Tabish SA, Nabil Syed
Abstract: Traumatic brain injury is a major public health problem both in developed economies and developing countries contribute to a substantial number of deaths and cases of permanent disability. This translates into a societal cost of billions of USD per year for medical care and lost productivity. Traumatic brain injury (TBI) has been called a silent epidemic. In developing countries the incidence of TBI is high and rapidly increasing. TBI has not attracted the attention of policy makers and researchers for decades until war injuries in Iraq and Afghanistan and also sports injuries affected large number of young adults. The World Health Organization predicts that TBI and road traffic accidents will be the third greatest cause of disease and injury worldwide by 2020. TBI is a heterogeneous condition in terms of etiology, severity, and outcome. TBI occurs mainly due to vehicle accidents, sudden falls and hits to brain; this includes both primary and subsequent secondary injuries. The severity of a TBI may range from mild, i.e., a brief change in mental status or consciousness to severe, i.e., an extended period of unconsciousness or amnesia after the injury. Currently, no effective TBI therapy exists, with patients treated through a combination of surgery, rehabilitation and pharmacological agents managing post-trauma conditions such as depression. Despite the availability of evidence-based guidelines for the management of head-injured patients, considerable variations in care remain. Continuous attempts have been made worldwide to discover the best possible treatment, but an effective treatment method is not yet available. Evidence-based intensive care management strategies improves outcome. The most definite benefits in terms of survival after TBI come from admission to a specialist neurosurgical centre, with goal-targeted therapy and intensive care services. Early detection and objective characterization of abnormalities in TBI are important objectives of modern neuroimaging. Improved treatment will come through understanding the physical changes in the brain that occur at the microscopic and molecular levels when the brain is subject to trauma. Novel achievements in neuroprotection are now expected from developing antiapoptotic agents, from more potent antioxidants, cholinergic agents, alpha blockers, from researching various physiological substances, advances in molecular medicine including stem cell and gene therapy. A more analytical approach to understanding the complex array of factors that influence the incidence, severity, and outcome of TBI is essential. Appropriate targeting of prevention and improving outcome requires a detailed understanding of incidence, causes of injury, treatment approaches and outcome results. Improved patient outcomes will depend on organised trauma response systems, particularly to prevent the potentially reversible effects of secondary brain injury strategies.
Keywords: Trauma, Brain Injury, Head Injury, GCS, TBI, Signature Injury, Sports Injury, neuroimaging, standardization of practice guidelines, PTSD, violence, ballistic trauma, accidents