Neurotrauma is a multifaceted disease. In recent decades, the number of injuries caused
by violence and accidents has increased. Cranioencephalic trauma is a major cause
of death in developed countries. It is estimated that alone in the United States of
America, about 100,000 people die annually, and among the survivors, there are a significant
number of people with disabilities with significant costs to the health system.[1
2
3]
Cranioencephalic trauma is considered to be the injury of traumatic origin that occurs
on the cranial vault and its contents. Traumatic brain injury is a major problem worldwide.
It accounts for at least half of trauma-related deaths and impacts on the high costs
for health systems, support for treatment, and rehabilitation of patients. In the
United States, the costs are estimated at 60 billion dollars annually, whether direct
or indirect for loss of labor productivity. Modern trauma response teams, new diagnostic
aids, neurosurgical centers, and intensive care treatment have contributed to lower
mortality rates for patients with traumatic brain injury, where available series in
the literature report mortality of 20%–30% of patients. Despite these effective advantages,
there are many aspects that should be improved with regard to the management of traumatic
brain injury.[4
5]
In prevention of neurotrauma injuries, at this point, we need to define the categories
of injury prevention, primary prevention is that which eliminates the event, secondary
prevention decreases the effect, and tertiary prevention improves outcomes.
NEW EPIDEMIOLOGICAL FINDINGS
Injuries associated with trauma are a silent epidemic. The field of violence prevention
is still under development but has grown significantly in the recent decades. International
discussions on violence prevention policies have been analyzed in scenarios such as
the United Nations Assembly and specifically in the World Health Assembly, where all
the health ministers of the member nations of the World Health Organization participate.[6
7
8]
Cranioencephalic trauma is a major cause of death not only in middle- and low-income
countries but also in high-income countries. In addition, it generates an important
number of people with disabilities, which implies an important cost burden for health
systems at a global level.
Multiple regulations have been imposed through national protection programs, among
which are the establishment of speed limits, mandatory use of seat belts, reflective
waistcoats, and helmets. In addition, it has been proposed to impose sanctions on
drunk drivers and police control on roads and areas at high risk of accidents. These
areas usually present conditions that can increase the risk of traffic accidents,
such as limitation of visibility, deterioration of their structure, defects of flatness,
lack of signaling, and sharp curves.[9]
The identification of areas of the greatest accident may contribute to the development
of prevention programs led by governments and their road authorities. Knowledge about
the magnitude and importance of prevention has increased markedly. It is important
to promote knowledge of the categories in injury prevention, taking into account that
primary prevention leads to the elimination of the causal event, secondary prevention
decreases the effect, and tertiary prevention improves outcomes.
DEVELOPING NEUROTRAUMA PREVENTION PROGRAMS
There are already clear examples of measures to reduce the severity of urban road
accidents, especially from an early age, such as the “Think First” program, supported
by the American Association of Neurological Surgeons and the Congress of Neurological
Surgeons. Other similar programs, largely using social networks, have been applied
in different regions of the world as part of national educational campaigns. Two examples
of easy application include the “Mayo Amarillo” movement for the prevention of traffic
accidents and the “Think Good” campaign, which was recently evaluated, by neurosurgery
services in Brazil, including basic aspects such as presentation of readings and videos,
distribution of educational pamphlets, design of graphic emblems of the campaign,
distribution of T-shirts, and dissemination by mass media.[10
11
12]
At present, we have evidence that interventions such as home visiting, parent education,
abusive head trauma prevention, and multicomponent program are useful in the prevention
of trauma, especially in child abuse injuries.
With the implementation of neurotrauma prevention strategies, it could impact on the
reduction of approximately 1.2 million deaths from traffic accidents that occur annually
in the world, representing about 3000 deaths/day. Most of these deaths occur in low-
and middle-income countries. The challenge is important and includes many aspects
such as measuring prevention legislation in neurotrauma, strengthening educational
programs, improving infrastructure in cities to protect the vulnerable user in the
public highway, and finally, the creation of databases that systematically compile
information to redirect prevention strategies.[13
14
15
16]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.