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Epidemiological Pattern of Traumatic Brain Injury in Brazil Between 2008

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Epidemiological Pattern of Traumatic Brain Injury in Brazil Between 2008 Published online: 2021-08-11 THIEME Original Article | Artigo Original Epidemiological Pattern of Traumatic Brain Injury in Brazil between 2008 and 2019 Padrão epidemiológico de traumatismo cranioencefálico no Brasil entre 2008 e 2019 André Akira Ramos Takahashi1 Saulo Barros Teixeira2 Giovanna Zambo Galafassi1 Maria Beatriz Almeida Silva1 Victoria Fernandez Comprido1 Anne Gabriele Senne Martinez1 Leonardo Alfano de Lima3 Luiz Vinicius de Alcântara Sousa3 Paulo Henrique Pires de Aguiar4 1 Faculdade de Medicina do ABC, Santo André, SP, Brazil Address for correspondence André Akira Ramos Takahashi, Av. Lauro 2 Department of Neurosurgery, Faculdade de Medicina do ABC, Santo Gomes, 2000, Santo André, SP, Brazil André, SP, Brazil (e-mail: [email protected]). 3 Department of Epidemiology, Faculdade de Medicina do ABC, Santo André, SP, Brazil 4 Department of Neurology and Neurosurgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil Arq Bras Neurocir Abstract Introduction Traumatic brain injuries (TBIs) are a public health problem with high economic impact, as well as an important cause of death and sequela in polytrauma patients, affecting mainly young adults. Objective To analyze the temporal trend of TBI incidence in Brazil between 2008 and 2019, according to age group and gender. Methods An ecological study, based on secondary data from hospital admissions for TBI in all Brazilian states between 2008 and 2019. The numbers were collected using the hospital information system of the Unified Health System in Brazil. We performed a descriptive analysis using the data obtained. Linear regression models were used to measure the incidence trend of TBI in the period adopted. Results The state of Piauí had the highest increase in the incidence of TBI in the country in the last 10 years (coefficient β ¼ 63.43 e p ¼ 0.002). The main concern, though, is the increase in the incidence of TBI amongst children (0–4yearsold)inthe states of Ceará (β ¼ 31.22 and p < 0.001 for boys; β ¼ 42.20 and p < 0.001 for girls), Paraná (β ¼ 37.26 and p ¼ 0.011 for boys; β ¼ 25.90 and p ¼ 0.015 for girls), Pernam- buco (β ¼ 20.08 and p ¼ 0.016 for girls), Mato Grosso (β ¼ 18.76 and p ¼ 0.005 for boys; Keywords β ¼ 16.11 and p ¼ 0.035 for girls), and Distrito Federal (β ¼ 48.87 and p ¼ 0.004 for ► traumatic brain injury girls; β ¼ 48.28 and p ¼ 0.006 for boys). ► trauma Conclusion The analysis of the results is able to point out improvements that can be ► incidence made. Besides that, it is remarkably important to redirect public polices to preventive ► epidemiology medicine since many of the TBI causes are avoidable through awareness and education ► Brazil of the population. received DOI https://doi.org/ © 2021. Sociedade Brasileira de Neurocirurgia. All rights reserved. September 1, 2020 10.1055/s-0041-1733865. This is an open access article published by Thieme under the terms of the accepted ISSN 0103-5355. Creative Commons Attribution-NonDerivative-NonCommercial-License, March 9, 2021 permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/ licenses/by-nc-nd/4.0/) Thieme Revinter Publicações Ltda., Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil Brazilian Incidence of TBI Takahashi et al. Resumo Introdução O traumatismo cranioencefálico (TCE) é um problema de saúde pública com alto impacto econômico, além de uma importante causa de morte e sequela em pacientes politraumatizados, afetando principalmente adultos jovens. Objetivo Analisar a tendência temporal da incidência de TCE no Brasil entre 2008 e 2019, segundo faixa etária e sexo. Método Estudo ecológico, baseado em dados secundários de internações hospita- lares por TCE em todos os estados brasileiros entre 2008 e 2019. Os números foram coletados por meio do sistema de informações hospitalares do Sistema Único de Saúde do Brasil. Realizamos uma análise descritiva a partir dos dados obtidos. Modelos de regressão linear foram utilizados para medir a tendência da incidência de TCE no período adotado. Resultados O estado do Piauí apresentou o maior aumento na incidência de TCE no país nos últimos dez anos (coeficiente β ¼ 63,43 e p ¼ 0,002). A principal preocupação, porém, é o aumento da incidência de TCE entre crianças (0-4 anos) nos estados do Ceará (β ¼ 31,22 e p < 0,001 para meninos; β ¼ 42,20 e p < 0,001 para meninas), Paraná (β ¼ 37,26 e p ¼ 0,011 para meninos; β ¼ 25,90 e p ¼ 0,015 para meninas), Palavras-chave Pernambuco (β ¼ 20,08 e p ¼ 0,016 para meninas), Mato Grosso (β ¼ 18,76 e p ¼ 0,005 ► traumatismo para meninos; β ¼ 16,11 e p ¼ 0,035 para meninas) e Distrito Federal (β ¼ 48,87 e cranioencefálico p ¼ 0,004 para meninas; β ¼ 48,28 e p ¼ 0,006 para meninos). ► trauma Conclusão A análise dos resultados é capaz de apontar melhorias que podem ser ► incidência feitas. Além disso, é extremamente importante redirecionar as políticas públicas para a ► epidemiologia medicina preventiva, uma vez que muitas das causas doTCE são evitáveis por meio da ► Brasil conscientização e educação da população. 