These guidelines include criteria on severe head trauma and can help provide uniform standards to emergency medical service (EMS) providers and first responders, to ensure that patients with TBI are taken to hospitals that are best suited to address their particular injuries.

Conducting Surveillance

Data are critical to help inform TBI prevention strategies, identify research and education priorities, and support the need for services among those living with a TBI. CDC collects and reports both national and state-based TBI surveillance data:

Implementing Primary Prevention and Education Strategies

CDC has multiple education and awareness efforts to help improve primary prevention of severe TBI, as well as those that promote early identification and appropriate care.

Epilepsy Can Follow Traumatic Brain Injury

Female doctor examining a brain cat scan

It’s Brain Injury Awareness Month and March 26 was Purple Day for Epilepsy Awareness! Did you know that traumatic brain injury (TBI) can cause epilepsy?

A traumatic brain injury (TBI) can happen to anyone, especially young children and older adults. TBIs can range from mild TBIs (such as concussions) to severe, life-threatening injuries. They can cause problems such as changes in:

  • Thinking and memory;
  • Sensations and balance;
  • Language, such as talking and understanding; and
  • Emotions, such as depression, anxiety, or aggression.1

TBIs can also cause epilepsy.

Epilepsy is a broad term used for a brain disorder that causes re-occuring seizures. There are many types of epilepsy and there are also many different kinds of seizures. TBIs can cause a seizure right after the injury happens or even months or years later. Researchers agree that the more severe the TBI, the greater the chance the person may develop epilepsy.2 Factors such as age and other medical conditions also influence the chance a person may develop epilepsy after a TBI.

The terms post-traumatic epilepsy (PTE) and post-traumatic seizures (PTS) are both used to describe seizures that happen because of a TBI.3 In 2013 there were over 280,000 hospitalizations for TBI in the US.4 A CDC-funded study found that among people aged 15 years and older, about 1 out of 10 developed epilepsy in the 3 years following a TBI that required hospitalization.2

Father fastening son's bike helmet

Always wear a helmet when riding a bike to prevent head injuries!

Doctor speaking with hospital patient and his wife

If you or someone you care for has had a head injury, talk to a doctor about the risk of seizures and epilepsy.

Everyone should:

  • Learn the signs and symptoms of TBI and when to seek medical care.
  • Take the CDC’s HEADS UP training to learn how to recognize, respond to, and minimize the risk of concussion or TBI if you’re a parent, coach, child care provider, or school professional.

If you or someone you care for has a head injury, here’s what you need to know:

  • Seek medical attention and share information about TBI signs and symptoms.
  • Talk to the doctor about the risk for having seizures or developing epilepsy after a TBI.
  • Learn to recognize the signs of a seizure. Sometimes it can be hard to tell. Some seizures cause a person to fall, cry out, shake or jerk, and become unaware of what’s going on around them. Other seizures can make a person appear confused, make it hard for them to answer questions, twitch, or cause the person to feel like they taste, see or smell something unusual.
  • Learn first aid so you are prepared if someone has a seizure.

To prevent TBIs that may cause epilepsy, protect your brain from injury. For example:

Related Pages

Additional Prevention Resources

Source: Centers for Disease Control and Prevention, CDC