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 Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and impairment. The impact on a victim and his or her family can be devastating.
Most people are unaware of the scope of TBI or its overwhelming nature. In fact TBI is a common injury and may be missed initially when the medical team is focused on saving the individual's life.
In the past, before medical knowledge and technology advanced to control breathing with respirators and decrease intracranial pressure, which is the pressure in the fluid surrounding the brain, the death rate from traumatic brain injuries was very high. Today, despite the tremendous advancement in neurosciences, the effects of TBI are still significant.
The incidence of TBI is increasing globally, largely due to an increase in motor vehicle use in low- and middle-income countries. In developing countries, automobile use has increased faster than safety infrastructure could be introduced. In contrast, vehicle safety laws have decreased rates of TBI in high-income countries, which have seen decreases in traffic-related TBI since the 1970s. Each year in the United States about two million people suffer a TBI and about 500,000 are hospitalized.
In the US, the mortality (death rate) rate is estimated to be 21% by 30 days after TBI. A study on Iraq War soldiers found that severe TBI carries a mortality of 30–50%. Deaths have declined due to improved treatments and systems for managing trauma in societies wealthy enough to provide modern emergency and neurosurgical services. The fraction of those who die after being hospitalized with TBI fell from almost half in the 1970s to about a quarter at the beginning of the 21st century. This decline in mortality has led to a concomitant increase in the number of people living with disabilities that result from TBI.
Biological, clinical, and demographic factors contribute to the likelihood that an injury will be fatal. In addition, outcome depends heavily on the cause of head injury. In the US, patients with fall-related TBIs have an 89% survival rate, while only 9% of patients with firearm-related TBIs survive. In the US, firearms are the most common cause of fatal TBI, followed by vehicle accidents and then falls. Of deaths from firearms, 75% are considered to be suicides.
A brain injury can be classified as mild if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes. While MRI and CAT scans are often normal, the individual has cognitive problems such as headache, difficulty thinking, memory problems, attention deficits, mood swings and frustration. These injuries are commonly overlooked. Even though this type of TBI is called "mild", the effect on the family and the injured person can be devastating.
In recent years a need for a reliable blood or spinal fluid test has been investigated with the goal of finding a chemical, or biological marker (biomarker), specific for the injured brain.
Such biomarkers should be readily accessible, provide information specific to the pathologic disruptions occurring in the central nervous system, and allow improved monitoring of the progression of secondary damage.
A major study on establishing biomarkers for TBI is being funded by the U.S. Defense Department. The Defense Department is collaborating with the company Banyan Biomarkers, Inc., which is focused on this particular problem. The study will involve testing various chemicals released during brain injury with the goal of finding a reliable biomarker. The future of this research will allow doctors to identify even very mild brain injury with a simple blood test.
Early detection of biomarkers in trauma patients will be especially helpful in smaller hospitals, not accustomed to deal with severe brain injury. If they realized through a simple blood test that they faced an injury with a devastating potential they would transfer the patient to a facility with neuro-intensive care unit, suited for monitoring and treatment of such injuries.
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