Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). TBI is a major cause of death and disability worldwide, especially in children and young adults. Causes include falls, vehicle accidents, and violence. Prevention measures include use of technology to protect those suffering from automobile accidents, such as seat belts and sports or motorcycle helmets, as well as efforts to reduce the number of automobile accidents, such as safety education programs and enforcement of traffic laws.
Brain trauma can be caused by a direct impact or by acceleration alone. In addition to the damage caused at the moment of injury, brain trauma causes secondary injury, a variety of events that take place in the minutes and days following the injury. These processes, which include alterations in cerebral blood flow and the pressure within the skull, contribute substantially to the damage from the initial injury. Depending on the injury, treatment required may be minimal or may include interventions such as medications and emergency surgery. Physical therapy, speech therapy, recreation therapy, and occupational therapy may be employed for rehabilitation.
TBI can cause a host of physical, cognitive, social, emotional, and behavioral effects, and outcome can range from complete recovery to permanent disability or death. Traumatic brain injury (TBI) can negatively affect a patient’s medical decision-making ability at a time when patients or their families are faced with countless complex decisions. Immediately following injury and during the rehabilitation and recovery period, patients and their families must make ongoing and often complex medical decisions, including treatment of brain trauma and orthopedic injuries, choice of rehabilitation programming and treatment of neuropsychiatry problems.
One month after injury, medical decision-making capacity is mostly intact for those classified with mild TBI, but significantly impaired for those classified with complicated mild TBI and those with moderate or severe TBI. Until more is known about the time required for return to normal decision-making capabilities, physicians need to carefully assess decisional capacity in their TBI patients, particularly those with complicated, moderate or severe TBI. Thus, impaired medical decision-making capacity is prevalent in acute TBI and is related to injury severity. Further, longitudinal studies are needed to better assess the time required for recovery of decisional capacity across varying levels of injury severity