Al-Hajj Samar, Hammoud Zeinab, Colnaric Jure, Ataya Maya, Macaron Marie Michele, Kadi Kamil, Harati Hayat, Phipps Helen, Mondello Stefania, Tamim Hani, Abou Abbass Hussein, Kobeissy Firas
Health Management and Policy Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Neuroepidemiology. 2021 Feb 10:1-12. doi: 10.1159/000511554.
Traumatic brain injury (TBI) represents a major health concern worldwide with a large impact in the Middle East and North Africa (MENA) region as a consequence of protracted wars and conflicts that adversely affect the general population. Currently, systematic TBI studies in the MENA region are lacking, nonetheless they are immensely needed to enhance trauma management and increase survival rates among TBI patients. This systematic review aims to characterize TBI in the MENA region to guide future policy choices and research efforts and inform tailored guidelines capable of improving TBI management and patient treatment and outcome. Furthermore, it will serve as a road map to evaluate and assess knowledge of trauma impact on regional health systems that can be adopted by health-care providers to raise awareness and improve trauma care.
We conducted a comprehensive search strategy of several databases including MEDLINE/Ovid, PubMed, Embase, Scopus, CINAHL, Google Scholar, and the grey literature in accordance with the PROSPERO systematic review protocol CRD42017058952. Abstracts were screened, and selected eligible studies were reviewed independently by 2 reviewers. We collected demographics information along with TBI characteristics, mortality rates, and regional distribution. Data were extracted using REDCap and checked for accuracy.
The search strategy yielded 23,385 citations; 147 studies met the eligibility criteria and were included in this review. Motor vehicle accident (MVA) was the leading cause of TBI (41%) in the MENA region, followed by the military- (15.6%) and fall- (8.8%) related TBI. Males predominantly suffer from TBI-related injuries (85%), with a high prevalence of MVA- and military-related TBI injuries. The TBI mortality rate was 12.9%. The leading causes of mortality were MVA (68%), military (20.5%), and assault (2.9%). The vast majority of reported TBI severity was mild (63.1%) compared to moderate (10.7%) and severe TBI (20.2%). Patients mainly underwent a Glasgow Coma Scale assessment (22.1%), followed by computed tomography scan (8.9%) and surgery (4.1%).
Despite its clinical, social, and economic burden, the evidence of TBI research in the MENA region is scarce. Further research and high-quality epidemiological studies are urgently needed to gain a deep understanding of the TBI burden in the region, facilitate the allocation of adequate resources, implement effective preventive and intervention strategies and advise on the TBI patient management as reflective on the TBI patterns and modes.
创伤性脑损伤（TBI）是全球主要的健康问题，由于长期战争和冲突对中东和北非（MENA）地区的普通民众产生了不利影响，因此该地区受其影响巨大。目前，中东和北非地区缺乏系统性的TBI研究，然而，为了加强创伤管理并提高TBI患者的生存率，此类研究极为必要。本系统评价旨在描述中东和北非地区的TBI特征，以指导未来的政策选择和研究工作，并为能够改善TBI管理以及患者治疗与预后的针对性指南提供依据。此外，它将作为一个路线图，用于评估和评价创伤对区域卫生系统影响的相关知识，医疗保健提供者可采用这些知识来提高认识并改善创伤护理。
我们按照PROSPERO系统评价方案CRD42017058952，对包括MEDLINE/Ovid、PubMed、Embase、Scopus、CINAHL、谷歌学术以及灰色文献在内的多个数据库进行了全面检索。对摘要进行筛选，由2名评审员独立评审选定的符合条件的研究。我们收集了人口统计学信息以及TBI特征、死亡率和区域分布情况。使用REDCap提取数据并检查其准确性。
检索策略共获得23385条引文；147项研究符合纳入标准并被纳入本评价。机动车事故（MVA）是中东和北非地区TBI的主要原因（41%），其次是与军事相关的（15.6%）和跌倒相关的（8.8%）TBI。男性主要遭受与TBI相关的损伤（85%），MVA和军事相关的TBI损伤患病率较高。TBI死亡率为12.9%。死亡的主要原因是MVA（68%）、军事（20.5%）和袭击（2.9%）。与中度（10.7%）和重度TBI（20.2%）相比，绝大多数报告的TBI严重程度为轻度（63.1%）。患者主要接受了格拉斯哥昏迷量表评估（22.1%），其次是计算机断层扫描（8.9%）和手术（4.1%）。
尽管创伤性脑损伤在临床、社会和经济方面造成了负担，但中东和北非地区关于TBI的研究证据却很匮乏。迫切需要进一步开展研究和高质量的流行病学研究，以深入了解该地区的TBI负担，促进充足资源的分配，实施有效的预防和干预策略，并根据TBI的模式和方式为TBI患者管理提供建议。
