Nguyen Rita, Fiest Kirsten M, McChesney Jane, Kwon Churl-Su, Jette Nathalie, Frolkis Alexandra D, Atta Callie, Mah Sarah, Dhaliwal Harinder, Reid Aylin, Pringsheim Tamara, Dykeman Jonathan, Gallagher Clare
1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada.
2Department of Community Health Sciences & O'Brien Institute for Public Health,University of Calgary,Calgary,Alberta,Canada.
Can J Neurol Sci. 2016 Nov;43(6):774-785. doi: 10.1017/cjn.2016.290. Epub 2016 Sep 27.
Understanding the epidemiology of traumatic brain injury (TBI) is essential to shape public health policy, implement prevention strategies, and justify allocation of resources toward research, education, and rehabilitation in TBI. There is not, to our knowledge, a systematic review of population-based studies addressing the epidemiology of TBI that includes all subtypes. We performed a comprehensive systematic review and meta-analysis of the worldwide incidence of TBI.
A search was conducted on May 23, 2014, in Medline and EMBASE according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Abstracts were screened independently and in duplicate to identify original research. Study quality and ascertainment bias were assessed in duplicate using a previously published tool. Demographic data and incidence estimates from each study were recorded, along with stratification by age, gender, year of data collection, and severity.
The search strategy yielded 4944 citations. Two hundred and sixteen articles met criteria for full-text review; 144 were excluded. Hand searching resulted in ten additional articles. Eighty-two studies met all eligibility criteria. The pooled annual incidence proportion for all ages was 295 per 100,000 (95% confidence interval: 274-317). The pooled incidence rate for all ages was 349 (95% confidence interval: 96.2-1266) per 100,000 person-years. Incidence proportion and incidence rate were examined to see if associated with age, sex, country, or severity.
We conclude that most TBIs are mild and most TBIs occur in males among the adult population. The incidence of TBI varies widely by ages and between countries. Despite being an important medical, economic, and social problem, the global epidemiology of TBI is still not well-characterized in the current literature. Understanding the incidence of TBI, particularly mild TBI, remains challenging because of nonstandardized reporting among neuroepidemiological studies.
了解创伤性脑损伤（TBI）的流行病学对于制定公共卫生政策、实施预防策略以及为TBI的研究、教育和康复资源分配提供依据至关重要。据我们所知，尚无针对包括所有亚型的TBI流行病学的基于人群研究的系统评价。我们对全球TBI发病率进行了全面的系统评价和荟萃分析。
根据系统评价和荟萃分析的首选报告项目指南，于2014年5月23日在Medline和EMBASE中进行检索。摘要由两人独立且重复筛选以识别原始研究。使用先前发表的工具对研究质量和确定偏倚进行两人重复评估。记录每项研究的人口统计学数据和发病率估计值，以及按年龄、性别、数据收集年份和严重程度进行的分层。
检索策略产生了4944条引文。216篇文章符合全文审查标准；144篇被排除。手工检索又得到10篇文章。82项研究符合所有纳入标准。所有年龄组的合并年发病率比例为每10万人295例（95%置信区间：274 - 317）。所有年龄组的合并发病率为每10万人年349例（95%置信区间：96.2 - 1266）。检查发病率比例和发病率是否与年龄、性别、国家或严重程度相关。
我们得出结论，大多数TBI为轻度，且在成年人群中大多数TBI发生在男性。TBI的发病率在不同年龄组和不同国家之间差异很大。尽管TBI是一个重要的医学、经济和社会问题，但目前文献中对其全球流行病学的描述仍不充分。由于神经流行病学研究报告不规范，了解TBI的发病率，尤其是轻度TBI的发病率仍然具有挑战性。
