150 Years of Treating Severe Traumatic Brain Injury: A Systematic Review of Progress in Mortality

Abstract

Considerable effort and resources have been devoted to preserving life in patients with severe closed traumatic brain injury (TBI). We sought to identify temporal trends in mortality rates of these patients from the late 1800s to the present. We searched the literature for articles on severe TBI, abstracting numbers of patients studied, numbers of deaths, and years of patient entry. Mortality rates were calculated for each study, and meta-regression was used to pool data and to test for significant temporal trends. We reviewed 207 case series comprising more than 140,000 cases of severe closed TBI admitted to hospital over a span of almost 150 years. Since the late 1800s mortality has fallen by almost 50%. However, the rate has varied considerably among the four epochs chosen. Between 1885 and 1930, mortality decreased at a rate of 3% per decade. From 1970 to 1990, mortality declined at a rate of 9% per decade. Both changes are significant. There was no observed improvement in mortality between 1930 and 1970, nor is progress evident since 1990. The authors discuss possible reasons for the apparently intermittent progress in TBI survival over time.

Prognosis in moderate and severe traumatic brain injury

“…It also implies that there has been limited improvement in outcome of TBI over recent years. This finding is in line with a meta-analysis conducted by Stein et al 15 (2010), which showed a steady decline of mortality of approximately 9% per year during the period 1970 to 1990 but no change in mortality rates between 1990 and 2005.…”

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

“…Mortality rates have not consistently decreased among patients with TBI over the past two decades. 47,48 Conflicting conclusions have been reached among patients with SAH and ICH, although trends have probably been favourable. [49][50][51][52][53] There are relatively few corresponding Canadian data.…”

Rehabilitation after Traumatic Brain Injuries - The Challenge of the Elderly

“…Furthermore, the creation of regional trauma referral centers and the introduction of standardized clinical procedures contribute to reduced mortality [3]. Still, severe TBI represent the number one cause of longterm disability for adults and the mortality rate has not declined over the last 10 years [4]. Increasing number of falls in the elderly associated with a high fatality rate in this patient population may outweigh the effects of the overall improvement in TBI management [5].…”