Cost of trauma in Europe

TBI is defined as an insult to the brain that leads to temporary or permanent impairments of cognitive abilities and physical functioning. Head injury results from an interaction between an individual and an external agent such as a mechanical force and contributes significantly to the outcomes in one half of all deaths from trauma (Kraus, 1987). This mechanical force may be related to road traffic accidents, falls (with or without alcohol consumption) and work/sport accidents. Trauma injures neural tissue by primary (direct brain tissue injury) or secondary mechanisms (increased intracranial pressure, ischemia related to general hypoxia and hypotension). The consciousness level is a valuable index of injury severity. Impairment of consciousness is stratified according to the Glasgow Coma Scale Scores (GCS) in terms of the responses to external stimuli. The lower the level of GCS on admission, the worse the outcome. Those patients with moderate or severe TBI who survive are often unable to return to full employment and require some degree of rehabilitation. This means that TBI is related to significant direct medical and non-medical costs in terms of hospitalization, outpatient care and rehabilitation, indirect costs due to lost productivity, and intangible costs due to reduced quality of life. This review provides an overview of existing epidemiological and economic evidence in TBI, and discusses the possibility of estimating the total costs of TBI in Europe. The results presented in this summary are described in more detail in previous publications (Kraus, 1987; Tagliaferri 2005). Methodology We searched Medline for epidemiological articles published between 1980 and 2004. The search was undertaken using the terms epidemiology, head injury, trauma, brain injury and Europe. These terms were linked using the following combinations: epidemiology plus head injury or brain injury and trauma and Europe. References from the retrieved reports were checked to identify other possible reports. The reports selected for review were limited to studies of European populations, without restrictions on age, gender or severity of TBI. While the search language was English, articles in French, German, Italian, Spanish and Portuguese were also included in the review if relevant. We studied the abstract in English of those papers in other languages. Data extracted (when available) included: country, number of patients, severity of trauma, incidence, male/female incidence ratio, hospital days, mortality, prevalence, cost of care and other relevant