Traumatic brain injury (TBI) (ICD-10 S06.-: Intracranial injury) refers to injuries to the skull involving the brain. Craniocerebral trauma often occurs in the context of traffic accidents and falls. Traumatic brain injury is classified as follows:
- Grade 1 – Commotio cerebri (concussion; S06.0); in this case, no permanent damage is present
- Grade 2 – Contusio cerebri (cerebral contusion; S06.3); there is open or closed damage to the brain
- Grade 3 – Compressio cerebri (cerebral contusion; S06.2); open or closed damage to the brain is present
A cranial contusion refers to an injury to the head/skull that occurs without fracture (broken bone) and/or functional limitation of the brain.If there is an opening of the dura with contact to the outside (= connection of the brain to the outside world), it is called an open craniocerebral trauma. The assessment after a traumatic brain injury is performed with the Glasgow Coma Scale (see classification below). Approximately 15% of individuals with severe traumatic brain injury have concomitant spinal injuries.Up to 30% of patients with TBI have polytrauma (combination of multiple concurrent injuries, where one injury or combination of injuries is life-threatening). Sex ratio: males to females is 2-3: 1.Peak incidence: the maximum incidence of TBI is firstly in childhood, at 5 years of age, and secondly at the age of 20 years and has a third age peak from the age of 70 years. The incidence (frequency of new cases) is about 200-330 cases per 100,000 inhabitants per year (in Germany). With an incidence of 581 patients per 100,000 population, TBI is the most common accidental injury in childhood.Approximately 2% of all patient contacts in the pediatric emergency department are due to mild/mild traumatic brain injuries; these account for approximately 10% of all inpatient admissions.Approximately 250,000 traumatic brain injuries occur annually in Germany, of which 91% are classified as mild, 54% as moderate, and 5% as severe. Course and prognosis: Since brain tissue has the lowest oxygen deficiency tolerance of all organs, timely and adequate treatment is of immense importance for the survival of the affected person or for the extent of possible permanent disabilities. In TBI, there is a risk of intracranial hemorrhage (bleeding within the skull; parenchymal, subarachnoid, sub- and epidural, and supra- and infratentorial hemorrhage)/intracerebral hemorrhage (ICB; cerebral hemorrhage) and other complications, so everyone affected is advised to remain in the hospital for observation.Cerebral hemorrhage can occur up to 48 hours after the trauma. Within the first five days after a TBI, intracranial pressure may still increase. Hospitalization for further diagnostic evaluation and observation of the patient is required if the following symptoms are present:
- Coma (loss of consciousness)
- Amnesia (form of disturbance of memory for temporal or content memories).
- Multiple vomiting when there is a close temporal relationship to the exposure to violence
- Increasing disturbance of consciousness
- (focal) neurological deficit
- Seizure
- Suspected CSF fistula (connection between the CSF system and the outside world: nasal or otogenic/ CSF leakage through nose or ears).
- Evidence of coagulopathy (e.g., anticoagulant (anticoagulant) treatment, nonstopping bleeding, laboratory findings, etc.)
- Clinical signs of skull fracture (skull fracture) or evidence on cranial CT (computed tomography of the skull)).
- Suspected impression fracture (indentation bone fracture) and/or penetrating injuries.
In severe TBI, permanent damage, such as changes in character or decrease in memory, is to be expected. Only ten to 30 percent of survivors have tolerable limitations. In around 25 percent of patients, the serious injuries lead to a waking coma – cerebral function fails, while functions of the diencephalon, brain stem and spinal cord are preserved. In Germany, 2,750 people die of a TBI every year. By early adulthood, traumatic brain injuries are the most common cause of long-term disability and death.In mild traumatic brain injury, the lethality (mortality in relation to the total number of people suffering from the disease) is very low. In severe TBI, the lethality is approximately 33%.In children, the overall lethality is 0.5%, but in severe TBI, the lethality is 14%.
