Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature

MAGALHÃES, Ana Luísa Gonçalves; BARROS, João Luís Vieira Monteiro de; CARDOSO, Maíra Glória de Freitas; ROCHA, Natália Pessoa; FALEIRO, Rodrigo Moreira; SOUZA, Leonardo Cruz de; MIRANDA, Aline Silva de; TEIXEIRA, Antônio Lúcio

doi:10.1590/0004-282X-ANP-2021-0035

Ana Luísa Gonçalves MAGALHÃES

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0003-2992-8171

João Luís Vieira Monteiro de BARROS

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0001-5419-8778

Maíra Glória de Freitas CARDOSO

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0002-4223-3297

Natália Pessoa ROCHA

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

University of Texas Health Science Center at Houston, McGovern Medical School, Texas, USA.

http://orcid.org/0000-0003-2616-8082

Rodrigo Moreira FALEIRO

Fundação Hospitalar do Estado de Minas Gerais, Hospital João XXIII, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0001-7166-0645

Leonardo Cruz de SOUZA

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0001-5027-9722

Aline Silva de MIRANDA

Universidade Federal de Minas Gerais, Faculdade de Medicina, Laboratório Interdisciplinar de Investigação Médica, Belo Horizonte MG, Brazil.

Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Morfologia, Laboratório de Neurobiologia, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0003-2811-7924

Antônio Lúcio TEIXEIRA

University of Texas Health Science Center at Houston, McGovern Medical School, Texas, USA.

Santa Casa Belo Horizonte, Ensino e Pesquisa, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0002-9621-5422

Correspondence: Aline Silva de Miranda; Email: mirandas.aline@gmail.com.

Conflict of interest: There is no conflict of interest to declare.

Authors’ contributions: ALGM: collected data; JLVMB, MGFC: drafted the manuscript; MGFC, NPR: conducted the statistical analyses; RMF, LCS: proofread the manuscript; ALSM, ALT: designed the study.

		n	%
Sex	Male	324	66.1
Sex	Female	166	33.9
Origin	Belo Horizonte	341	69.9
	Metropolitan region	107	21.8
	Metropolitan region outskirts	4	0.8
	Outside metropolitan region (but still within the state of Minas Gerais)	29	5.9
	Different State	2	0.4
	Not informed	7	1.4
Age	0-18 years	149	30.4
	19-59 years	259	52.9
	60 years or more	82	16.7
Race	Brown	336	68.6
	White	114	23.3
	Black	32	6.5
	Not informed	8	1.6
Outcome	Death	15	3.1
	Discharge<24h	367	74.9
	Discharge >24h	95	19.4
	Hospitalized	7	1.4
	Not informed	6	1.2
TBI mechanism	Unspecified fall	124	25.3
	Fall from own height	118	24.1
	Fall from superior height	43	8.8
	Aggression	61	12.4
	Firearm	6	1.2
	Hit or struck by a car	45	9.2
	Traffic collision	66	13.5
	Non-traffic-related collision	16	3.3
	Repetitive TBI	4	0.8
	Not informed	7	1.4

		GCS Score			p-value
		Mild (13 to 15)	Moderate (12 to 9)	Severe (8 to 3)	p-value
Sex	Male	240 (63%)	19 (20.1%)	5 (16.1%)	0.022
Sex	Female	141 (37%)	5 (79.2%)	26 (83.9%)	0.022
Use of drugs		12 (3.1%)	2 (8.7%)	1 (3.2%)	0.36
Alcohol		71 (18.6%)	9 (37.5%)	3 (9.7%)	0.029
Comorbidity		95 (25%)	6 (25%)	2 (6.5%)	0.065
CT neuroimaging findings		39 (11.7%)	13 (54.2%)	24 (77.4%)	<0.001
Hemodynamic instability		0 (0%)	2 (8.3%)	4 (13.8%)	<0.001
Ventilation Support		4 (1.1%)	6 (25%)	24 (80%)	<0.001
Outcome	Death	3 (0.8%)	3 (13.6%)	8 (29.6%)	<0.001
	Discharge>24h	61 (16.3%)	12 (54.5%)	16 (59.3%)
	Discharge<24h	311 (82.9%)	7 (31.8%)	3(11.1%)

Predictive variable	B	SE	Wald	df	p-value	OR	95%CI for OR
Predictive variable	B	SE	Wald	df	p-value	OR	Lower	Upper
CT neuroimaging changes	-2.909	0.378	59.220	1	0.000	0.055	0.026	0.114
Medical comorbidity	-0.703	0.347	4.115	1	0.043	0.495	0.251	0.977
GCS score	-1.838	0.491	13.998	1	0.000	0.159	0.061	0.417

