The human brain is a complex, multifaceted organ responsible for nearly every function and thought. A brain injury, be it a mild concussion or a traumatic brain injury (TBI), can have serious consequences, including death and disability.

The specialists at UF Health’s Traumatic Brain Injury Clinic understand that traumatic brain injury goes beyond just the physical damage and can impact your cognitive and mental abilities too. As part of the Trauma Concussion and Sports Medicine (TRACS) program, our neurotrauma specialists work side-by-side with researchers to understand and find the best treatment and prevention options for concussion and traumatic brain injury.

Every year in the United States, 1.4 million people sustain a traumatic brain injury. In 2021 approximately 214,000 TBI injuries required hospitalization, while over 69,000 resulted in fatality, and the remaining 1.1 million being treated and released the same day.

To receive Level 1 verification, a hospital must meet rigorous criteria in areas of its emergency department facilities, operating room facilities, intensive care units and 24-hour in-house coverage by emergency room physicians and trauma surgeons, and prompt availability of care in orthopedic surgery, neurosurgery, anesthesiology, radiology, thoracic surgery and critical care. UF Health is one of seven Level 1 Trauma centers in the state of Florida.

What is a traumatic brain injury?

A traumatic brain injury is any hit to the head or body that causes damage to your brain. The main causes of traumatic brain injury are falls, car accidents and assaults. Sports injuries are also a major contributor and certain diseases, such as strokes, can lead to traumatic brain injury.

Though there are many different types of traumatic brain injury, below are some of the more commonly seen:

• Skull fractures: result from a significant blow to the head and can be associated with any of the above listed injuries
• Concussions: refers to a relatively minor injury, often causing a relatively brief loss of consciousness
• Cerebral contusions: "brain bruises'' that occur from acceleration and deceleration of the head; head trauma can also produce microscopic changes that are scattered throughout the brain
• Diffuse axonal injury (DAI): the microscopic severing of axons (fibers which allow brain neurons to communicate with each other); if enough axons are injured in this way, the ability of nerve cells to integrate and function may be lost or greatly impaired
• Epidural hematomas: occur between the skull and the duras (outer covering of the brain)
• Subdural hematomas: occur between the brain and the dura
• Intracerebral hematomas: occur inside the brain and are a type of stroke

Symptoms

Symptoms of a traumatic brain injury can be physical and mental and include:

• Dizziness
• Headache
• Vomiting
• Loss of consciousness
• Difficulty speaking, slurred words or incoherent speech
• Blurry vision
• Ringing in ears
• Dilated pupils
• Weakness in hands and feet
• Inability to walk or poor coordination
• Seizures
• Unusual behavior or personality changes

Treatments and services

• Initial exam and evaluation
• Diagnostic scans
• Level 1 trauma center certification (PDF)
• Pediatric trauma program
• Cognitive and behavioral health testing
• Electronic gait and balance testing
• Occupational therapy
• Physical therapy
• Psychiatric care and therapy
• Rehabilitation program
• Sports medicine rehabilitation

If you have suffered a blow to the head or serious bodily injury, consult a medical professional immediately. A traumatic brain injury can have severe consequences; the faster they are treated, the lower your risk of permanent or severe damage.

What to expect when seeking emergency treatment for a traumatic brain injury?

Initial treatment

• In case of loss of consciousness, first control the person's airway, breathing, and circulation, and then stabilize the head and neck. This is usually performed at the scene of injury before bringing the patient to the hospital.
• Most patients are quickly transferred to a Level 1 Trauma center where they are evaluated for injuries, specifically injuries that can affect the brain, including those to the spinal cord and jolts or blows to the head.
• The Glasgow Coma Scale (GCS) is often employed to assess severity:
• This scale helps determine if a head injury is mild, moderate, or severe. Higher scores indicate less severity while lower scores indicate more damage. Once scored, patients are treated as follows:

Mild head injury

Most patients with a head injury will receive a head CT scan to evaluate. If the patient is doing well with no findings on CT scan, they may be sent home with instructions for observation by a family member or friend.

Severe head injury

Patients with severe head injury will be admitted to an intensive care unit for neurological monitoring.

• Patients who remain unconscious and have low GCS scores (less than 8) will often be monitored in the intensive care unit for signs of increased intracranial pressure (ICP).
• Intracranial pressure monitoring is placed within the brain to record pressure within the skull. High pressures correlate with poor outcome, thus prompt recognition of elevated ICP is important. Treatment consists of surgery if there is significant brain swelling or bleeding. In cases where surgery is not indicated, a medication called mannitol may be used to lower the ICP.
• Other methods of controlling ICP include:
  • Drainage of cerebrospinal fluid through a ventriculostomy (drainage tube placed into a brain ventricle).
  • Deep sedation with chemical paralysis.

Prognosis

The prognosis of a head injury correlates with the GCS score upon arrival. High scores, e.g. GCS 13-15, tend to do well. Patients treated at Level 1 trauma centers tend to have better outcomes. The outlook for someone with a minor head injury is generally good, although recovery may be delayed and symptoms such as headache, dizziness, and cognitive problems can persist for up to a year or longer. Serious head injuries can be devastating, producing permanent mental and physical disability. Epileptic seizures may occur after a severe head injury, especially a penetrating brain injury, a severe skull fracture, or a serious brain hemorrhage. Risk factors associated with an increased likelihood of memory problems or seizures after head injury include age, length and depth of coma, duration of post-traumatic and retrograde amnesia, presence of focal brain injuries, and low initial Glasgow Coma Scale score.