1 1,2 Introduction scalp, occurring due to physical impact. Traumatic brain injury can cause temporary or permanent sequela in cogni- Traumatic brain injuries (TBIs) are a public health problem tive, behavioral, emotional and physical performances. The with high economic impact. They are an important cause of clinical features of a TBI patient are represented by conscious deaths and sequela in polytrauma patients,1 affecting mainly changes; neuromuscular function, sensory, language, per- young adults.2,3 The World Health Organization (WHO) sonality and visual disorders; epilepsy; incontinence; cranial estimates that TBIs are responsible for one third to half of nerve palsy; changes in the autonomic function and abnor- trauma deaths worldwide.1 Their incidence changes accord- mal postures, which may be the signs of decortication or ing to country and region, and there is an estimation that decerebration.4,11 TBI classification depends on the severity almost 90% of deaths from injuries occur in countries with (mild, moderate or severe), morphology (extra or intracra- low and middle incomes.1 Moreira Jr et al. mentioned that car nial injuries) and on the mechanism of trauma (blunt or accidents, being run over, cycling and motorcycle accidents, penetration).1 physical aggressions, falls, and firearm injuries are the main The diagnosis of TBI involves an extensive neurological causes of TBI.4 examination. The Glasgow coma scale is used to evaluate the The actual incidence of TBI changes according to place due severity of the trauma.3 The interventions may vary between to underdiagnosis, lower assistance to patients, and lack of postural measures, pharmacological therapies, monitoring, monitoring and registration systems in many health care induced coma and even craniotomy.3 – units.5 7 The incidence of TBI is approximately In Brazil and in other Latin American countries, little is 538.2/1,000.00 inhabitants in the USA,1 322/1,000.00 in known about this topic. In Brazil, there is an estimative of Australia,1 and 235/1,000.00 in the European Union,1 with a 100,000 deaths per year, furthermore over one million people remarkable variability in the last one. Germany had an inci- became disabled between the years of 2007 and 2017,1 which dence of 340/1,000.00 inhabitants2; Finland, 101/1,000.00,2 has a massive impact in the countrý s socioeconomics. and Italy, 212-372/1,000.00.2 The mortality rate also varies Considering this scenario, this study aims to analyze the worldwide from 15 to 24.6/1,000.00.2,8,9 In Brazil, the South- temporal trend of TBI incidence in Brazilian states between east (42.5%) and Northeast (25.8%) areas of the country have 2008 and 2019, according to age group and gender. This the highest incidence of cases in the country.1,10 research aims to help the development of preventive meas- TBI is an anatomical and/or functional lesion that affects ures and hospital interventions that may reduce TBI inci- brain, meninges, neurovascular components, skull and even dence and its sequelaes.12 Arquivos Brasileiros de Neurocirurgia © 2021. Sociedade Brasileira de Neurocirurgia. All rights reserved. Brazilian Incidence of TBI Takahashi et al. Methods The North Region (Acre, Amapá, Amazonas, Pará, Rondônia, Roraima, Tocantins) This ecological study was conducted based on secondary data In Acre, there was a statistically significant reduction in the from hospital admissions for TBI in all Brazilian states between incidence of hospital admissions for both female and male 2008 and 2019. Data was collected from the Department of patients (β coefficient: -2.09 e -0.86, respectively). The Informatics of the Unified Health System (DATASUS). The largest reduction was observed in men in the 30 to 40 years Department of Informatics of the Unified Health System is old age group (β coefficient: -51.15). the official database of the Brazilian Health Ministryandcan be In Amazonas, the total incidence of admissions increased visited for free on the website www.datasus.gov.br. in the female gender (β coefficient: 0.66), mainly in the age We searched DATASUS for the number of hospital admis- extremes (0–4and 75 years old). In the male gender, the sions between 2008 and 2019, including female/male global increase of the incidence of TBI in 2.5 times (β patients in different age groups, from 0 to 80 years old, all coefficient: 2.53) was a result of the higher number of cases identified by the ICD 10-S09.
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