Reference	Location	Study design	TBI severity/type	Most Common TBI severity (if applicable)	Male		Female		Most afflicted age group	Most afflicted ethnicity	Death	Most common TBI mechanism
Reference	Location	Study design	TBI severity/type	Most Common TBI severity (if applicable)	n	%	n	%	Most afflicted age group	Most afflicted ethnicity	Death	Most common TBI mechanism
Melo et al., 2019²⁴24. Melo RPR, Pinheiro JS, Medeiros DD, Melo MLRP, Casa VIANA, Gouveia SSV. Epidemiological profile of traumatic brain injury in a reference hospital of Parnaíba - PI. Braz J Surg Cli. Res. 2019 Dec-Feb;25(3):22-7 [accessed on 27 Apr 2020]. Available at: Available at: https://www.mastereditora.com.br/periodico/20190206_203031.pdf https://www.mastereditora.com.br/periodi...	Parnaíba, Piauí, Brazil	Retrospective and Descriptive	General	Mild, n=50 (42.7%)	94	80.3%	23	19.7%	Mean age: 33.17 years (SD±17.2)	Not informed	Not informed	Automobile accidents, n=96 (82.1%)
Marinho et al., 2017³¹31. Marinho C da SR, Leite RB, Morais Filho LA, Martins QCS, Valença CN, Bay Júnior O de G, et al. Epidemiological profile of traumatic brain injury victims of a general hospital in a Brazilian capital. Biosci J. 2017;33(3)779-87 [accessed on 27 Apr 2020] Available at: Available at: https://docs.bvsalud.org/biblioref/2018/12/966238/epidemiological-profile-of-traumatic-brain-injury-victims-of-a-_qkqLXWG.pdf https://docs.bvsalud.org/biblioref/2018/...	Natal, Rio Grande do Norte, Brazil	Cross-sectional	General	Moderate, n=228 (61.3%)	317	85.2%	55	14.8%	18-30 years old, n=209 (56.2%)	Not informed	Not informed	Automobile accidents, n=95 (25.6%)
De Almeida et al., 2016¹¹11. De Almeida CER, De Sousa Filho JL, Dourado JC, Gontijo PAM, Dellaretti MA, Costa BS. Traumatic brain injury epidemiology in Brazil. World Neurosurg. 2016 Mar;87:540-7. https://doi.org/10.1016/j.wneu.2015.10.020 https://doi.org/https://doi.org/10.1016/...	Not applicable	Cross-sectional	General	Not informed	97,552 (mean per year)	77.7% (mean per year)	28,017 (mean per year)	22.3 (mean per year)	20-29 years old, n=28,905.4 (mean per year)	Mixed race, n=3,142,782.4* (mean per year) *Greater number of cases because data were missing	n=9,714 (7.7%)(mean per year)	Not informed
Vieira et al., 2016¹⁵15. Vieira RCA, Paiva WS, De Oliveira DV, Teixeira MJ, De Andrade AF, De Sousa RMC. Diffuse axonal injury: Epidemiology, outcome and associated risk factors. Front Neurol. 2016 Oct;7:178. https://doi.org/10.3389/fneur.2016.00178 https://doi.org/https://doi.org/10.3389/...	São Paulo, São Paulo, Brazil	Prospective Cohort Study	Severe TBI with diffuse axonal injury	Not applicable	70	89.7%	8	10.3%	18-28 years old, n=34 (43.6%)	White, n=51 (65.4%)	n=24 (30.8%)	Traffic accidents, n=65 (83.3%)
Tavares et al., 2014³²32. Tavares CB, Sousa EB, Campbell Borges IB, Almeida Gomes Braga F das CS. Pacientes com traumatismo cranioencefálico tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal (Brasília-Brasil). Arq Bras Neurocir. 2014 Sep;33(03):225-32. https://doi.org/10.1055/s-0038-1626218 https://doi.org/https://doi.org/10.1055/...	Distrito Federal, Brasília, Brazil	Cross-sectional	General	Severe, n=108 (55.7%)	161	82.99%	33	17.01%	21-40 years old, n=67 (34.5%)	Not informed	Not informed	Physical aggression, n=57 (29.4%)
De Souza et al., 2013¹⁹19. de Souza RB, Todeschini AB, Veiga JCE, Saade N, de Aguiar GB. Traumatic brain injury by a firearm projectile: a 16 years experience of the neurosurgery service of Santa Casa de São Paulo. Rev Col Bras Cir. 2013 Jul-Aug;40(4):300-4. https://doi.org/10.1590/s0100-69912013000400008 https://doi.org/https://doi.org/10.1590/...	São Paulo, São Paulo, Brazil	Cross-sectional	General TBI caused by firearm projectiles	Severe, n=68 (37.6%)	154	85%	27	15%	21-30 years old, (47%)	Not informed	Not informed	Not applicable
