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Introduction
Traumatic Brain Injuries Are A Public Health Issue In New Hampshire.
Traumatic brain injury (TBI), often referred to as the “Silent Epidemic”, presents as an
often unseen and underreported public health issue. According to the CDC (1), at
minimum 5.3 million Americans live with the long-term consequences of a TBI. Each
year an estimated 1.4 million TBI-related deaths, hospitalizations, and ED visits occur in
the United States (1). This report is a comprehensive effort to describe the frequency,
causes, and demographic characteristics of new cases (2000-2005) of traumatic brain
injuries (TBI) among residents of New Hampshire.
What is a traumatic brain injury and why should we be concerned?
A traumatic
brain injury is caused by a blow or jolt to the head, or a penetrating head injury that
disrupts the normal function of the brain. Such a blow can launch the brain on a collision
course with the inside of the skull. The skull itself can often withstand a forceful external
impact without fracturing. The result, an injured brain inside an intact skull, is known as
a closed-head injury. A traumatic brain injury may also occur when a projectile, such as
a bullet, rock or fragment of a fractured skull, actually penetrates the brain. This type is
much less common and is known as an open-head injury. In both instances, these injuries
can lead to primary injuries, occurring immediately as a direct result of the force applied
to the brain such as contusions, lacerations, hemorrhages and defuse axonal injury. They
can also cause secondary injuries, which evolve over time causing conditions such as
cerebral edema, cerebral infarction, cerebral anoxia or hypoxia, cerebral infection,
seizures and changes in brain chemistry and neurotransmitter functioning. Not all blows
or jolts to the head result in a TBI. The severity of a TBI may range from “mild”, or a
brief change in mental status or consciousness, to “severe”, or an extended period of
unconsciousness or amnesia after the injury.
Why are traumatic brain injuries a public health issue?
Traumatic brain injuries can
cause many different types of changes to the way a person thinks and understands the
world around him. They can affect senses such as touch, taste, and smell. A traumatic
brain injury may interfere with communication and the expression of one’s thoughts. It
may also facilitate social inappropriateness, depression, anxiety, personality changes,
aggression and acting out (1). Additionally, changes in attention and concentration,
memory and executive functioning are all hallmarks of traumatic brain injury.
Traumatic brain injuries may also increase a person’s risk for developing Alzheimer’s
disease, Parkinson’s disease, and other brain disorders that become more prevalent as one
ages (1). Sustaining a traumatic brain injury can also lead to epilepsy.
Repeated mild traumatic brain injuries that occur over months and even years can result
in additive neurological and cognitive deficits. Repeated mild traumatic brain injuries
over hours, days, or weeks, under certain circumstances can be fatal (5).
Brain injuries do not heal like other injuries. Recovery is a functional recovery, based on
mechanisms that remain uncertain. No brain injuries are alike and the consequence of