Traumatic Brain Injury (TBI)

By traumatic brain injury (TBI) we refer to an injury resulting from a violent trauma to the brain. The most common cause (at least, in peacetime) is a road traffic accident, though of course some result from falls, sports accidents, and assault.

TBI may be distinguished from non-traumatic brain injuries, such as stroke or anoxia due to cardio-respiratory arrest. For a given pattern of disabilities, life expectancy after stroke is generally worse than after TBI because TBI is a one-time event whereas a stroke is generally the result of a disease process that is still present. For one-time nontraumatic brain injuries, such as those due to anoxia, prognosis for survival may be similar to that in TBI, other factors being equal, though there are reasons to suspect it may be somewhat worse.

As is the case in stroke or cerebral palsy, the resulting pattern of disabilities may range from none or mild, when the life expectancy would be nearly normal, down to the vegetative state, with no voluntary motor function or awareness of the environment. In the latter case, of course, life expectancy is dramatically reduced.

Time since injury is a significant issue in the estimation of life expectancy after TBI. It is necessary to ask whether the pattern of abilities and disabilities stabilized? If major further improvements (or, indeed, regression) in function is expected, this needs to be taken into account. The life expectancy estimates reported in our more recent California research assume that the subject’s abilities and disabilities have stabilized.

An oft-cited rule of thumb is that improvement in motor and cognitive function may occur for the first two years after injury. Although this rule has some merit, in reality the situation is more complex than this; the period for potential recovery may depend on the age of the injured person, the type of injury (traumatic versus non-traumatic), the type and quantity of therapy received, and possibly other factors.

For a recent and comprehensive review of the published literature on life expectancy in TBI, see Shavelle et al. The reader interested in life expectancy after TBI is referred to this review as a good starting point. For convenience, the Table of life expectancies is reproduced below.

Life Expectancies from Recent Study
References

  1. Shavelle RM, Strauss DJ, Day SM, Ojdana KA (2007). Life Expectancy. In: ND Zasler, DI Katz & RD Zafonte (Eds.), Brain Injury Medicine: Principles and Practice. New York: Demos Medical Publishing.
  2. Ratcliff G, Colantonio A, Escobar M, Chase S, Vernich L (2005). Long-term survival following traumatic brain injury. Disability and Rehabilitation, 27:305-314.
  3. Brown AW, Leibson CL, Malec JF, Perkins PK, Diehl NN, Larson DR (2004). Long-term survival after traumatic brain injury: A population-based analysis, NeuroRehabilitation, 19:37-43.
  4. Harrison-Felix C, Whiteneck G, DeVivo M, Hammond FM, Jha A (2004). Mortality following rehabilitation in the traumatic brain injury model systems of care. NeuroRehabilitation, 19:45-54.
  5. Strauss DJ, Shavelle RM, DeVivo MJ, Harrison-Felix C, Whiteneck GG (2004). Life expectancy after traumatic brain injury [letter]. NeuroRehabilitation, 19:257-258.
  6. Shavelle R, Strauss D (2000). Comparative mortality of adults with traumatic brain injury in California, 1988-97. Journal of Insurance Medicine, 32:163-166.
  7. Strauss D, Shavelle R, Anderson TW (1998). Long-term survival of children and adolescents after traumatic brain injury. Archives of Physical Medicine & Rehabilitation, 79:1095-1100.
  8. Strauss D, Shavelle R, DeVivo MJ (1999). Life tables for people with traumatic brain injury [letter]. Journal of Insurance Medicine, 31:104-105.
  9. Shavelle RM, Strauss DJ, Whyte, J, Day SM, Yu YL (2001). Long-term causes of death after traumatic brain injury. American Journal of Physical Medicine and Rehabilitation, 80:510-516.
  10. Baguley I, Slewa-Younan S, Lazarus R, Green A (2000). Long-term mortality trends in patients with traumatic brain injury. Brain Injury, 14:505-512.
  11. Lewin W, Marshall TFD, Roberts AH (1979). Long-term outcome after severe head injury. British Medical Journal 2:1533-8.
  12. Zafonte RD, Mann NR, Millis SR, Wood DL, Lee CY, Black KL (1997). Functional outcome after violence related traumatic brain injury. Brain Injury, 11:403-407.
  13. Weiss GH, Caveness WF, Einseidel-Lechtape H, McNeel ML (1982). Life expectancy and causes of death in a group of head-injured veterans of World War I. Archive of Neurology, 39:741-743.
  14. Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, Murray GD, Maas AI (2003). Patient age and outcome following severe traumatic brain injury: An analysis of 5600 patients. J Neurosurg, 99:666-673.
  15. Cameron CM, Purdie DM, Kliewer EV, McClure RJ (2008). Ten-year outcomes following traumatic brain injury: A population-based cohort. Brain Injury, 22:437-449.

[The studies referenced above are available on the articles page. Cause of death codes from the 2001 study are available here.]