Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world. Reliable quantification of the burden caused by TBI is difficult owing to inadequate standardization and incomplete capture of data on the incidence and outcome of brain injury, with variability in the definition of TBI being partly to blame. Reports show changes in epidemiological patterns of TBI: the median age of individuals who experience TBI is increasing, and falls have now surpassed road traffic incidents as the leading cause of this injury. Despite claims to the contrary, no clear decrease in TBI-related mortality or improvement of overall outcome has been observed over the past two decades. In this Perspectives article, we discuss the strengths and limitations of epidemiological studies, address the variability in its definition, and highlight changing epidemiological patterns. Taken together, these analyses identify a great need for standardized epidemiological monitoring in TBI.
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Maas, A. I., Stocchetti, N. & Bullock, R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 7, 728–741 (2008).
Langlois, J. A. & Sattin, R. W. Traumatic brain injury in the United States: research and programs of the Centers for Disease Control and Prevention (CDC). J. Head Trauma Rehabil. 20, 187–188 (2005).
Tagliaferri, F., Compagnone, C., Korsic, M., Servadei, F. & Kraus, J. A systematic review of brain injury epidemiology in Europe. Acta Neurochir. (Wien) 148, 255–268 (2006).
Langlois, J., Rutland-Brown, W. & Thomas, K. Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths. Centers for Disease Control and Prevention [online], (2004).
Firsching, R. & Woischneck, D. Present status of neurosurgical trauma in Germany. World J. Surg. 25, 1221–1223 (2001).
Servadei, F. et al. Regional brain injury epidemiology as the basis for planning brain injury treatment. The Romagna (Italy) experience. J. Neurosurg. Sci. 46, 111–119 (2002).
Baldo, V. et al. Epidemiological aspect of traumatic brain injury in Northeast Italy. Eur. J. Epidemiol. 18, 1059–1063 (2003).
Engberg A, W. & Teasdale, T. W. Traumatic brain injury in Denmark 1979–1996. A national study of incidence and mortality. Eur. J. Epidemiol. 17, 437–442 (2001).
Koskinen, S. & Alaranta, H. Traumatic brain injury in Finland 1991–2005: a nationwide register study of hospitalized and fatal TBI. Brain Inj. 22, 205–214 (2008).
Ingebrigtsen, T., Mortensen, K. & Romner, B. The epidemiology of hospital-referred head injury in northern Norway. Neuroepidemiology 17, 139–146 (1998).
Andelic, N., Sigurdardottir, S., Brunborg, C. & Roe, C. Incidence of hospital-treated traumatic brain injury in the Oslo population. Neuroepidemiology 30, 120–128 (2008).
Andersson, E. H., Bjorklund, R., Emanuelson, I. & Stalhammar, D. Epidemiology of traumatic brain injury: a population based study in western Sweden. Acta Neurol. Scand. 107, 256–259 (2003).
Styrke, J., Stålnacke, B. M., Sojka, P. & Björnstig, U. Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. J. Neurotrauma 24, 1425–1436 (2007).
Maset, A. et al. Epidemiologic features of head injury in Brazil. Arq. Bras. Neurocirurg. 12, 293–302 (1993).
Zhao, Y. D. & Wang, W. Neurosurgical trauma in People's Republic of China. World J. Surg. 25, 1202–1204 (2001).
Raja, I. A., Vohra, A. H. & Ahmed, M. Neurotrauma in Pakistan. World J. Surg. 25, 1230–1237 (2001).
Nell, V. & Brown, D. S. Epidemiology of traumatic brain injury in Johannesburg—II. Morbidity, mortality and etiology. Soc. Sci. Med. 33, 289–296 (1991).
Faul, M., Xu, L., Wald, M. M. & Coronado, V. G. Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control [online], (2010).
Bazarian, J. J., Veazie, P., Mookerjee, S. & Lerner, E. B. Accuracy of mild traumatic brain injury case ascertainment using ICD-9 codes. Acad. Emerg. Med. 13, 31–38 (2006).
Carroll, C. P., Cochran, J. A., Guse, C. E. & Wang, M. C. Are we underestimating the burden of TBI: surveillance of severe TBI using CDC ICD-9-CM traumatic brain injury codes. Neurosurgery 71, 164–1070 (2012).
Mild Traumatic Brain Injury Committee of the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. Definition of mild traumatic brain injury. J. Head Trauma Rehabil. 8, 86–87 (1993).
Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J. & Coronado, V. G. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J. Rehabil. Med. 43 Suppl., 113–125 (2004).
Menon, D. K., Schwab, K., Wright, D. W. & Maas, A. I. Position statement: definition of traumatic brain injury. Arch. Phys. Med. Rehabil. 91, 1637–1640 (2010).
Ruff, R. M., Iverson, G. L., Barth, J. T., Bush, S. S. & Broshek D. K. Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology education paper. Arch. Clin. Neuropsychol. 24, 3–10 (2009).
Centers for Disease Control and Prevention. Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged ≤19 years—United States, 2001–2009. MMWR Morb. Mortal. Wkly Rep. 60, 1337–1342 (2011).
