Traumatic brain injury hits older adults hardest, usually after a fall

An 81-year-old woman slips getting out of the bath and knocks her head on the tile. She feels shaken but fine, with no cut and only a small bump. She takes a blood thinner for her heart. Her daughter wonders whether a trip to the emergency department is an overreaction.

By CDC’s reckoning it is not, and the reason upends the usual picture of brain injury. The American most likely to be hospitalized or to die with a traumatic brain injury (TBI) is not a football player or a soldier. According to the Centers for Disease Control and Prevention (CDC), people 75 and older have the highest numbers and rates of TBI-related hospitalizations and deaths, accounting for about 32% of hospitalizations and 28% of deaths. Falls lead to nearly half of all TBI hospitalizations.

The leading cause of TBI deaths is different again. CDC says firearm-related suicide is the most common cause of TBI-related death in the United States.

If you or someone you know is thinking about suicide, call or text 988, or chat at chat.988lifeline.org. The line is free and confidential, and it answers 24 hours a day, every day. Veterans and service members can dial 988 and press 1. In an emergency, call 911.

Who gets hurt, and how

CDC counted 68,663 TBI-related deaths in 2023 and about 214,110 TBI-related hospitalizations in 2020, the most recent years on its data page. That is more than 586 hospitalizations and 190 deaths a day. The hospital count leaves out everyone treated only in an emergency department, urgent care or a doctor’s office, and everyone never treated at all. Males were nearly twice as likely as females to be hospitalized and three times as likely to die.

Falls are the most common cause of TBI overall, according to the National Institute of Neurological Disorders and Stroke (NINDS), and they cluster at the two ends of life, in the very young and the very old. Crashes involving cars, pedestrians and bicycles are other major causes. CDC’s falls data add that more than 1 in 4 older adults fall each year, fewer than half tell their doctor, and falls are the most common cause of TBI in older adults.

Brain injury in older people is also easy to miss. CDC notes that TBI symptoms in older adults overlap with those of other conditions, such as dementia, so an injury can be missed or misdiagnosed. CDC also names groups at greater risk from TBI, among them rural residents, service members and veterans, survivors of intimate partner violence, people who are homeless or incarcerated, and racial and ethnic minority groups.

What mild, moderate and severe mean

Doctors have long graded TBI with the Glasgow Coma Scale, a 3-to-15 score built from how a person opens their eyes, speaks and moves in response to prompts. A score of 13 to 15 is mild, 9 to 12 moderate, and 3 to 8 severe. Concussion sits at the mild end; how it is recognized and managed is the subject of the library’s concussion article.

The labels are blunt. A 2025 paper from an NINDS working group called the score-only system unsatisfactory because it overlooks differences in injury severity, care needs and outlook. In 2022 NINDS launched an international effort, with 94 participants from 14 countries including people living with TBI, to build something better. Published in The Lancet Neurology in 2025, the proposed framework is called CBI-M. It adds three pillars to the clinical exam: blood biomarkers, imaging and modifiers, such as age, frailty and other illnesses that shape how someone recovers.

A large test arrived in October 2026. Using data from more than 7,000 patients in European and US studies, researchers found CBI-M predicted CT findings, care needs and death or severe disability at six months very well, but quality of life only modestly. The authors say it still needs prospective testing before routine use. For now, “mild, moderate, severe” remains the common shorthand.

Early predictions can be wrong

Severity on day one is a poor crystal ball. A 2021 study in JAMA Neurology followed 484 people with moderate or severe TBI at 18 US trauma centers. Two weeks after injury, only 12.4% of those with severe TBI had a favorable outcome on a standard global recovery scale. By 12 months, 52.4% did. Nearly 1 in 5 people with severe TBI reported no disability at a year, and 78% of those in a vegetative state at two weeks had regained consciousness by 12 months.

The authors warned clinicians against early, definitive statements predicting a poor outcome, including in discussions about withdrawing life support. For families, that does not answer what any one person’s recovery will look like. It does mean a grim forecast in the first two weeks deserves careful questions about how certain it is.

