TBI prevention may depend as much on roads, emergency access and local risks as hospital care, a global study suggests.
Researchers examining traumatic brain injury across 29 countries found motor vehicle crashes were the largest single cause globally, although patterns varied substantially between countries.
In wealthier countries, for example, ground-level falls accounted for high rates of traumatic brain injury among older adults.
Ahmed Raslan, chair of neurological surgery in the OHSU School of Medicine and senior author, said: “You can’t solve a global brain injury crisis in operating rooms alone.”
“This study shows the importance of fixing the systems that surround us.
“If it takes two hours to get to a hospital in wealthy countries, it can take five days in some low-income countries.
The study, led by researchers at Oregon Health & Science University, analysed data from more than 2,000 patients at 100 hospitals between 2019 and 2022.
Tens of millions of people sustain traumatic brain injuries worldwide each year, with almost 5 million deaths.
Medical students collected the patient data, allowing researchers to compare injury patterns, care practices and outcomes across countries with different levels of development.
The analysis used countries’ human development index, a measure incorporating factors including income, education and gross domestic product.
The study found lower rates of TBI in less developed countries than in more industrialised nations.
Researchers said this could partly reflect poorer access to medical care, particularly in rural areas where critically injured people may not survive long enough to reach hospital.
The researchers said measures outside hospitals could therefore play an important role in reducing injuries and improving outcomes.
Joseph Nugent, a fourth-year resident neurosurgeon at OHSU and lead author, highlighted measures including better roads, improved emergency services and encouraging helmet use.
Nugent previously worked as a paramedic in Baltimore while studying public health at Johns Hopkins University’s Bloomberg School of Public Health before moving into neurosurgery.
He said: “When I was a paramedic, I brought countless patients to the hospital with traumatic brain injuries.
“Skilled neurosurgeons can accomplish a lot, but my fire department and public health mentors showed me the best way to optimise outcomes for trauma is to direct efforts toward preventing the injury in the first place.”
The researchers also stressed that prevention strategies need to reflect the causes of injury in individual countries.
Ground-level falls, for example, are the most common cause of traumatic injury treated at OHSU Hospital.
Raslan said: “We could reduce a lot of mortality from traumatic brain injuries in Oregon if we could make sure that frail people don’t fall.
“Prevention strategies may differ in other countries where young people in motor vehicle accidents account for the largest share of injuries.
“The gaps are not the same in every country, and policymakers need to design solutions based on their own needs.”
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