Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature.

BACKGROUND: Traumatic brain injury (TBI) is a serious public health problem worldwide. Although TBI is common in developing countries, there are few epidemiological studies. OBJECTIVE: To investigate the sociodemographic and clinical features of patients with TBI at the Hospital João XXIII, a public reference center for trauma in Belo Horizonte, Brazil, and to systematically review the available literature on TBI in Brazil. METHODS: Clinical and sociodemographic data were collected from electronic medical records for the entire month of July 2016. The literature on epidemiology of TBI in Brazil was systematically reviewed using MeSH/DeCS descriptors in the PubMed and Lilacs databases. RESULTS: Most patients admitted with TBI were male and under 60 years of age. Mild TBI was the most prevalent form and the most common cause of TBI was falls. A Glasgow Coma Scale score below 12, neuroimaging changes on computer tomography, and presence of any medical conditions were significantly associated with longer hospital stay. Brazilian studies showed that TBI affected mainly men and young adults. In addition, mild TBI was the most common TBI severity reported and the most common causes were motor vehicle accidents and falls. CONCLUSIONS: Overall, the profile of TBI in this center reflects the data from other Brazilian studies.

Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature / Traumatismo cranioencefálico no Brasil: um estudo epidemiológico e uma revisão sistemática da literatura

ABSTRACT Background: Traumatic brain injury (TBI) is a serious public health problem worldwide. Although TBI is common in developing countries, there are few epidemiological studies. Objective: To investigate the sociodemographic and clinical features of patients with TBI at the Hospital João XXIII, a public reference center for trauma in Belo Horizonte, Brazil, and to systematically review the available literature on TBI in Brazil. Methods: Clinical and sociodemographic data were collected from electronic medical records for the entire month of July 2016. The literature on epidemiology of TBI in Brazil was systematically reviewed using MeSH/DeCS descriptors in the PubMed and Lilacs databases. Results: Most patients admitted with TBI were male and under 60 years of age. Mild TBI was the most prevalent form and the most common cause of TBI was falls. A Glasgow Coma Scale score below 12, neuroimaging changes on computer tomography, and presence of any medical conditions were significantly associated with longer hospital stay. Brazilian studies showed that TBI affected mainly men and young adults. In addition, mild TBI was the most common TBI severity reported and the most common causes were motor vehicle accidents and falls. Conclusions: Overall, the profile of TBI in this center reflects the data from other Brazilian studies.

RESUMO Antecedentes: O traumatismo cranioencefálico (TCE) representa, mundialmente, um problema sério de saúde pública. Apesar de o TCE ser prevalente em países em desenvolvimento, estudos epidemiológicos permanecem escassos. Objetivo: Investigar as características sociodemográficas e clínicas de pacientes acometidos por TCE no Hospital João XXIII - centro de referência em trauma situado em Belo Horizonte, Brasil - e revisar sistematicamente toda a literatura disponível sobre o TCE no Brasil. Métodos: Os dados clínicos e sociodemográficos foram coletados apenas para o mês de julho, 2016, por meio de prontuários eletrônicos. A literatura sobre a epidemiologia do TCE no Brasil foi sistematicamente revisada usando descritores Medical Subject Headings (MeSH)/Descritores em Ciências da Saúde (DeCS) nos bancos de dados PubMed e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Resultados: Os pacientes acometidos por TCE eram em sua maioria homens com menos de 60 anos. O TCE leve foi a gravidade mais prevalente entre os casos. O TCE foi causado principalmente por quedas. Escores menores que 12 na escala de Coma de Glasgow mais alterações de neuroimagem em tomografia computadorizada e a presença de qualquer comorbidade médica estão significativamente associados à maior estadia hospitalar. Estudos brasileiros demonstraram que o TCE acomete principalmente homens e adultos jovens. Além disso, o TCE leve foi a gravidade mais comum reportada, e os mecanismos de TCE mais comuns foram acidentes automobilísticos e quedas. Conclusões: O perfil de pacientes acometidos por TCE no centro de referência em questão reflete os dados de outros estudos brasileiros.

Epidemiologia do traumatismo cranioencefálico no Brasil / Epidemiology of traumatic brain injury in Brazil

Introdução: O traumatismo cranioencefálico (TCE) é considerado a maior causa de morte e incapacidade em todo mundo, principalmente entre adultos jovens. No Brasil, estima-se que mais de um milhão de pessoas vivam com sequelas neurológicas decorrentes do TCE. Apesar da sua alta prevalência e taxas de incidência em constante elevação, estudos epidemiológicos permanecem escassos. Objetivo: Discutir as evidências disponíveis em relação ao perfil epidemiológico da população brasileira acometida por TCE. Métodos: Realizou- se uma revisão de literatura nas bases de dados SciELO, LILACS e PubMed. Os termos utilizados na busca foram traumatismo cranioencefálico, e/ou epidemiologia, e/ou Brasil. Para a busca no PubMed foram utilizados os termos em inglês traumatic brain injury, e/ou epidemiology, e/ou Brazil. Foram incluídos artigos originais, descritivos e de revisão que não restringiram a causa, a gravidade do TCE e a faixa etária estudada. Resultados: Foram encontrados oito estudos de 1993 a 2015, todos retrospectivos, sendo cinco deles realizados em hospitais de emergência e três baseados em bancos de dados. Indivíduos com menos de 40 anos, do sexo masculino foram os mais acometidos e as causas principais foram quedas e os acidentes de trânsito, destacando-se os motociclísticos. Conclusão: Estudos epidemiológicos robustos sobre o TCE no Brasil ainda são escassos. Todos os estudos foram retrospectivos e apenas dois apresentaram dados nacionais. Nesse contexto, estudos epidemiológicos de caráter prospectivo que investiguem de forma sistemática os fatores associados ao TCE, são urgentemente recomendados. (AU)

Introduction: Traumatic brain injury (TBI) is the leading cause of death and disability worldwide, especially among young adults. In Brazil, it is estimated that more than one million people live with disabilities due to TBI. Despite the high incidence of TBI and related socioeconomic burden, epidemiological studies are scarce. Objective: To discuss the available evidence regarding the epidemiological profile of Brazilian people victims of TBI. Methods: A literature review was conducted on the SciELO, LILACS and PubMed databases. The terms used were traumatic brain injury and/or epidemiology, and/or Brazil. Original, descriptive and review studies that investigated only one specific cause of TBI, only one level of severity or a specific age group were not included in the current review. Results: Eight retrospective articles published between 1993 and 2015 were included. Five studies were conducted in emergency hospitals and three studies were based on databases records. Men under 40 years old were the most affected group, and the main causes of TBI were falls and traffic accidents, especially involving motorcycle. Conclusion: Sound epidemiological studies on TBI are still rare. All studies included were retrospective and only two reported national data. In this scenario, prospective epidemiological studies that systematically investigate the profile of TBI victims in Brazil are urgently necessary. (AU)