neu.2009.1206.pdfVIP

Review 150 Years of Treating Severe Traumatic Brain Injury: A Systematic Review of Progress in Mortality Sherman C. Stein,1 Patrick Georgoff,1 Sudha Meghan,1 Kasim Mizra,1 and Seema S. Sonnad2 Abstract Considerable effort and resources have been devoted to preserving life in patients with severe closed traumatic brain injury (TBI). We sought to identify temporal trends in mortality rates of these patients from the late 1800s to the present. We searched the literature for articles on severe TBI, abstracting numbers of patients studied, numbers of deaths, and years of patient entry. Mortality rates were calculated for each study, and meta- regression was used to pool data and to test for significant temporal trends. We reviewed 207 case series comprising more than 140,000 cases of severe closed TBI admitted to hospital over a span of almost 150 years. Since the late 1800s mortality has fallen by almost 50%. However, the rate has varied considerably among the four epochs chosen. Between 1885 and 1930, mortality decreased at a rate of 3% per decade. From 1970 to 1990, mortality declined at a rate of 9% per decade. Both changes are significant. There was no observed improvement in mortality between 1930 and 1970, nor is progress evident since 1990. The authors discuss possible reasons for the apparently intermittent progress in TBI survival over time. Key words: head injury; meta-analysis; traumatic brain injury Introduction In 1964 the distinguished Oxford University neurologistW. Ritchie Russell delivered a lecture on neurological trauma (Russell, 1964). In the course of his talk he despaired of continued improvements in treating head injury, stating ‘‘. . . already some completely hopeless cases are being kept alive, and nobody hopes for more success in that direction.’’ At the same time two pioneers in modern head injury re- search, Thomas Langfitt and Brian Jennett, were working to prove Russell wrong. In the 1970s, both Langfitt and Jennett commented on the care of