Traumatic brain injury: The South African landscape

Abstract

In referring to injuries of the brain the term, ‘traumatic brain injury’ (TBI) is preferred over the use of the less specific and more generic ‘head injury’. While a skull fracture may suggest the presence of an underlying TBI, the presence of neurological symptoms or the demonstration of intracranial pathology is needed to establish the diagnosis of TBI. TBI need not always be caused by direct trauma to the head. TBI is an extremely important cause of mortality and morbidity in the developed world. In the western hemisphere, TBI is the leading cause of mortality in persons under 45. Population-based studies in countries such as South Africa (SA), Taiwan and India suggest even higher rates in developing countries accounted for primarily by road traffic accidents or motor vehicle accidents (MVAs). Indeed, males in South-East Asia and Africa have the highest and second highest incidences of road traffic injury-related fatalities in the world, and it can be assumed that a significant proportion, if not the majority, of these deaths are attributable to TBI. In the United States (US), where the overall incidence of TBI is 506.4 per 100 000 population,2 equating to approximately 1.5 million people suffering a TBI in each year, a number of states undertake TBI surveillance. This TBI surveillance relies largely on hospital admissions for data collection and ignores mild TBI that does not result in a hospital admission or visit. The overall incidence of TBI is therefore probably higher than officially reported, even in the developed world. SA does not have a TBI databank, and contemporaneous studies on the overall incidence and prevalence of TBI are lacking. In 1991, Brown et al. reported an average incidence of 316 brain injuries per 100 000 persons per year. The methodological difficulties in undertaking such a study were well described by the authors. While some of the difficulties alluded to, such as segregated hospitals, no longer apply, others continue to be relevant 22 years later. These include incomplete and unreliable hospital records, poor research (and epidemiological) funding, and overcrowded and poorly resourced public hospitals. A recent developmental accord signed by the national Minister of Health, the Gauteng Health MEC and the Vice-Chancellor of the University of the Witwatersrand is an encouraging step in the eventual eradication of these persistent shortcomings. Language: en