Médecine d'urgence: libre accès
Libre accès

Abstrait

Recent Advances and Future Trends in Traumatic Brain Injury

Tabish SA and Nabil Syed

Traumatic brain injury (TBI) has been called a silent epidemic and is a major health and socioeconomic problem. TBI is the leading cause of morbidity and mortality among young adults in developed economies and the incidence in the elderly population is increasing. In developing countries the incidence of TBI is high and rapidly increasing. The World Health Organization predicts that TBI and road traffic accidents will be the third greatest cause of disease and injury worldwide by 2020. TBI is a heterogeneous condition in terms of etiology, severity, and outcome. Currently, no effective TBI therapy exists, with patients treated through a combination of surgery, rehabilitation and pharmacological agents managing post-trauma conditions such as depression. Evidence-based guidelines and management protocols help to guide target-driven care and are associated with better outcome. Continuous attempts have been made worldwide to discover the best possible treatment, but an effective treatment method is not yet available. Evidence-based intensive care management strategies improves outcome. The most definite benefits in terms of survival after TBI come from admission to a specialist neurosurgical centre, with goal-targeted therapy and intensive care services. Early detection and objective characterization of abnormalities in TBI are important objectives of modern neuroimaging. Improved treatment will come through understanding the physical changes in the brain that occur at the microscopic and molecular levels when the brain is subject to trauma. Novel achievements in neuroprotection are now expected from developing antiapoptotic agents, from more potent antioxidants, cholinergic agents, alpha blockers, from researching various physiological substances, advances in molecular medicine including stem cell and gene therapy. A more analytical approach to understanding the complex array of factors that influence the incidence, severity, and outcome of TBI is essential. Future therapies that are currently under investigation hold promise. Unless systematic efforts are made towards prevention, management and rehabilitation, many more individuals, children and middle-aged adults will continue to die. There is a strong need to enhance TBI prevention and to improve treatment. Appropriate targeting of prevention and improving outcome requires a detailed understanding of incidence, causes of injury, treatment approaches and outcome results. Specific topics addressed in this paper include scientific understanding of the problem in its various dimensions, complexities and controversies regarding diagnostic and therapeutic modalities, outcome and impact of TBIs on rapidly transforming societies, challenges and opportunities in research and linking research to practice. Improved patient outcomes will depend on organised trauma response systems, particularly to prevent the potentially reversible effects of secondary brain injury strategies.