Research in context
Evidence before this study
In November, 2017, the Commission onTraumatic brain injury: integrated approaches to improve prevention, clinical care, and research in The Lancet Neurology highlighted existing deficiencies in epidemiology and patient characterisation. An extensive literature search was undertaken as a basis for writing the Commission, which went beyond the academic literature and included national and international policy documents and statistical resources. These data were updated through more focused literature reviews for this manuscript. The Commission concluded that concerted efforts are urgently needed to address deficiencies in prevention, care, and research, and recommended that large collaborative studies be done, which could provide the framework for precision medicine and comparative effectiveness research.
Added value of this study
The CENTER-TBI registry and core study provide detailed insights into the contemporary landscape of traumatic brain injury (TBI) in Europe and constitute a unique resource for improving the characterisation of TBI, developing precision medicine approaches, and identification of best practices. The epidemiology of TBI as observed in the CENTER-TBI core study and registry differs from previous observational studies: patients were older, were most commonly injured by a fall, and many had comorbidities. Advanced neuroimaging and blood biomarkers can improve characterisation of injury type and severity. Differentiation of patients by care pathways provided novel insights. Around 95% of patients discharged from the emergency room or admitted to the ward, and a third of those primarily admitted to the ICU, had a so-called mild TBI. However, nearly a third of patients discharged from the emergency room and over half of those admitted to the hospital ward did not attain full recovery. There are substantial national and regional variations in care pathways and clinical management in Europe.
Implications of all the available evidence
The results from CENTER-TBI suggest that TBI should no longer be considered predominantly a disease of otherwise healthy young men. Falls were the most common cause of TBI and should motivate an increased focus for prevention. Mild TBI not only poses the greatest societal burden to health care, but also affects functional recovery and quality of life more than was commonly thought. Improved disease characterisation can contribute to precision medicine approaches through the development of multidimensional classifications of initial injury severity and outcome. Variations in care offer an opportunity for comparative effectiveness research to identify best practice.