Santos et al., 2013²⁵25. Santos F dos, Casagranda LP, Lange C, Farias JC de, Pereira PM, Jardim VM da R, et al. Traumatic brain injury: causes and profile of victims attended to at an emergency health clinic in Pelotas, Rio Grande do Sul, Brazil. Reme Rev Min Enferm. 2013 Oct-Dec;17(4):882-7. https://doi.org/10.5935/1415-2762.20130064 https://doi.org/https://doi.org/10.5935/...	Pelotas, Rio Grande do Sul, Brazil	Epidemiological, Descriptive, and Retrospective	General	Mild, n=202 (40.7%)	314	63.3%	182	36.7%	0-15 years old, n=220 (44.3%)	Not informed	n=2 (0.4%)	Falls, n=233 (47.0%)
Fernandes et al., 2013³³33. Fernandes RNR, Silva M. Epidemiology of traumatic brain injury in Brazil. Arq Bras Neurocir. 2013;32(3):136-42 [accessed on 27 Apr 2020]. Available at: Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0038-1626005.pdf https://www.thieme-connect.com/products/...	Not applicable	Cross-sectional, descriptive	General	Not informed	358,780	81.5%	81,706	18.5%	14-34 years old, n=231,827 (53.0%)	Not informed	n=52,087 (12.0%)	Falls, n=154,170 (35.0%)
Carvalho Viégas et al., 2013³⁴34. Carvalho Viégas ML, Rodrigues Pereira EL, Targino AA, Furtado VG, Rodrigues DB. Traumatismo cranioencefálico em um hospital de referência no estado do Pará, Brasil: prevalência das vítimas quanto a gênero, faixa etária, mecanismos de trauma, e óbito. Arq Bras Neurocir. 2013 Mar;32(01):15-8. https://doi.org/10.1055/s-0038-1625920 https://doi.org/https://doi.org/10.1055/...	Ananindeua, Pará, Brazil	Epidemiological, Cross-sectional, observational	General	Not informed	220	88%	30	12%	20-30 years old, n=81 (32.4%)	Not informed	n=55 (22%)	Traffic accidents, n=91 (36.4%)
Ruy and Rosa, 2011³⁵35. Ruy EL, Rosa MI. Perfil epidemiológico de pacientes com traumatismo crânio encefálico. Epidemiological profile of patients with traumatic brain injury. Arq Catarinenses Med. 2011;40(3):17-20 [accessed on 27 Apr 2020]. Available at: Available at: https://www.acm.org.br/acm/revista/pdf/artigos/873.pdf https://www.acm.org.br/acm/revista/pdf/a...	Criciúma, Santa Catarina, Brazil	Cross-sectional, descriptive, retrospective	General	Severe, n=63 (67.7%)	82	88.2%	11	11.8%	Mean age: 34.6 years (SD±16.7)	White n=84 (90.3%)	n=25 (26.9%)	Automobile accidents, n=52 (55.9%)
Moura et al., 2011²⁶26. de Moura JC, Ramos Rangel BL, Evangelista Creôncio SC, Barros Pernambuco JR. Perfil clínico-epidemiológico de traumatismo cranioencefálico do Hospital de Urgências e Traumas no município de Petrolina, estado de Pernambuco. Arq Bras Neurocir. 2011;30(03):99-104 [accessed on 27 Apr 2020]. Available at: Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0038-1626501.pdf https://www.thieme-connect.com/products/...	Petrolina, Pernambuco, Brazil	Cross-sectional, epidemiological	General	Mild, n=54 (53.47%)	87	86.14%	14	13.86%	21-40 years old, n=52 (51.49%)	Not informed	n=8 (7.92%)	Motorcycle accident, n=45 (44.55%)
Ramos et al., 2010³⁶36. Ramos EMS, da Silva MKB, Siqueira GR, Vieira RAG, França WLC. Aspectos epidemiológicos dos traumatismos cranioencefálicos atendidos no hospital regional do agreste de Pernambuco de 2006 a 2007. Rev Bras Promoç Saude. 2010 Jan;23(1):4-10. https://doi.org/10.5020/18061230.2010.p4 https://doi.org/https://doi.org/10.5020/...	Caruaru, Pernambuco, Brazil	Document-based	General	Not informed	139	81.2%	32	18.7%	25-49 years old, n=56 (29.9%)	Not informed	Not informed	Motorcycle accident, n=34 (19.9%)
Guerra et al., 2010²¹21. Guerra SD, Andrade Carvalho LF, Affonseca CA, Ferreira AR, Machado Freire HB. Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries. J Pediatr (Rio J). 2010 Jan-Feb;86(1):73-9. https://doi.org/10.2223/JPED.1960 https://doi.org/https://doi.org/10.2223/...	Belo Horizonte, Minas Gerais, Brazil	Retrospective cohort study	General TBI patients who developed intracranial hypertension	Severe, n=132 (100%)	89	67.4%	43	32.6%	7-9 years old	Not informed	n=68 (51.5%)	Getting hit by a vehicle, n=68 (51.5%)
