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The International Incidence of Traumatic Brain Injury: A Systematic Review and Meta-Analysis

  • Rita Nguyen (a1), Kirsten M. Fiest (a1) (a2), Jane McChesney (a2), Churl-Su Kwon (a3), Nathalie Jette (a1) (a2) (a4), Alexandra D. Frolkis (a2), Callie Atta (a1), Sarah Mah (a1), Harinder Dhaliwal (a1), Aylin Reid (a5), Tamara Pringsheim (a1) (a2), Jonathan Dykeman (a2) and Clare Gallagher (a1) (a4)...

Abstract

Background: Understanding the epidemiology of traumatic brain injury (TBI) is essential to shape public health policy, implement prevention strategies, and justify allocation of resources toward research, education, and rehabilitation in TBI. There is not, to our knowledge, a systematic review of population-based studies addressing the epidemiology of TBI that includes all subtypes. We performed a comprehensive systematic review and meta-analysis of the worldwide incidence of TBI. Methods: A search was conducted on May 23, 2014, in Medline and EMBASE according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Abstracts were screened independently and in duplicate to identify original research. Study quality and ascertainment bias were assessed in duplicate using a previously published tool. Demographic data and incidence estimates from each study were recorded, along with stratification by age, gender, year of data collection, and severity. Results: The search strategy yielded 4944 citations. Two hundred and sixteen articles met criteria for full-text review; 144 were excluded. Hand searching resulted in ten additional articles. Eighty-two studies met all eligibility criteria. The pooled annual incidence proportion for all ages was 295 per 100,000 (95% confidence interval: 274-317). The pooled incidence rate for all ages was 349 (95% confidence interval: 96.2-1266) per 100,000 person-years. Incidence proportion and incidence rate were examined to see if associated with age, sex, country, or severity. Conclusions: We conclude that most TBIs are mild and most TBIs occur in males among the adult population. The incidence of TBI varies widely by ages and between countries. Despite being an important medical, economic, and social problem, the global epidemiology of TBI is still not well-characterized in the current literature. Understanding the incidence of TBI, particularly mild TBI, remains challenging because of nonstandardized reporting among neuroepidemiological studies.

Revue systématique et méta-analyse de l’incidence internationale des traumatismes cranio-cérébraux. Contexte: Mieux comprendre l’épidémiologie des traumatismes cranio-cérébraux (TCC) demeure indispensable si l’on veut façonner des politiques de santé publique, mettre en œuvre des stratégies de prévention et justifier l’affectation de ressources consacrées à la recherche, à l’éducation et à la réadaptation en matière de TCC. À notre connaissance, il n’existe pas de revue systématique des études populationnelles qui tiendrait compte de l’épidémiologie des TCC et de tous leurs sous-types. Voilà pourquoi nous avons mené une telle revue de façon détaillée en plus de procéder à une méta-analyse de l’incidence internationale des TCC. Méthodes: C’est au moyen de MEDLINE et d’Embase® que nous avons, le 23 mai 2014, effectué notre recherche. Pour ce faire, nous nous en sommes tenus aux lignes directrices de l’outil PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Des résumés reproduits en deux exemplaires ont ainsi été passés au crible de façon séparée afin de repérer l’étude d’origine. Nous avons aussi évalué la qualité des études et leurs biais d’échantillonnage au moyen d’un outil publié précédemment. Pour chaque étude, nous avons consigné leurs données démographiques, leurs estimations en matière d’incidence mais aussi la stratification selon l’âge et le sexe, l’année de collecte des données et la sévérité des TCC. Résultats: Notre stratégie de recherche nous a permis de repérer 4944 citations. De plus, 216 articles ont satisfait aux critères d’une revue complète tandis que 144 ont été éliminés en fonction de ces mêmes critères. Au moyen d’une recherche manuelle, nous avons aussi pu obtenir 10 articles additionnels. Au total, 82 études ont rempli tous les critères d’admissibilité établis. L’incidence annuelle cumulée pour tous les groupes d’âge était de 295 sur 100 000 (IC à 95% : 274-317). Le taux d’incidence cumulée pour tous les groupes d’âge était de 349 (IC à 95% : 96,2-1266) par 100 000 personnes-années. Enfin, nous avons examiné l’incidence cumulée et le taux d’incidence afin de vérifier dans quelle mesure ils étaient associés aux variables suivantes : âge, sexe, pays d’origine ou sévérité d’un TCC. Conclusions: Nous sommes parvenus à la conclusion que la plupart des TCC sont mineurs et que leur incidence, au sein de la population adulte, est plus élevée chez les hommes. À noter que l’incidence des TCC varie grandement selon les âges ou d’un pays à l’autre. Bien que l’épidémiologie mondiale des TCC constitue un enjeu majeur sur les plans médical, économique et social, elle demeure plutôt méconnue dans les ouvrages scientifiques actuels. Mieux comprendre l’incidence des TCC, notamment ceux qui sont mineurs, demeure un défi en raison des aspects non standardisés de la divulgation scientifique propre aux études neuro-épidémiologiques.

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Copyright

Corresponding author

Correspondence to: Clare Gallagher, Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Foothills Medical Center, 12th floor, 1403 29th St NW, Calgary, Alberta, Canada T2N 2T9. E-mail: galclare@gmail.com.

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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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