After a fall on a blood thinner

Blood thinners change the calculation. NINDS says these drugs may increase the risk of bleeding in the brain, and that subdural hematomas, collections of blood between the brain and its outer covering, are very common in older adults after a fall. CDC’s advice is that an older person who falls and hits their head should see a doctor right away to check for a brain injury.

The American College of Emergency Physicians (ACEP) addressed these patients in its 2023 clinical policy. It describes the threshold for a first head CT in people taking anticoagulants or antiplatelet drugs as very low, because missing an early bleed has serious consequences, and it says the scoring rules that spare many other adults a scan are not reliable enough to skip one here. Aspirin taken alone is treated differently. The bigger question ACEP took up is what happens after a clean first scan.

Older reports put the risk of a delayed bleed as high as 6%. The studies ACEP reviewed found it rare. So ACEP advises against routinely repeating the CT, or routinely admitting or observing the patient, when the first scan shows no bleeding and the person is at their usual neurological baseline (both Level B, ACEP’s middle tier).

What the guidance adds up to

This summary of CDC and ACEP guidance is a map, not a substitute for the clinician on the scene:

1. Same day. A head strike in someone on a blood thinner warrants prompt medical assessment, even when the person seems fine.
2. Bring the list. Note every anticoagulant, antiplatelet drug and aspirin product, and when the last dose was taken.
3. Emergency signs mean 911, at any point. CDC’s list for adults includes a headache that worsens and will not go away, repeated vomiting, seizures, slurred speech or unusual behavior, weakness or numbness, confusion or agitation, one pupil larger than the other, and being very drowsy or impossible to wake.
4. At discharge, ACEP’s consensus advice is that instructions should list the symptoms of a rare delayed bleed. Ask to have them written down.
5. The blood thinner itself. Whether to pause, continue or change it is the prescriber’s decision. ACEP suggests an outpatient referral to weigh the risks and benefits of anticoagulation alongside fall risk.
6. The next fall. The prevention section below covers the exercise programs with the best evidence for cutting fall risk.

Rehabilitation and the long haul

For moderate and severe TBI, the hospital stay is the start. NINDS describes care moving to a rehabilitation team that can include neurologists, nurses, psychologists and physical, occupational, speech and vocational therapists. Cognitive rehabilitation retrains thinking skills and teaches ways to work around lasting problems.

The best long-term picture comes from the TBI Model Systems, a network of specialized US centers that has followed 19,647 people with moderate to severe TBI admitted to inpatient rehabilitation since 1989. This group looks different from CDC’s fall-heavy hospital data: vehicles caused 49% of their injuries, falls 29% and violence 11%. Recovery in the first year is real. On a standard scale of independence in daily tasks, average scores rose from 51 at rehabilitation admission to 90 at discharge and 113 at one year. Work is harder to regain: 61% had jobs when injured, but only 29% were working a year later and 32% at two years.

A CDC fact sheet drawn from the same database calls moderate to severe TBI a lifelong condition. About half of these patients experience further decline in daily life or die within five years, and life expectancy is 9 years shorter. Among those alive at five years, 57% are moderately or severely disabled, 33% rely on others for everyday activities and 12% live in nursing homes or other institutions. These figures describe the most severely injured, who make up fewer than 1 in 10 people hospitalized with TBI, not everyone who has a head injury. NINDS also notes that moderate or severe TBI in early or middle life may be associated with a higher risk of dementia later, a question the library’s dementia-risk coverage takes up.

What cognitive rehabilitation guidelines support

The international INCOG 2.0 guidelines, published in 2023 for moderate to severe TBI, make 80 recommendations. Among the most practical:

• Look for fixable contributors first. Problems with attention should prompt screening for hearing, vision, fatigue, sleep, anxiety, depression, pain, substance use and medications.
• Train real tasks. Metacognitive strategy training, which teaches people to plan and check their own performance in everyday activities, is recommended. Practicing stand-alone computer attention drills is not, because the gains do not carry over to daily life.
• Use external memory aids. For severe memory problems, reminder systems such as smartphones are the preferred primary strategy. Computer memory training should be therapist-guided, and transcranial direct current stimulation is not recommended.
• Medication has a narrow role. Methylphenidate is recommended to improve processing speed, a prescribing decision for the treating team. Evidence for mindfulness or noninvasive brain stimulation to improve attention is insufficient.