Martins et al., 2009³⁷37. Martins ET, Linhares MN, Sousa DS, Schroeder HK, Meinerz J, Rigo LA, et al. Mortality in severe traumatic brain injury: A multivariated analysis of 748 Brazilian patients from florianópolis city. J Trauma - Inj Infect Crit Care. 2009 Jul;67(1):85-90. https://doi.org/10.1097/TA.0b013e318187acee https://doi.org/https://doi.org/10.1097/...	Florianópolis, Santa Catarina, Brazil	Prospective	Severe	Not applicable	631	84%	117	15.6%	Mean age: 34.8 years old (SD±16.3)	Not informed	n=249 (33.3%)	Road accident, n=225 (30.1%)
Braga et al., 2008²³23. Braga FM, Netto AA, Rosso E, Santos D, De P, Braga B, et al. Avaliação de 76 casos de traumatismo crânio-encefálico por queda da própria altura atendidos na emergência de um hospital geral. Arq Catarinenses Med. 2008;37(4):35-9 [accessed on 27 Apr 2020]. Available at: Available at: https://www.acm.org.br/acm/revista/pdf/artigos/608.pdf https://www.acm.org.br/acm/revista/pdf/a...	Florianópolis, Santa Catarina, Brazil	Prospective	General TBI caused by one’s own height	Mild, n=69 (90.7%)	44	57.9%	32	42.1%	Mean age for men: 44.7 years Mean age for women: 47.2	Not informed	Not informed	Not applicable
Faria et al., 2008³⁸38. De Faria JWV, Nishioka SDA, Arbex GL, Alarcão GG, De Freitas WB. Occurrence of severe and moderate traumatic brain injury in patients attended in a Brazilian Teaching Hospital: Epidemiology and dosage of alcoholemy. Arq Neuro-Psiquiatr. 2008;66(1):69-73 [accessed on 27 Apr 2020]. Available at: Available at: https://www.scielo.br/j/anp/a/HLJfnSwH6yMCTVmB4rY9Wqt/?format=pdf https://www.scielo.br/j/anp/a/HLJfnSwH6y...	Uberlândia, Minas Gerais, Brazil	Epidemiological, Prospective	General (Severe and moderate were grouped together)	Severe and moderate (grouped together), n=56 (66.7%)	68	80.9%	16	19.1%	Mean age for severe and moderate: 40.6 years Mean age for mild: 34.8	Not informed	Not informed	Transport accidents, n=54 (64.74%)
Pereira et al., 2006²⁷27. Pereira CU, Duarte GC, Silva Santos EA. Avaliação epidemiológica do traumatismo craniencefálico no interior do Estado de Sergipe. Arq Bras Neurocir. 2006 Mar; 25(1): 8-16 [accessed on 27 Apr 2020]. Available at: Available at: https://pdfs.semanticscholar.org/ceb0/d93c7501a58de43a3d823454b970fb3f0389.pdf https://pdfs.semanticscholar.org/ceb0/d9...	Aracaju, Sergipe, Brazil	Longitudinal Prospective	General	Mild, n=422 (89%)	344	73%	126	27%	10-29 years old	Not informed	n=3 (0.6%)	Accidental fall, n=148 (31.5%)
Melo et al., 2006²⁸28. Melo JRT, De Santana DLP, Pereira JLB, Ribeiro TF. Traumatismo craniencefálico em crianças e adolescentes na Cidade do Salvador - Bahia. Arq Neuro-Psiquiatr. 2006 Dec;64(4):994-6. https://doi.org/10.1590/S0004-282X2006000600020 https://doi.org/https://doi.org/10.1590/...	Salvador, Bahia, Brazil	Cross-sectional descriptive	General	Mild, n=249 (63.8%)	280	71.8%	110	28.2%	Not applicable (Study conducted on a specific group age (0-19 years old)	Not informed	Not informed	Fall from height, n=134 (34.4%)
Melo et al., 2004²⁹29. Melo JRT, Da Silva RA, Moreira ED. Characteristics of patients with head injury at Salvador City (Bahia - Brazil). Arq Neuropsiquiatr. 2004 Sep;62(3A):711-4. https://doi.org/10.1590/s0004-282x2004000400027 https://doi.org/https://doi.org/10.1590/...	Salvador, Bahia, Brazil	Cross-sectional	General	Mild, n=146 (38.4%)	460	82.9%	95	17.1%	21-30 years old, n=128 (23.2%)	Not informed	n=127 (22.9%)	Traffic accidents, n=226 (40.7%)
Dantas Filho et al., 2004³⁹39. Dantas Filho VP, Falcão ALE, Sardinha LA da C, Facure JJ, Araújo S, Terzi RGG. Fatores que influenciaram a evolução de 206 pacientes com traumatismo craniencefálico grave. Arq Neuro-Psiquiatr. 2004 Jun;62(2A):313-8. https://doi.org/10.1590/S0004-282X2004000200022 https://doi.org/https://doi.org/10.1590/...	Campinas, São Paulo, Brazil	Cross-sectional	Severe	Not applicable	166	80.58%	40	19.42%	Mean age: 29.21 years old	Not informed	n=75 (36.40%)	Traffic accidents, n=147 (71.36%)
