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 Table of Contents  
REVIEW ARTICLE
Year : 2017  |  Volume : 1  |  Issue : 6  |  Page : 19-21

Knowledge gaps in the global practice of management of severe traumatic brain injury


1 Department of Emergency Medicine and Intensive Care, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
2 Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
3 Department of Intensive Care, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City – National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication23-Nov-2017

Correspondence Address:
Sami Alsolamy
Department of Emergency Medicine and Intensive Care, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City – CR, Riyadh 11426
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sccj.sccj_26_17

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  Abstract 

Traumatic brain injury (TBI) was referred to as silent epidemic, neglected epidemic, and public health crisis by the World Health Organization due to its growing incidence and global public health, social, and economic burden. Despite the massive technological progress, no definitive treatment was found to cure TBI medically.The available evidence-based protocols are primarily directed toward stabilizing the patient and preventing secondary brain injuries, and their effectiveness has been validated in in high-income countries, but they may not be applicable to low and middle-income countries due to the lack of the appropriate infrastructure and limited human resources. Therefore, discrepancies are predicted between centers in high, low and middle-income countries and further studies are needed to asses the global managment of TBI.

Keywords: Global TBI management, Head trauma management, TBI Gap


How to cite this article:
Alsolamy S, Alotaibi F, Arabi Y. Knowledge gaps in the global practice of management of severe traumatic brain injury. Saudi Crit Care J 2017;1, Suppl S2:19-21

How to cite this URL:
Alsolamy S, Alotaibi F, Arabi Y. Knowledge gaps in the global practice of management of severe traumatic brain injury. Saudi Crit Care J [serial online] 2017 [cited 2017 Dec 15];1, Suppl S2:19-21. Available from: http://www.sccj-sa.org/text.asp?2017/1/6/19/219132

Traumatic brain injury (TBI) is an injury that disrupts the normal brain function produced by the application of external mechanical forces to the skull.[1] The pathophysiology of brain injury includes a complex series of processes that progress over hours, days, and weeks after a direct head injury.[2] Primary brain injury results from the mechanical damage of the trauma.[3] It is followed by a secondary brain injury that arises hours or days after the primary injury due to the release of pro-inflammatory mediators, dysfunction, and death of neural cells, which contribute to further damage.[3] TBI is a heterogeneous and complicated condition surrounded by several controversies, starting from its description to its outcome.[4] Terms such as silent epidemic, neglected epidemic, and public health crisis were used by the World Health Organization (WHO) to define TBIs due to its growing incidence and global public health, social, and economic burden.[5],[6]

TBI accounts for 40% of all deaths from acute injuries affecting all ages, leading to decreased quality of life among patients and relatives.[7] It is responsible for approximately 2.5 million emergency department visits; 283,630 hospitalizations; 52,844 deaths; and an estimated annual cost exceeding $76.5 billion in the United States alone.[1],[8] TBI has an estimated annual incidence of up to 500/100,000 in the United states; 790/100,000 in New Zealand; 316/100,000 in South Africa; and 262/100,000 in Europe, similar to that found in Australia.[9],[10],[11],[12],[13] However, a few data exist on the epidemiology and burden of TBI in low- and middle-income countries (LMICs). The incidence of TBI in Saudi Arabia is high, with an extrapolated rate of 116/100,000 population.[14] In all age groups, males are affected more than females, reaching a ratio of 13:1 in Saudi Arabia.[14] Those aged 75 years or older have the highest risk for hospitalization and death.[2] Among cases for which TBI–related mortality data were recorded, 90% of deaths caused by TBI were recorded in the first 48 h, usually caused by increased intracranial pressure and cerebral edema as a consequence of ischemic and hypoxic insult.[1],[15]

Falls are the most common cause of TBI in high-income countries (HICs), especially in elderly populations.[12] Meanwhile, road traffic accidents constitute the bulk of TBI causes in LMICs, especially in young populations.[12] In addition, due to the rapid industrialization and the increased use of motor vehicles that outpace the implementation of safety infrastructure and limited human resources, the incidence of TBI is growing rapidly on a global level and largely in LMICs.[12] Moreover, TBI-related mortality and overall outcomes did not change over the past two decades.[13] The WHO has predicted that by 2020, road traffic accidents will have moved from ninth to the third disease in the world ranking of burden of disease and will be the second disease in LMICs.[5] The world will be facing devastating consequences, which will be distributed disproportionately between HICs and LMICs due to the increased use of motor vehicles, the limited resources and lack of proper healthcare infrastructure to follow the existing evidence-based protocols.[4],[15] The discrepancy in the estimation of the incidence of TBI was found in studies conducted worldwide.[15] Thereon, conducting rigorous studies and improving the surveillance tools for TBI are critical to obtaining reliable observations of the trends of TBI on which treatment, preventative strategies, quality control, and planning are based.

