Global study reveals brain injury prevention lies far outside hospitals

Tens of millions of people suffer from traumatic brain injury every year worldwide, with almost 5 million deaths. Yet when it comes to improving clinical outcomes, new research suggests the solution lies far outside hospital operating rooms.

The first-of-its-kind global study led by researchers at Oregon Health & Science University was published today in the journal Nature Medicine.

The study relied upon medical school students to gather data involving more than 2,000 patients from 100 hospitals in 29 countries from 2019 to 2022. They found motor vehicle crashes accounted for the biggest single cause of traumatic brain injury globally, although causes varied by country. For example, the study found high rates of traumatic brain injuries from ground-level falls among older adults in wealthier countries.

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."

Ahmed Raslan, M.D., senior author, chair of neurological surgery, OHSU School of Medicine

Paradoxically, the study found lower rates of traumatic brain injury in less-developed countries than in more industrialized countries. That may be related to the lack of easy access to medical care, especially in rural areas where critically injured people may not survive long enough to make it to a hospital.

"If it takes two hours to get to a hospital in wealthy countries, it can take five days in some low-income countries," Raslan said.

'Preventing the injury in the first place'

Previous research delved into effectiveness of various clinical and surgical approaches to treat traumatic brain injuries. Even as surgical and medical teams are continuing to improve care for these patients, the new study is among the first to define injury patterns, care practices and outcomes across countries measured by their human development index accounting for measures like income, education and gross domestic product.

The study suggests the importance of improving infrastructure such as roads and encouraging use of helmets, said lead author Joseph Nugent M.D., M.P.H. M.H.S., a fourth-year resident neurosurgeon at OHSU.

Nugent previously worked as a paramedic in Baltimore while studying public health at Johns Hopkins University's Bloomberg School of Public Health. He subsequently transitioned to a career as a neurosurgeon.

He was gratified that the study suggests an approach rooted in principles of public health - better roads, improved emergency services, encouraging the use of helmets - will be needed to reduce the global scourge of traumatic brain injuries.

"When I was a paramedic, I brought countless patients to the hospital with traumatic brain injuries," he said. "Skilled neurosurgeons can accomplish a lot, but my fire department and public health mentors showed me the best way to optimize outcomes for trauma is to direct efforts toward preventing the injury in the first place."

Strategies to reduce traumatic brain injuries will vary from country to country, researchers said. For example, ground-level falls are the single most common cause of traumatic injury treated at OHSU Hospital.

"We could reduce a lot of mortality from traumatic brain injuries in Oregon if we could make sure that frail people don't fall," Raslan said. "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."