Jordan, B. The clinical spectrum of sports-related traumatic brain injury. Nat. Rev. Neurol. (in press).
McCrea, M. et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J. Int. Neuropsychol. Soc. 19, 22–33 (2012).
Zetterberg. H., Smith, D. H. & Blennow, K. Biomarkers of mild traumatic brain injury in cerebrospinal fluid and blood. Nat. Rev. Neurol. http://dx.doi.org/10.1038/nrneurol.2013.9.
McCrea, M. et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 290, 2556–2563 (2003).
Prichep, L. S., McCrea, M., Barr, W., Powell, M. & Chabot, R. J. Time course of clinical and electrophysiological recovery after sport-related concussion. J. Head Trauma Rehabil. http://dx.doi.org/10.1097/HTR.0b013e318247b54e.
Livingston, S. C. et al. Differential rates of recovery after acute sport-related concussion: electrophysiologic, symptomatic, and neurocognitive indices. J. Clin. Neurophysiol. 29, 23–32 (2012).
Yuh, E. et al. MRI Improves 3-month outcome prediction in mild traumatic brain injury. Ann. Neurol. http://dx.doi.org/10.1002/ana.23783.
Committee on a Framework for Developing a New Taxonomy of Disease. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease (National Academies Press, Washington DC, 2011).
Chiu, W. T., Kuo, C. Y., Hung., C. C. & Chen, M. The effect of the Taiwan motorcycle helmet use law on head injuries. Am. J. Public Health 90, 793–796 (2000).
MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 336, 425–429 (2008).
Harrison, D. A. Risk adjustment in neurocritical care (RAIN): prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care. Health Technol. Assess. (in press).
Parekh, A. K. & Barton, M. B. The challenge of multiple comorbidity for the US health care system. JAMA 303, 1303–1304 (2010).
Stein, S. C., Georgoff, P., Meghan, S., Mizra, K. & Sonnad, S. S. 150 years of treating severe traumatic brain injury: a systematic review of progress in mortality. J. Neurotrauma 27, 1343–1353 (2010).
Rosenfeld, J. V. et al. Early management of severe traumatic brain injury. Lancet 380, 1088–1098 (2012).
McMillan, T. M., Teasdale, G. M., Weir, C. J. & Stewart, E. Death after head injury: the 13 year outcome of a case control study. J. Neurol. Neurosurg. Psychiatry 82, 931–935 (2011).
Fleminger, S. Why do some patients after head injury deteriorate over the long term? J. Neurol. Neurosurg. Psychiatry 83, 1036 (2012).
Goldstein, L. E. et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci. Transl. Med. 4, 134ra60 (2012).
Johnson, V. E., Stewart, W. & Smith, D. H. Widespread τ and amyloid-β pathology many years after a single traumatic brain injury in humans. Brain Pathol. 22, 142–149 (2012).
Foulkes, M. A., Eisenberg, M. H. & Jane, A. J. The Traumatic Coma Data Bank: design, methods and baseline characteristics. J. Neurosurg. 75 (Suppl. 1s), S8–S13 (1991).
Murray, L. S. et al. Head injuries in four British neurosurgical centres. Br. J. Neurosurg. 13, 564–569 (1999).
Murray, G. D. et al. The European Brain Consortium survey of head injuries. Acta Neurochir. (Wien) 141, 223–236 (1999).
Andriessen, T. M. et al. Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study. J. Neurotrauma 28, 2019–2031 (2011).
Rusnak, M., Janciak, I., Majdan, M., Wilbacher, I. & Mauritz, W. Severe traumatic brain injury in Austria I: introduction to the study. Wien Klin. Wochenschr. 119, 23–28 (2007).
Stocchetti, N., Paternò, R., Citerio, G., Beretta, L. & Colombo, A. Traumatic brain injury in an aging population. J. Neurotrauma 29, 1119–1125 (2012).
Jennett, B. et al. Severe head injuries in three countries. J. Neurol. Neurosurg. Psychiatry 40, 291–298 (1977).
Myburgh, J. A. et al. Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J. Trauma 64, 854–862 (2008).
Ng, I., Lee, K. K., Lim, J. H., Wong, H. B. & Yan, X. Y. Investigating gender differences in outcome following severe traumatic brain injury in a predominantly Asian population. Br. J. Neurosurg. 20, 73–78 (2006).
Darnoux, E. et al. Impairment and quality of life four years after a severe traumatic brain injury. Ann. Phys. Rehabil. Med. 54, e22–e23 (2011).
Dowling, S., Wells, G. A. & Stiell I. G. Outcomes in adult patients with traumatic brain injury [abstract 59]. CJEM 12, a59 (2010).
Chesnut, R. et al. Outcome from severe traumatic brain in Latin America: results from the Latin American pilot traumatic coma databank [abstract P130]. J. Neurotrauma 28, A111–A112 (2011).
Part of this work was funded by NIH grant NS042691. The authors acknowledge with gratitude the input of V. De Keyser in preparing the manuscript.
The authors declare no competing financial interests.
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Roozenbeek, B., Maas, A. & Menon, D. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol 9, 231–236 (2013). https://doi.org/10.1038/nrneurol.2013.22
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