Lingering symptoms after milder injuries follow a different evidence trail, which the library’s piece on long-term symptoms after injury traces.

Brain injury in the military

From 2000 through the end of 2025, the Defense Department recorded more than half a million TBI diagnoses among active-duty service members, wherever they were stationed. Roughly 8 in 10 were mild. The Defense Health Agency says most service members with a mild TBI return to full duty within 10 to 14 days. NINDS notes that blast injuries from roadside bombs became a common cause of TBI in recent conflicts, and that most were classified as mild.

The Veterans Crisis Line serves veterans, service members, National Guard and Reserve members and their families: dial 988 and press 1, or text 838255. Enrollment in VA benefits or health care is not required.

CTE and traumatic encephalopathy syndrome

Chronic traumatic encephalopathy (CTE) is defined by what a pathologist sees in brain tissue: a buildup of an abnormal form of the protein tau in nerve and support cells, clustered around small blood vessels at the bottom of the brain’s folds. It can be confirmed only after death. NINDS calls it a progressive neurological disorder and says research to date suggests repeated TBIs may cause it.

Two opposite beliefs both overstate the evidence. One is that every concussion leads to CTE. The other is that CTE is a myth. The 2023 international consensus on concussion in sport says the tissue finding is not a clinical diagnosis, that it is not known whether it inevitably progresses, and that studies of former athletes cannot establish cause or measure risk. It found that former amateur players, mostly in American football, were not at higher risk of depression, suicidality or cognitive impairment than the general population, while studies of former professional American football and soccer players found higher death rates from neurological disease and dementia.

In 2021 an NINDS-led panel published research criteria for traumatic encephalopathy syndrome (TES), the proposed clinical counterpart of CTE in living people. TES requires substantial exposure to repeated head impacts, problems with memory or planning and/or with controlling behavior, a worsening course, and symptoms not better explained by another condition. The panel’s stated purpose was to advance CTE research.

A May 2026 study in Nature Medicine tested those criteria against autopsies. Of 1,038 people in a brain bank for neurodegenerative disease, 25 met TES criteria, and only 6 of them had CTE, a positive predictive value of 24%. What predicted CTE was the history of head impacts, not the proposed symptoms. The authors warned that the criteria could cause psychological harm by wrongly labeling former contact-sport athletes with a progressive brain disease. A July 2026 study of 177 former football players found that p-tau217, a blood marker that helps rule out Alzheimer’s-type amyloid changes, is unlikely to be useful for detecting CTE. No scan or blood test diagnoses CTE in a living person.

That matters for anyone who has played contact sports and now struggles with mood or memory. Those symptoms are real and deserve evaluation and treatment whatever their cause, and a CTE label applied to a living person is outrunning the science. Thoughts of suicide, in a former athlete or anyone else, are a reason to call or text 988.

Hyperbaric oxygen: a strong no from the VA and Defense Department

Hyperbaric oxygen means breathing pure oxygen inside a pressurized chamber. It has established uses: one FDA clearance for a single-patient chamber, from 2008, lists 13, including decompression sickness, carbon monoxide poisoning, gas bubbles in the blood and wounds that will not heal. Brain injury is not among them. In a 2021 consumer update, FDA said some centers promote chambers for uses it has not cleared, naming cancer, Lyme disease, autism and Alzheimer’s disease.

It has also been proposed for concussion and its aftermath, and the military tested that idea rigorously. Four randomized trials in US service members with lingering post-concussion symptoms, reported in six papers between 2012 and 2018, compared real hyperbaric oxygen with sham sessions in the same kind of chamber, in which participants breathed room air at slightly raised pressure or, in one trial, a low-oxygen mix designed to match ordinary air. The results:

• Air Force, 50 participants: 30 sessions. No difference from sham on symptoms or PTSD scores. Both groups improved.
• Navy site, about 60 Marines: 40 sessions at two oxygen levels. No benefit over sham on symptoms, thinking, balance or fine motor skills, one week or three months later.
• Multicenter, 72 participants: no benefit over sham. Both chamber groups improved more than a group getting usual care alone, which the authors said points to placebo-type effects rather than oxygen.
• A fourth trial, 71 participants: oxygen beat sham on symptoms at 13 weeks, especially in people with PTSD, but the gains faded by 6 and 12 months.

