Why is TBI a global burden?
TBI represents the various and heterogeneous types of brain dysfunction that result secondary to an exterior impact [1–4] and is one of the leading diseases that lead to loss of life and disability globally. This pathology has a direct impact on patients and an indirect impact on families and people around them, their environment, and society [1–4].
TBI epidemiology
Almost 60 million people suffer a TBI each year globally [4].
As defined by the World Bank, the magnitude of TBI varies around the globe, with the incidence being highest in low-middle-income countries [4].
Several factors significantly influence its’ incidence, including the failure or inability of patients with minor injuries to present to the hospital, as well as the differences among countries regarding data gathering and availability. High-income countries have better-quality data due to effective data collection and analysis. However, variations still exist. For example, in Europe, there are significant differences among countries regarding the reported mortality and hospital admission rates; the latter are three times higher compared to the USA [1,2,4].
Consequently, there is important variation regarding the causes of TBI between continents, regions, and countries [1–4].
What are the common causes of traumatic brain injury (TBI)?
The causes of TBI vary from:
- road traffic accidents
- falls
- sports injuries
- self-violence
- combat injuries
- gunshots
- being struck by an object, etc. [1–4].
Fig.1 Main causes of TBI
Who does TBI affect?
TBI affects people regardless of age, race, ethnicity, gender, or nationality [3].
- Elderly and very young people represent the main risk groups for TBI.
- Because of the aging population, the incidence of TBI in this age groups is continuously rising, with associated hospital admissions.
- Increased age leads to falling due to various causes, from motor deficits, problems with balance, weakness, and infirmity, to cognitive deficits, substance abuse, medication, and other comorbidities.
- The elderly have the highest risk of death related to TBI, partly due to the different responses of the body, as opposed to younger people. However, this dichotomy should make no difference in the treatments and management of these patients.
- Children outweigh young adults, accounting for the majority of the TBI-related urgent hospital presentations, even though young adults used to represent an essential age group at risk for road traffic-related TBI.
What is post-traumatic disability?
Post-traumatic disability ranges in accordance with severity: from physical to intellectual, emotional, and behavioral deficits. All of them have a significant impact on the patients and their surrounding environment [5]. Some of the encountered deficits may include:
TBI impact on the quality of life
The post-TBI encountered disability leads to several social limitations, with a major impact on the quality of life, including on the ability to:
- Self-care
- Continue education or work
- Take part in various social activities
- Take part in leisure activities
- Fulfill the required position within the family household
- Maintain family, sexual, and personal relationships [5].
These lead to a lower quality of life and life expectancy [4].
The burden of TBI is reflected not only on an individual level, but also on an economic level, affecting society: from costs related to medical care, rehabilitation, the cause of TBI (road traffic accidents, work-related TBI, etc.) to the impact on family finances as well as the economic effect of productivity loss secondary to unemployment [3,4].
Prevention, prevention, prevention
The worldwide impact of TBI has highlighted the need for and importance of prevention strategies and policy making to address these issues [3,4].
Several causes and risk factors related to TBI are preventable. That is why the emphasis on prevention strategies is of utter importance since it can lead to lack of disability, reduced disability, and even saving lives.
Different aspects of TBI identified through epidemiologic studies have been used for primary and secondary prevention strategies:
- Reduction of road traffic accidents by introducing rigorous legislative measures addressing different aspects, as follows:
- enforcing seat belt use
- regulating the use of smartphones
- interdiction on the consumption of alcohol and other substances while driving
- improvement of roads
- road signaling
- lowering of speed limits
- vehicle maintenance
- proper drivers’ education
- Some of the measures also apply to cyclists, such as wearing helmets and other protective gear when cycling, introducing separate roads, and signaling.
- TBI related risk reduction in the at-risk age groups, namely children, adolescents, and the elderly. These vary from identifying risk factors for falls and other causes of TBI to identifying the potential impact of a TBI on the person to simplifying protective and preventive measures. For example, this could be the use of protective gear in sports practice, the use of car seats for young children, and the implementation of programs addressing the management of repetitive TBI occurring in sports.
- Prevention of TBI related to alcohol consumption by using educational programs showing its risks and consequences, as well as legislative measures.
- Early education is the first step in preventing violence that can lead to TBI. However, other factors may trigger aggression (including TBI itself).
- Combat-related TBI represents a separate group of TBI due to its causes and mechanisms, like blasts, gunshots, or other penetrating injuries. In these situations, the preventive measures regarding TBI are of utter importance, ranging from the use of helmets, armor, and proper military training.
- Use of informative programs regarding the risk of TBI associated with treatable diseases as well as medication needs to be taken into consideration [3,4].
What are some policy needs and recommendations regarding TBI?
There is a need to establish a homogenous and standardized policy regarding the methodology used in epidemiologic studies and health economic studies, starting with the gathering, interpreting and comparing the results [3,4].
Increasing TBI research through additional resources, will help us identify better solutions for treatments, as well as aid in a more comprehensive understanding of the causes and sequelae [3,4].
Researching the functioning of healthcare systems with an emphasis on the different elements affecting and influencing it will lead to better decision-making regarding the use of different resources, consequently opening the way to lessening the burden of TBI [3,4].
References
1. Centers for Disease Control and Prevention. (2019). TBI: Get the facts. Retrieved from: https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
2. National Institute of Neurological Disorders and Stroke. (2020). Traumatic brain injury: Hope through research. Retrieved from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through-Research/Traumatic-Brain-Injury-Hope-Through
3. Gallo J., Loftus C., Neurotrauma and Critical care of the Brain, 2nd Edition, Thieme 2018, pg. 3-17
4 Traumatic Brain Injury Fact sheets and Policy brief CENTER-TBI. Retrieved from: https://www.center-tbi.eu/files/news/21571f81-20b8-4860-a3dd-1f6e27d02b3d.pdf
5. Rehabilitation following acquired brain injury: national clinical guidelines (Turner-Stokes L, ed). London: RCP, BSRM, 2003, pg. 7-19; Retrieved from: https://www.headway.org.uk/media/3320/bsrm-rehabilitation-following-acquired-brain-injury.pdf