Despite the massive technological progress and expanding knowledge, no definitive treatment was found to cure TBI medically.[4] The current standard management of TBI mainly relies on prehospital management and selection of level I trauma centers where evidence-based protocols, neurosurgical interventions, and intensive care units are available.[4] Management protocols and evidence-based guidelines can facilitate target-driven care by standardizing prehospital and in-hospital care and are associated with favorable outcomes.[16] The available evidence-based protocols are primarily directed toward stabilizing the patient and preventing secondary brain injuries, and their effectiveness has been validated in HICs, but they may not be applicable to LMICs due to the lack of the appropriate infrastructure and limited human resources.[4],[15] Therefore, discrepancies are predicted between centers in HICs and LMICs. Similarly, studies have found considerable discrepancies in care among centers within the same region.[17]

Multiple preventative strategies have been implemented to reduce the damage of TBI. Prevention can be outlined as primary, secondary, and tertiary. Primary prevention attempts to stop traumas altogether and prevent them from happening, such as road safety laws and traffic conditions.[4],[15] Secondary prevention aims to reduce the injury after trauma occurred including prehospital and hospital care.[4],[15] Tertiary prevention includes physical and psychological rehabilitation to reduce disabilities.[4],[15]


  Summary Top


Traumatic brain injury is a global issue

In every 15 s, a head injury occurs globally, and in every 12 min, a patient dies due to TBI.[18] Efforts are needed to establish and also to overcome the critical gap in surveillance tools, epidemiology, evidence-based approaches, and rehabilitation, considering the heterogeneity and complexity of the disease and the vast variation in facility infrastructure and capabilities of countries worldwide. Furthermore, research efforts are required to standardize treatment strategies among HICs and LMICs. For this reason, descriptive databases about global management strategies of TBI are needed with emphasis on therapeutic schemas to provide an insight to differences between HICs and LMICs. The existing literature varies regarding the management of severe TBI in HICs and LMICs. Therefore, a study of the current practice will help illustrate the proficiency and cost-effectiveness of global standardization of TBI management protocols and their efficacy in improving patient outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Centers for Disease Control and Prevention. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control. Atlanta, GA: Division of Unintentional Injury Prevention; 2015. p. 1-72.  Back to cited text no. 1
    
2.
Granacher RP Jr. Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment. 3rd ed. Riyadh, Saudi Arabia: CRC Press; 2015.  Back to cited text no. 2
    
3.
Finnie JW, Blumbergs PC. Traumatic brain injury. Vet Pathol 2002;39:679-89.  Back to cited text no. 3
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4.
Tabish SA, Syed N. Recent advances and future trends in traumatic brain injury. Emerg Med (Los Angel.) 2015;5:229.  Back to cited text no. 4
    
5.
World Health Organization. Neurological Disorders: Public Health Challenges. Geneva, Switzerland. WHO Press; 2006.  Back to cited text no. 5
    
6.
Ghajar J. Traumatic brain injury. Lancet 2000;356:923-9.  Back to cited text no. 6
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7.
Finkelstein EA, Corso PS, Miller TR. The Incidence and Economic Burden of Injuries in the United States. USA: Oxford University Press; 2006.  Back to cited text no. 7
    
8.
Maas AI, Murray GD, Roozenbeek B, Lingsma HF, Butcher I, McHugh GS, et al. Advancing care for traumatic brain injury: Findings from the IMPACT studies and perspectives on future research. Lancet Neurol 2013;12:1200-10.  Back to cited text no. 8
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9.
Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: A brief overview. J Head Trauma Rehabil 2006;21:375-8.  Back to cited text no. 9
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10.
Feigin VL, Theadom A, Barker-Collo S, Starkey NJ, McPherson K, Kahan M, et al. Incidence of traumatic brain injury in New Zealand: A population-based study. Lancet Neurol 2013;12:53-64.  Back to cited text no. 10
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11.
Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil 2010;25:72-80.  Back to cited text no. 11
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12.
Peeters W, van den Brande R, Polinder S, Brazinova A, Steyerberg EW, Lingsma HF, et al. Epidemiology of traumatic brain injury in Europe. Acta Neurochir (Wien) 2015;157:1683-96.  Back to cited text no. 12
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13.
Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008;7:728-41.  Back to cited text no. 13
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14.
Arabi YM, Haddad S, Tamim HM, Al-Dawood A, Al-Qahtani S, Ferayan A, et al. Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury. J Crit Care 2010;25:190-5.  Back to cited text no. 14
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15.
Park E, Bell JD, Baker AJ. Traumatic brain injury: Can the consequences be stopped? CMAJ 2008;178:1163-70.  Back to cited text no. 15
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16.
Maas AI, Marmarou A, Murray GD, Teasdale SG, Steyerberg EW. Prognosis and clinical trial design in traumatic brain injury: The IMPACT study. J Neurotrauma 2007;24:232-8.  Back to cited text no. 16
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17.
Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ, et al. Management of severe head injury: Institutional variations in care and effect on outcome. Crit Care Med 2002;30:1870-6.  Back to cited text no. 17
    
18.
Yattoo GH, Tabish SA, Afzal WM, Kirmani A. Factors influencing outcome of head injury patients at a tertiary care teaching hospital in India. Int J Health Sci (Qassim) 2009;3:59-62.  Back to cited text no. 18
    




 

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