In 2021 the VA/DoD guideline on mild TBI recommended against hyperbaric oxygen for symptoms attributed to mild TBI. It is the only strong recommendation among the guideline’s 19. In this library’s terms, hyperbaric oxygen for lingering concussion symptoms has been tested and not supported. The improvement people reported was real, but sham sessions produced much the same improvement, which points to the experience of treatment rather than the oxygen.

Severe TBI in intensive care is a separate question. A trial of hyperbaric oxygen in that setting, called HOBIT, was described in December 2025 as ongoing with low enrollment, and it has no result yet.

Prevention, and the single most useful step

The strongest prevention evidence targets the biggest group at risk. Exercise programs to prevent falls earned a Grade B, the second-highest grade, from the US Preventive Services Task Force in June 2024, for people 65 and older who live at home and are at higher risk of falling. The most studied components were gait, balance and functional training, often in groups, with some trials using tai chi or dance. Multifactorial programs, which tailor a mix of checks and fixes to each person, got a Grade C, a decision to make case by case.

For cyclists, a 2017 meta-analysis of 40 studies covering more than 64,000 injured riders linked helmet use to about half the odds of head injury and about a third of the odds of serious or fatal head injury. The studies compared injured riders who did and did not wear helmets, so they show an association. CDC reported that the rate of bicycle-related TBI emergency visits fell 48.7% among children from 2009 to 2018, but only 5.5% among adults.

If one habit comes out of all these numbers, make it this one. For an older adult on a blood thinner, a fall with a knock to the head is a same-day medical question, however well the person seems afterward. That is what CDC advises, and ACEP’s very low bar for scanning these patients explains why.

