Incidence

Accurate statistics regarding the incidence and prevalence of TBI in the United States are difficult to obtain. Not surprisingly, incidence rates varied significantly among the nine published studies reviewed by Kraus (1995), with an average annual incidence of 180 per 100,000 children per year in children younger than 15 years of age. The Centers for Disease Control and Prevention (CDC) reported population data on TBI across the life span during a 6-year period and found that approximately 475,000 TBIs occurred annually in children ages 0-14 years (Langlois et al. 2006). Approximately 435,000 of these cases required emergency department visits and 37,000 required hospital admission.

Table 27-3. Ranchos Los Amigos Levels of Cognitive Functioning

Level I

No response

Level II

Generalized response; reacts to environment but not a specific response

Level III

Localized response; reacts in a specific manner to a stimulus

Level IV

Confused and agitated; unable to cooperate; may be aggressive, combative, or incoherent

Level V

Confused, inappropriate/nonagitated; may wander if mobile; is able to respond to simple commands; needs external structure

Level VI

Confused, appropriate; goal-directed behavior emerges; consistently follows simple instructions

Level VII

Automatic, appropriate; does well in familiar settings but is confused in unfamiliar settings; impaired judgment and slow learning

Level VIII

Purposeful, appropriate; can function independently but perhaps not as well as before injury; deficits in higher-order cognitive skills

The most common causes of head trauma are transportation-related incidents, including those involving motor vehicles and bicycles, and falls. Together, transportation-related trauma and falls typically account for between 75% and 80% of all brain injuries in published studies (Kraus 1995). Other causes of injury may include assaults and sports participation. The distribution of causes varies significantly as a function of children's ages (Kraus 1995). Infants and young children are especially likely to be injured in falls. Among older children, sports and recreational accidents and pedestrian or bicycle collisions with motor vehicles account for an increasing proportion of head injuries. Adolescents are especially likely to be injured in motor vehicle accidents.

The incidence of TBI varies significantly according to demographic factors. Boys are at considerably higher risk for closed head trauma than are girls (Langlois et al. 2006). In published studies, the ratio of boys to girls rises from approximately 1.5 to 1 for preschool children to approximately 2 to 1 for school-age children and adolescents (Kraus 1995). The change appears to reflect a sharp increase in head injuries among males and a gradual decrease among females (Kraus et al. 1986). Kraus found that the incidence is relatively stable from birth to age 5 years, with injuries occurring in about 160 per 100,000 children in this age group. After age 5, the overall incidence gradually increases until early adolescence and then shows rapid growth, reaching a peak incidence of approximately 290 per 100,000 by age 18 (Kraus et al. 1986). The CDC population data suggest a bimodal distribution of TBI occurrence across childhood, with peaks during the preschool and high school years (Langlois et al. 2006).

Pregnancy And Childbirth

Pregnancy And Childbirth

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