Gusmão et al., 2002²²22. Gusmão SS, Pittella JEH. Hypoxic brain damage in victims of fatal road traffic accident: prevalence, distribution and association with survival time and other head and extracranial injuries. Arq Neuro-Psiquiatr. 2002 Sep;60(3B):801-6. https://doi.org/10.1590/S0004-282X2002000500022 https://doi.org/https://doi.org/10.1590/...	Belo Horizonte, Minas Gerais, Brazil	Prospective	Fatal TBI victims	Not applicable	90	75.0%	30	25.0%	Mean age: 37.5 years old (SD±18.3)	Not informed	Not applicable (Post-mortem study)	Not applicable (all patients came from traffic accidents)
Koizumi et al., 2001⁴⁰40. Koizumi MS, Jorge MHPM, Nóbrega LRB, Waters C. Crianças internadas por traumatismo crânio-encefálico, no Brasil, 1998: causas e prevenção. Inf Epidemiol Sus. 2001 Jun;10(2):93-101. https://doi.org/10.5123/S0104-16732001000200004 https://doi.org/https://doi.org/10.5123/...	Not applicable	Cross-sectional	General	Not informed	10,251	62.6%	6,125	37.4%	(Study conducted on children who were ≥ 10 years old) 0-4 years old, n=9,302 (56.8%)	Not informed	n=332 (2.0%)	Falls, n=10,022 (61.2%)
Koizumi et al., 2000²⁰20. Koizumi MS, Lebrão ML, Prado De Mello-Jorge MH, Primerano V. Morbidity and mortality due to traumatic brain injury in São Paulo city, Brazil, 1997. Arq Neuro-Psiquiatr. 2000 Mar;58(1):81-9. https://doi.org/10.1590/S0004-282X2000000100013 https://doi.org/https://doi.org/10.1590/...	São Paulo, São Paulo, Brazil	Cross-sectional, retrospective	General	Not informed	2784	76.6%	851	23.41%	≤10 years old (20.3%)	Not informed	n=371 (10.2%)	Aggression, n=1,767 (48.6%)
Colli et al., 1997¹⁶16. Colli BO, Sato T, Oliveira RS de, Sassoli VP, Cibantos Filho JS, Manço ARX, et al. Características dos pacientes com traumatismo craniencefálico atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Vol. 55, Arq Neuro-Psiquiatr. 1997;55(1):91-100. https://doi.org/10.1590/S0004-282X1997000100015 https://doi.org/https://doi.org/10.1590/...	Ribeirão Preto, São Paulo, Brazil	Cross-sectional	General	Mild, n=2,584 (74.5%)	2476	71.4%	992	28.6%	0-10 years old (about 30% of all men about 10% of all women)	Not informed	n=209 (6%)	Traffic accidents, n=1,241(35.8%)
Gennari et al., 1995¹⁷17. Gennari TD, Koizumi MS. Determination of trauma severity level by means of the injury severity score. Rev Saude Publica. 1995 Oct;29(5):333-41. https://doi.org/10.1590/S0034-89101995000500001 https://doi.org/https://doi.org/10.1590/...	São Paulo, Brazil	Prospective	General	Mild, n=47 (47%)	85	85%	15	15%	Closed head injury patients’ mean age: 35.4 years old Penetrating head injury patients’ mean age: 27.2 years old	Not informed	n=12 (12%)	Traffic accidents, n=40 (40%)
Masini et al., 1994³⁰30. Masini M. Perfil Epidemiológico do traumatismo cranioencefálico no Distrito Federal em 1991. J Bras Neurocir. 1994 Dec;5(2):61-8. https://doi.org/10.22290/jbnc.v5i2.129 https://doi.org/https://doi.org/10.22290...	Distrito Federal, Brazil	Retrospective	General	Mild, n=76 (76%) (Independent 100 people sample)	65 (Independent 100 people sample)	65% (Independent 100 people sample)	35 (Independent 100 people sample)	35% (Independent 100 people sample)	1-30 years old, n=72 (72%) (Independent 100 people sample)	Not informed	n=797 (14.7%)	Traffic accident, n=2391 (44%)
Maset et al., 1993¹⁸18. Maset A, Andrade A, Martucci SC, Frederico LM. Epidemiologic Features of Head Injury in Brazil. Arq Bras Neurocir. 1993 Dec;12(4):293-302.	Sao Jose do Rio Preto, São Paulo, Brazil	Cross-sectional	General	Not informed	759	70.0%	325	30.0%	20-29 years old, n=303 (28.0%)	Not informed	Full text was not retrievable	Full text was not retrievable