Sources

1. Centers for Disease Control and Prevention. “TBI Data (last reviewed April 27, 2026).” cdc.gov
2. Centers for Disease Control and Prevention. “Facts About TBI (last reviewed August 4, 2025).” cdc.gov
3. Centers for Disease Control and Prevention. “Older Adult Falls Data (last reviewed September 8, 2026).” cdc.gov
4. Centers for Disease Control and Prevention. “Signs and Symptoms of Mild TBI and Concussion (last reviewed September 15, 2025).” cdc.gov
5. Centers for Disease Control and Prevention. “Moderate to Severe Traumatic Brain Injury is a Lifelong Condition (fact sheet, undated).” stacks.cdc.gov
6. National Institute of Neurological Disorders and Stroke. “Traumatic Brain Injury (TBI) (last reviewed March 13, 2026).” ninds.nih.gov
7. Traumatic Brain Injury Model Systems National Data and Statistical Center (Model Systems Knowledge Translation Center). “TBI Model Systems National Database slide summary (data as of December 31, 2022).” msktc.org
8. Defense Health Agency, Traumatic Brain Injury Center of Excellence. “DOD Numbers for Traumatic Brain Injury Worldwide (last updated September 21, 2026).” health.mil
9. U.S. Department of Veterans Affairs and Department of Defense. “VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury, Clinician Summary (2021).” healthquality.va.gov
10. U.S. Preventive Services Task Force. “Falls Prevention in Community-Dwelling Older Adults: Interventions (June 4, 2024).” uspreventiveservicestaskforce.org
11. U.S. Food and Drug Administration. “510(k) Summary K081506, monoplace hyperbaric chamber systems (prepared May 26, 2008).” accessdata.fda.gov
12. U.S. Food and Drug Administration. “Hyperbaric Oxygen Therapy: Get the Facts (consumer update bulletin, July 2021).” content.govdelivery.com
13. British Journal of Sports Medicine. “Patricios JS, Schneider KJ, Dvorak J, et al. "Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022." Br J Sports Med, 2023;57(11):695-711. DOI: 10.1136/bjsports-2023-106898.” doi.org
14. 988 Suicide & Crisis Lifeline. “988 Suicide & Crisis Lifeline (home page).” 988lifeline.org
15. U.S. Department of Veterans Affairs. “Veterans Crisis Line.” veteranscrisisline.net
16. The Lancet Neurology. “Manley GT, Dams-O'Connor K, Alosco ML, Awwad HO, Bazarian JJ, Bragge P, Corrigan JD, Doperalski A, et al. "A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative." Lancet Neurol, 2025. PubMed. DOI: 10.1016/S1474-4422(25)00154-1.” pubmed.ncbi.nlm.nih.gov
17. Journal of Neurotrauma. “Menon DK, Silverberg ND, Ferguson AR, Bayuk TJ, et al. "Clinical Assessment on Days 1-14 for the Characterization of Traumatic Brain Injury: Recommendations from the 2024 NINDS Traumatic Brain Injury Classification and Nomenclature Initiative Clinical/Symptoms Working Group." J Neurotrauma, 2025. PubMed. DOI: 10.1089/neu.2024.0577.” pubmed.ncbi.nlm.nih.gov
18. PLOS Medicine. “Pisică D, Mikolić A, Yue JK, McCrea MA, Dams-O'Connor K, et al. "The CBI-M framework for characterization of traumatic brain injury: Evaluation of performance using data from the CENTER-TBI and TRACK-TBI prospective cohort studies." PLoS Med, 2026. PubMed. DOI: 10.1371/journal.pmed.1004945.” pubmed.ncbi.nlm.nih.gov
19. JAMA Neurology. “McCrea MA, Giacino JT, Barber J, Temkin NR, Nelson LD, Levin HS, et al.; TRACK-TBI Investigators. "Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study." JAMA Neurol, 2021. PubMed. DOI: 10.1001/jamaneurol.2021.2043.” pubmed.ncbi.nlm.nih.gov
20. American College of Emergency Physicians (Annals of Emergency Medicine). “American College of Emergency Physicians Clinical Policies Subcommittee; Valente JH, Anderson JD, Paolo WF, Sarmiento K, et al. "Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Mild Traumatic Brain Injury." Ann Emerg Med, 2023. PubMed. DOI: 10.1016/j.annemergmed.2023.01.014.” pubmed.ncbi.nlm.nih.gov
21. Journal of Head Trauma Rehabilitation. “Bayley MT, Janzen S, Harnett A, Teasell R, Patsakos E, Marshall S, Bragge P, Velikonja D, et al. "INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: Methods, Overview, and Principles." J Head Trauma Rehabil, 2023. PubMed. DOI: 10.1097/HTR.0000000000000838.” pubmed.ncbi.nlm.nih.gov
22. Journal of Head Trauma Rehabilitation. “Ponsford J, Velikonja D, Janzen S, Harnett A, McIntyre A, Wiseman-Hakes C, Togher L, Teasell R, et al. "INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part II: Attention and Information Processing Speed." J Head Trauma Rehabil, 2023. PubMed. DOI: 10.1097/HTR.0000000000000839.” pubmed.ncbi.nlm.nih.gov
