Is the silent epidemic keeping patients awake?

A pproximately 1.4 million people sustain a Traumatic Brain Injury (TBI) each year in the United States according to statistics collected by the Centers for Disease Control and Prevention (CDC). 1 Of these, 1.1 million individuals are seen, treated and released from an emergency department and 235,000 are hospitalized. Countless others sustain a mild TBI and never seek medical attention. Traffic accidents and falls make up the majority of TBIs, though the impact of injuries acquired on the athletic field may be as significant. The dramatic presentation of moderate to severe TBI draws initial attention but the long term consequences of even mild traumatic brain injury, including headaches, memory problems, personality changes, and attention deficits, are poorly understood and often go unidentified. Because of the staggering numbers and the potentially subtle cognitive, emotional and behavioral consequences, TBI has been referred to as the " silent epidemic. " Due to publicity surrounding repetitive head injuries to high profile athletes and to the large number of casualties in our overseas conflicts, this epidemic is no longer silent. This epidemic now calls out for our attention. Wars have often been linked to a specific " signature " injury. World War II, with the use of atomic bombs, was associated with radiation-induced cancer. The Vietnam War will be remembered for the use of the defoliant Agent Orange and the physical ailments suspected by exposure to it and for the identification of Post Traumatic Stress Disorder (PTSD) in war veterans. Unfortunately, the signature injury for the current conflicts in Afghanistan and Iraq is the TBI. 2 The use of advanced protective gear such as Kevlar helmets and body armor has reduced the risk of penetrating trauma and has improved survival rates. Kevlar helmets, though, do not completely protect from closed head injuries resulting from blasts such as those generated by improvised explosive devices (IEDs). It has been noted at Walter Reed Army Medical Center in Washington, D.C, that 59% of blast-exposed patients have a TBI, a figure representing thousands of veterans who will need ongoing care for those injuries. For a successful outcome in a patient with TBI, more is required than the good work of intensivists, acute care nurses or neurosur-geons in an inpatient setting. That is just the beginning. Long-term success, as measured by the best quality of life possible, mandates the use of an interdisciplinary team that can assess and manage a …