Reference	Neuroimaging findings	Other clinical comorbidities/findings	Hospital stay length	Alcohol intake
Melo et al., 2019²⁴24. Melo RPR, Pinheiro JS, Medeiros DD, Melo MLRP, Casa VIANA, Gouveia SSV. Epidemiological profile of traumatic brain injury in a reference hospital of Parnaíba - PI. Braz J Surg Cli. Res. 2019 Dec-Feb;25(3):22-7 [accessed on 27 Apr 2020]. Available at: Available at: https://www.mastereditora.com.br/periodico/20190206_203031.pdf https://www.mastereditora.com.br/periodi...	Computerized tomography, n=83 (70.9%) reported no encephalic lesions. From the remaining patients: (i), n=18 (15.4%) presented frontal lobe lesions; (ii), n=12 (10.3%) presented parietal lobe lesions; (iii), n=7 (6%) presented temporal lobe lesions; (iv), n=4 (3.4%) presented occipital lobe lesions.	Not informed	Not informed	19.7% (n=23) of patients displayed intoxication signs, according to their records. The remaining records did not include any information on patients’ alcoholic statuses.
Marinho et al., 2017³¹31. Marinho C da SR, Leite RB, Morais Filho LA, Martins QCS, Valença CN, Bay Júnior O de G, et al. Epidemiological profile of traumatic brain injury victims of a general hospital in a Brazilian capital. Biosci J. 2017;33(3)779-87 [accessed on 27 Apr 2020] Available at: Available at: https://docs.bvsalud.org/biblioref/2018/12/966238/epidemiological-profile-of-traumatic-brain-injury-victims-of-a-_qkqLXWG.pdf https://docs.bvsalud.org/biblioref/2018/...	Not informed	Not informed	Not informed	Not informed
De Almeida et al., 2016¹¹11. De Almeida CER, De Sousa Filho JL, Dourado JC, Gontijo PAM, Dellaretti MA, Costa BS. Traumatic brain injury epidemiology in Brazil. World Neurosurg. 2016 Mar;87:540-7. https://doi.org/10.1016/j.wneu.2015.10.020 https://doi.org/https://doi.org/10.1016/...	Not informed	Not informed	Mean hospital stay length for: (i) 2008: 5.4 days; (ii) 2009: 5.3 days; (iii) 2010: 5.5 days; (iv) 2011: 5.6 days; (v) 2012: 5.8 days. Overall mean length of hospital stays: 5.5 days.	Not informed
Vieira et al., 2016¹⁵15. Vieira RCA, Paiva WS, De Oliveira DV, Teixeira MJ, De Andrade AF, De Sousa RMC. Diffuse axonal injury: Epidemiology, outcome and associated risk factors. Front Neurol. 2016 Oct;7:178. https://doi.org/10.3389/fneur.2016.00178 https://doi.org/https://doi.org/10.3389/...	Early diffuse axonal injury and intracranial hypertension signs in computerized tomography are associated with greater mortality	Hypotension, hypertension, hypothermia, hyperthermia, hypoglycemia, hyperglicemia, bradycardia, tachycardia, and hypoxia.	Not informed	n=33 (42.3%) patients reported alcohol intake prior the trauma event.
Tavares et al., 2014³²32. Tavares CB, Sousa EB, Campbell Borges IB, Almeida Gomes Braga F das CS. Pacientes com traumatismo cranioencefálico tratados cirurgicamente no serviço de neurocirurgia do Hospital de Base do Distrito Federal (Brasília-Brasil). Arq Bras Neurocir. 2014 Sep;33(03):225-32. https://doi.org/10.1055/s-0038-1626218 https://doi.org/https://doi.org/10.1055/...	Chronic subdural hematoma, n=63 (32.5%) Acute extradural hematoma, n=49 (25.3%) Acute subdural hematoma, n=30(15.5%) Cerebral edema, n=2 (1.0%) Firearm projectile, n=7 (3.6%) Depressed skull fracture, n=38 (19.6%) Intraparenchymal hematoma, n=5 (2.6%)	Not informed	Not informed	Not informed
