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Largest ever study on traumatic brain injury highlights global inequality in treatment and causes

Published: 21 March 2022

Neurosurgery experts have led the largest ever study examining the surgical management of traumatic brain injuries, highlighting regional inequalities in major causes and treatment of injuries.

The Global Neurotrauma Outcomes Study, funded by the NIHR and led by the University of Cambridge, provides data to assist in decision making and improve outcomes for patients with traumatic brain injury globally.

The paper, published in The Lancet Neurology, focuses on types of cases, the way they are managed and death rates. It was compiled using data submitted by 159 hospitals in 57 countries to a central database, which researchers then analysed.

The research involved stratifying countries into four tiers (very high, high, medium, low) according to their Human Development Index (HDI), which takes account of factors like life expectancy, education, and income.

The study determined that patients in the low HDI tier were often young and suffered skull fractures due to assault but were classified as ‘mild’ traumatic brain injury (TBI).

In the medium and high HDI tiers, patients were also young, but most had moderate to severe TBI caused by a road traffic collision and extradural haematoma – a bleed on the outside of the dura mater, the membrane covering of the brain.

In the very high tier, patients tended to be older and presented with a moderate or severe TBI associated with a fall and acute subdural haematoma - a bleed on the inner surface of the dura mater.

The quality of care was generally less favourable in lower HDI settings, including delays to surgery, a lack of postoperative monitoring equipment and intensive care.

The very high HDI tier had the highest proportion of operations in which the most senior surgeon present in the operating theatre was a fully qualified neurosurgeon and the medium HDI tier had the lowest proportion. 

The study also found significant between-hospital variations in the outcome of patients.

Angelos Kolias, Consultant Neurosurgeon and NIHR Global Neurotrauma Research Group associate director, said: “The results show that overall mortality is low, reflecting the life-saving nature of surgery for traumatic brain injuries. Many of these patients would have died without an operation. However, we also need to address deficits in pre-hospital management and long-term rehabilitation.”

Professor Peter Hutchinson, Professor of Neurosurgery and Director of the NIHR Global Neurotrauma Research Group, said: “This is the largest study in the world looking at the surgical management of head injuries and will be of practical value to clinicians and others planning strategies for the future.”


The study was funded by The Global Health Research Programme. 

Find out more about the study on The NIHR Funding & Awards Website.

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