Traumatic brain injury (TBI): morbidity, mortality and economic implications

Rafael Soares De Souza,Paula Pessoa Pinheiro,João Marcos Ferreira De Lima Silva,Modesto Leite Rolim Neto,Joao Ananias Machado Filho

doi:10.3823/1672

Abstract

Traumatisms, in general, result in high costs for health systems worldwide. They consist of the leading cause of death in young adults, primarily males. Traumatic brain injury (TBI) represents good part of this spending, reaching globally significant mortality rate, around 1.5 million victims a year. Only in the United States (US) attendances related to traumatic brain injuries in emergency departments revolve around 1.35 million annually, plus about 275,000 hospitalizations and 52,000 deaths. In Brazil, only in 2012 was spent over one billion dollars with hospitalizations related to external causes, including TBI. Mild TBI (Glasgow Coma Scale (GCS) 14-15) occur in about 80% of the total demand, moderate (GCS 9-13) in 10% and serious (GCS 3-8) in 10 %. Regarding mortality rate, this is relatively low compared to the total number, since much of fatal outcomes fits in the moderate to severe groups. One of lesions a valuable prognostic factor related to the TBI is the subdural hematoma (SDH), responsible for complications in up to 45% of cases of TBI, expressing mortality between 60-80% depending on the implemented workup and may even reach 90% when in delay of appropriate treatment. The acute subdural hematoma (ASDH) thus represents a neurosurgical emergency, taking most of these patients to be subjected to urgent evacuation of the hematoma by craniotomy, which also is not without risks, with several reports in literature of new contralateral hematoma formation after craniotomy for evacuation of hematoma, further aggravating the patient's prognosis. For best results of the TBI is needed better understanding of the pathophysiology, identification of newer parameters of brain function and development of innovative therapeutic modalities. According to the Centers for Disease Control and Prevention (CDC), under the Department of Health and Human Services, population data on TBI are fundamental for understanding its impact on the society and know the profile of patients and the mechanisms trauma, to assist in the formulation of prevention strategies and in setting priorities for research and support services to patients living with traumatic brain injury.

Highlights

Traumatisms, in general, result in high costs for health systems worldwide
According to the Guideline of attention to rehabilitation of patients with traumatic brain injury, published by the Ministry of Health, Traumatic brain injury (TBI) in Brazil is responsible for high mortality rates, being more prevalent in young adults, male, where the main cause is to accidents with means of transport
In accordance with data obtained by the Departamento de Informática do Sistema Único de Saúde (DataSUS) of Brazil, between the period January 2005 to September 2006, there was a total of approximately 49,000 hospitalizations resulting from TBI, and 21,541 belonging only to the metropolitan area São Paulo, verified in this period the mortality rate for the cases of 9.63%; in 2011, were reported 547,468 hospitalizations due to external causes variables, that the TBI included, resulting in 12,800 deaths in total, representing 2.34% of the mortality rate in the year [9]

Summary

Introduction

Traumatisms, in general, result in high costs for health systems worldwide. They consist of the leading cause of death in young adults, primarily males. In Brazil only in 2012 was spent by the Sistema Único de Saúde (SUS), the public health system under the Ministry of Health of this country, in favor to care of external causes including the TBI, a value of over one billion reais in 998,994 hospitalizations, where average per admission was around R$ 1,079.6; with an average of hospital stay about 5.3 days and 2.48% mortality rate, not taking into account outpatients expenses, medications, rehabilitation or loss by a separation of activities [4].

Results

Conclusion