23. Journal of Head Trauma Rehabilitation. “Velikonja D, Ponsford J, Janzen S, Harnett A, Patsakos E, Kennedy M, Togher L, Teasell R, et al. "INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part V: Memory." J Head Trauma Rehabil, 2023. PubMed. DOI: 10.1097/HTR.0000000000000837.” pubmed.ncbi.nlm.nih.gov
24. Neurology. “Katz DI, Bernick C, Dodick DW, Mez J, Mariani ML, Adler CH, Alosco ML, Balcer LJ, et al. "National Institute of Neurological Disorders and Stroke Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome." Neurology, 2021. PubMed. DOI: 10.1212/WNL.0000000000011850.” pubmed.ncbi.nlm.nih.gov
25. Journal of Neuropathology and Experimental Neurology. “Bieniek KF, Cairns NJ, Crary JF, Dickson DW, Folkerth RD, Keene CD, Litvan I, Perl DP, et al. "The Second NINDS/NIBIB Consensus Meeting to Define Neuropathological Criteria for the Diagnosis of Chronic Traumatic Encephalopathy." J Neuropathol Exp Neurol, 2021. PubMed. DOI: 10.1093/jnen/nlab001.” pubmed.ncbi.nlm.nih.gov
26. Nature Medicine. “Arena JD, Stewart W, Schneider ALC, Robinson JL, Donahue RP, Irwin DJ, Wolk DA, Lee EB, et al. "Performance of traumatic encephalopathy syndrome criteria in identifying individuals with chronic traumatic encephalopathy." Nat Med, 2026. PubMed. DOI: 10.1038/s41591-026-04392-9.” pubmed.ncbi.nlm.nih.gov
27. JAMA Network Open. “Miner AE, Zetterberg H, Blennow K, Groh JR, Singh A, Dieckhoff K, Tripodis Y, Adler CH, et al. "Plasma Phosphorylated Tau 217 in Participants at Risk for Chronic Traumatic Encephalopathy." JAMA Netw Open, 2026. PubMed. DOI: 10.1001/jamanetworkopen.2026.22966.” pubmed.ncbi.nlm.nih.gov
28. Journal of Neurotrauma. “Wolf G, Cifu D, Baugh L, Carne W, Profenna L. "The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury." J Neurotrauma, 2012. PubMed. DOI: 10.1089/neu.2012.2549.” pubmed.ncbi.nlm.nih.gov
29. Journal of Head Trauma Rehabilitation. “Cifu DX, Hart BB, West SL, Walker W, Carne W. "The effect of hyperbaric oxygen on persistent postconcussion symptoms." J Head Trauma Rehabil, 2014. PubMed. DOI: 10.1097/HTR.0b013e3182a6aaf0.” pubmed.ncbi.nlm.nih.gov
30. Annals of Neurology. “Cifu DX, Walker WC, West SL, Hart BB, Franke LM, Sima A, Graham CW, Carne W. "Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes." Ann Neurol, 2014. PubMed. DOI: 10.1002/ana.24067.” pubmed.ncbi.nlm.nih.gov
31. Neurorehabilitation and Neural Repair. “Walker WC, Franke LM, Cifu DX, Hart BB. "Randomized, Sham-Controlled, Feasibility Trial of Hyperbaric Oxygen for Service Members With Postconcussion Syndrome: Cognitive and Psychomotor Outcomes 1 Week Postintervention." Neurorehabil Neural Repair, 2014. PubMed. DOI: 10.1177/1545968313516869.” pubmed.ncbi.nlm.nih.gov
32. JAMA Internal Medicine. “Miller RS, Weaver LK, Bahraini N, Churchill S, Price RC, Skiba V, et al. "Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial." JAMA Intern Med, 2015. PubMed. DOI: 10.1001/jamainternmed.2014.5479.” pubmed.ncbi.nlm.nih.gov
33. Undersea & Hyperbaric Medicine. “Weaver LK, Wilson SH, Lindblad AS, Churchill S, Deru K, Price RC, et al. "Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial." Undersea Hyperb Med, 2018. PubMed. (No DOI in the record; PMID 29734566).” pubmed.ncbi.nlm.nih.gov
34. Contemporary Clinical Trials Communications. “Rahman MM, Saif MSI, Beall J, Martin RL, Rockswold GL, Barsan WG, Korley FK, Silbergleit R, Stevenson V, Gajewski B. "A Bayesian model with seasonal effects for predicting accrual in clinical trials: Application to HOBIT and BOOST-3 trials for severe traumatic brain injury." Contemp Clin Trials Commun, 2025. PubMed. DOI: 10.1016/j.conctc.2025.101586.” pubmed.ncbi.nlm.nih.gov
35. International Journal of Epidemiology. “Olivier J, Creighton P. "Bicycle injuries and helmet use: a systematic review and meta-analysis." Int J Epidemiol, 2017. PubMed. DOI: 10.1093/ije/dyw153.” pubmed.ncbi.nlm.nih.gov
36. Centers for Disease Control and Prevention (MMWR). “Sarmiento K, Haileyesus T, Waltzman D, Daugherty J. "Emergency Department Visits for Bicycle-Related Traumatic Brain Injuries Among Children and Adults – United States, 2009-2018." MMWR Morb Mortal Wkly Rep, 2021. PubMed. DOI: 10.15585/mmwr.mm7019a1.” pubmed.ncbi.nlm.nih.gov