Epidemiology of traumatic brain injury in Europe

Abstract

Background: Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence and outcome of TBI necessary. We aimed to describe the epidemiology of traumatic brain injury in Europe and to evaluate the methodology of incidence studies.

Method: We performed a systematic review and meta-analyses of articles describing the epidemiology of TBI in European countries. A search was conducted in the PubMed electronic database using the terms: epidemiology, incidence, brain injur*, head injur* and Europe. Only articles published in English and reporting on data collected in Europe between 1990 and 2014 were included.

Results: In total, 28 epidemiological studies on TBI from 16 European countries were identified in the literature. A great variation was found in case definitions and case ascertainment between studies. Falls and road traffic accidents (RTA) were the two most frequent causes of TBI, with falls being reported more frequently than RTA. In most of the studies a peak TBI incidence was seen in the oldest age groups. In the meta-analysis, an overall incidence rate of 262 per 100,000 for admitted TBI was derived.

Conclusions: Interpretation of published epidemiologic studies is confounded by differences in inclusion criteria and case ascertainment. Nevertheless, changes in epidemiological patterns are found: falls are now the most common cause of TBI, most notably in elderly patients. Improvement of the quality of standardised data collection for TBI is mandatory for reliable monitoring of epidemiological trends and to inform appropriate targeting of prevention campaigns.

Keywords: Epidemiology; External cause; Incidence; Mortality; Systematic review; Traumatic brain injury.

Fig. 1

Flow diagram of the literature search and selection of articles

Fig. 2

Reported incidence rates for TBI. Rates are expressed per 100,000 population. Each study is marked by an open circle; the size of the blue centre is proportional to the size of the population under study

Fig. 3

Forest plot of incidence rate per study sorted by year of publication. The forest plot represents the meta-analysis on 17 studies focusing on patients with all TBI severities. A random effects model was applied. Incidence rates are denoted by the black boxes and the 95 % CIs by the horizontal lines. The overall incidence rate is represented by the black diamond, where the diamond width correspondents to the 95 % CIs. Heterogeneity is substantial: τ² = 17650.3; χ² = 72801.5, df = 16 (p = 0.000); I ² = 99.9 %