Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world's population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders—policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI. Traumatic brain injury: a priority for public health policyThe Lancet Neurology Commission1 draws attention to the devastating impact of traumatic brain injury (TBI) on patients and their families, and the huge public health burden and economic cost of TBI globally. About 50–60 million new TBI cases are estimated to occur annually, with 2·5 million occurring in the European Union.1 The burden of TBI is greatest in low-income and middle-income countries, where 90% of trauma-related deaths occur.2,3 The Commission sets priorities for prevention, clinical care, and research, calling for a combination of innovative research methods and global collaboration to address the huge but poorly recognised public health challenge of TBI, with steps to ensure that developments in care and progress in research are effectively translated into clinical practice and public health policy. Full-Text PDF Traumatic brain injury: a global challengeTraumatic brain injury (TBI) is a leading cause of death and disability worldwide, with enormous economic consequences. The Lancet Neurology Commission1 on TBI sets priorities and provides recommendations for future clinical practice, research, and policy to reduce this overwhelming burden. The Commission comes at a time when the global incidence of TBI is rising, access to care is severely lacking in many parts of the world, and methods of monitoring and diagnosis are frequently inadequate. Full-Text PDF Outcome assessment after traumatic brain injury – Authors' replyWe thank Thomas McMillan and colleagues for their thoughtful comments on assessment of outcomes, with many of which we fully agree. As with many outcome assessments in traumatic brain injury (TBI), the Glasgow Outcome Scale (GOS) is open to a wide variety of influences other than brain injury: factors related to acute TBI appear to explain at best 35% of the variance.1 The predictors, moderators, and mediators of outcome after TBI are incompletely understood. There is thus much progress to be made in identifying confounding covariates for the effects of interventions. Full-Text PDF Outcome assessment after traumatic brain injuryIn their wide ranging and impressive Commission of traumatic brain injury (TBI), Andrew Maas and colleagues1 recommend the development and validation of multidimensional outcome constructs that quantify overall burden of disability from TBI. Their observation that there are already nearly 1000 assessment instruments to consider is one of many challenges that need to be overcome to achieve this aim. Full-Text PDF The burden of traumatic brain injury in childrenOn Feb 21, the US Centers for Disease Control and Prevention (CDC), in collaboration with the National Institutes of Health, published the Report to Congress: The Management of Traumatic Brain Injury (TBI) in Children, to review the public health burden and to make recommendations for the future management and treatment of this population. In a field with such a lack of scientific research and evidence, the report has drawn on all existing resources and studies to comprehensively present the US experience. Full-Text PDF