De Souza et al., 2013¹⁹19. de Souza RB, Todeschini AB, Veiga JCE, Saade N, de Aguiar GB. Traumatic brain injury by a firearm projectile: a 16 years experience of the neurosurgery service of Santa Casa de São Paulo. Rev Col Bras Cir. 2013 Jul-Aug;40(4):300-4. https://doi.org/10.1590/s0100-69912013000400008 https://doi.org/https://doi.org/10.1590/...	Study conducted on TBI caused by projectile firearms Frontal lobe lesion, n=49 (27%) Temporal lobe lesion, n=45 (25%) Parietal lobe lesion, n=25 (14%) Occipital lobe lesion, n=31 (17%) Facial lesion, n=20 (11%) Multiple lesions, n=11 (6%)	Tangential TBI, n=29 (16%) Penetrating TBI, n=152 (84%)	Not informed	Not informed
Santos et al., 2013²⁵25. Santos F dos, Casagranda LP, Lange C, Farias JC de, Pereira PM, Jardim VM da R, et al. Traumatic brain injury: causes and profile of victims attended to at an emergency health clinic in Pelotas, Rio Grande do Sul, Brazil. Reme Rev Min Enferm. 2013 Oct-Dec;17(4):882-7. https://doi.org/10.5935/1415-2762.20130064 https://doi.org/https://doi.org/10.5935/...	Not informed	Not informed	Not informed	Not informed
Fernandes et al., 2013³³33. Fernandes RNR, Silva M. Epidemiology of traumatic brain injury in Brazil. Arq Bras Neurocir. 2013;32(3):136-42 [accessed on 27 Apr 2020]. Available at: Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0038-1626005.pdf https://www.thieme-connect.com/products/...	Study did not specify whether lesions were chronic or acute. Fractures, n=11,125 (2.5%) Extradural hematoma, n=20,923 (4.8%) Subdural hematoma, n=27,447 (6.3%) Focal lesions, n=31,644 (7.2%) Diffuse lesions, n=159,241 (36.3%) Subarachnoid hemorrhage, n=1,856 (0.4%) Non-specified lesions, n=186,742 (42.5%)	Not informed	Not informed	Not informed
Carvalho Viégas et al., 2013³⁴34. Carvalho Viégas ML, Rodrigues Pereira EL, Targino AA, Furtado VG, Rodrigues DB. Traumatismo cranioencefálico em um hospital de referência no estado do Pará, Brasil: prevalência das vítimas quanto a gênero, faixa etária, mecanismos de trauma, e óbito. Arq Bras Neurocir. 2013 Mar;32(01):15-8. https://doi.org/10.1055/s-0038-1625920 https://doi.org/https://doi.org/10.1055/...	Not informed	Not informed	Not informed	Not informed
Ruy and Rosa, 2011³⁵35. Ruy EL, Rosa MI. Perfil epidemiológico de pacientes com traumatismo crânio encefálico. Epidemiological profile of patients with traumatic brain injury. Arq Catarinenses Med. 2011;40(3):17-20 [accessed on 27 Apr 2020]. Available at: Available at: https://www.acm.org.br/acm/revista/pdf/artigos/873.pdf https://www.acm.org.br/acm/revista/pdf/a...	Not informed	Sensory reduction, n=45 (48.5%) Anisocoria, n=15 (16.3%) Mental confusion, n=11 (12.1%) Psychomotor agitation, n=10 (10.9%) Cardiopulmonary arrest, n=10 (10.9%) Respiratory failure, n=9 (9.8%) Seizures, n=6 (6.7%) ICU clinical complications: Pneumonia, n=16 (17.3%) Sepsis, n=2 (2.2%) Acute renal failure, n=2 (2.2%) Cerebral hemorrhage, n=36 (38.9%) Cerebral contusion, n=36 (38.5%) Cerebral edema, n=23 (24.9%) Bone fracture of any kind, n=18 (19.6%) Pneumocephalus, n=12 (12.9%)	Not informed	Not informed
