Traumatic brain injury severe enough to necessitate hospital admission has an incidence of between 100 and 400
per 100 000 population per year in both Europe and North America.1 Head injuries are among the most common types of trauma seen in North American emergency departments, with an estimated one million cases seen annually.2 "Minor" head injury (sometimes known as "mild") is defined by a history of loss of consciousness, amnesia, or disorientation in a patient who is conscious and talking, that is, with a Glasgow Coma Scale score of 13-15 (Table 2.1). The most common causes are road traffic accidents, falls,3 assaults, sports injuries,4 and domestic accidents.5 Legislation and public health measures have helped reduce the incidence, by restricting blood alcohol levels while driving, mandating the wearing of seat belts, demanding protective helmets for construction workers and motor and pedal cyclists,6 limiting traffic speeds, and encouraging increasing use of SRS (Supplementary Restraint System) airbags in modern cars. Males are affected by TBI twice as often as females, with a peak incidence between the ages of 15 and 35, with lesser peaks in children and the elderly.
The importance of injury as a major public health problem worldwide was highlighted in the seminal report "The Global Burden of Disease". Worldwide, injuries account for approximately one in eight deaths among males and one in 14 deaths among females. Motor vehicle injuries alone constitute the ninth leading cause of disease burden as measured by the number of associated disability-adjusted life years. By the year 2020, motor vehicle injuries are projected to increase in rank to third in the global burden.7
Since this population of patients is largely made up of young males, the economic cost of survival of dependent patients is great. Up to half of all head-injured patients admitted to hospital remain disabled at one year. The combination of this factor and young age make the economic burden greater than in, for example, stroke.
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