Moura et al., 2011²⁶26. de Moura JC, Ramos Rangel BL, Evangelista Creôncio SC, Barros Pernambuco JR. Perfil clínico-epidemiológico de traumatismo cranioencefálico do Hospital de Urgências e Traumas no município de Petrolina, estado de Pernambuco. Arq Bras Neurocir. 2011;30(03):99-104 [accessed on 27 Apr 2020]. Available at: Available at: https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0038-1626501.pdf https://www.thieme-connect.com/products/...	Study did not specify whether lesions were acute or chronic. Diffuse axonal injury, n=1 (0.99%) Extradural hematoma, n=20 (19.82%) Cerebral contusion, n=18 (17.82%) Subarachnoid hemorrhage, n=10 (9.9%) Subdural hematoma, n=6 (5.94%) Most afflicted cranial sites: Frontal, n=25 (24.75%) Temporal, n=12 (11.88%) Temporoparietal, n=12 (11.88%) Parietal, n=9 (8.91%) Occipital, n=6 (5.94%) Parietofrontal, n=6 (5.94%) Frontotemporal, n=4 (3.96%) Temporooccipital, n=2 (1.98%) Basilar skull fracture, n=2 (1.98%)	At admission: Headache, n=17 (16.83%) Vomiting, n=16 (15.84%) Otorrhagia, n=9 (8.91%) Coma, n=6 (5.94%)	Not informed	Not informed
Ramos et al., 2010³⁶36. Ramos EMS, da Silva MKB, Siqueira GR, Vieira RAG, França WLC. Aspectos epidemiológicos dos traumatismos cranioencefálicos atendidos no hospital regional do agreste de Pernambuco de 2006 a 2007. Rev Bras Promoç Saude. 2010 Jan;23(1):4-10. https://doi.org/10.5020/18061230.2010.p4 https://doi.org/https://doi.org/10.5020/...	General nervous system lesion, n=34 (19.9%)	Bone lesion, n=39 (22.8%) Vascular lesion, n=55 (32.2%) Multiple lesions, n=26 (15.2%) Soft tissues, n=7 (4.1%)	Not informed	n=20 (11.7%)
Guerra et al., 2010²¹21. Guerra SD, Andrade Carvalho LF, Affonseca CA, Ferreira AR, Machado Freire HB. Factors associated with intracranial hypertension in children and teenagers who suffered severe head injuries. J Pediatr (Rio J). 2010 Jan-Feb;86(1):73-9. https://doi.org/10.2223/JPED.1960 https://doi.org/https://doi.org/10.2223/... (Only severe TBI) cases were analyzed)	Diffuse Axonal Injury, n=56 (42.4%) Swelling, n=74 (56.1%) Intraparenchymal hemorrhage, n=46 (34.8%) Subarachnoid hemorrhage, n=41 (31.1%) Study did not specify whether lesions were acute or chronic: Subdural hematoma, n=20 (15.2%) Intraventricular hemorrhage, n=15 (11.4%) Extradural hematoma, n=14 (10.6%)	Thoracic lesion, n=48 (36.4%) Skeletal muscle lesion, n=37 (28.0%) Abdomen, n=21 (15.9%) Spinal cord, n=6 (4.6%)	Not informed	Not informed
Martins et al., 2009³⁷37. Martins ET, Linhares MN, Sousa DS, Schroeder HK, Meinerz J, Rigo LA, et al. Mortality in severe traumatic brain injury: A multivariated analysis of 748 Brazilian patients from florianópolis city. J Trauma - Inj Infect Crit Care. 2009 Jul;67(1):85-90. https://doi.org/10.1097/TA.0b013e318187acee https://doi.org/https://doi.org/10.1097/... (Only severe TBI cases were analyzed)	Marshall type I injury, n=22 (2.9%) Marshall type II injury, n=175 (23.4%) Marshall type III injury, n=172 (23.0%) Marshall type IV injury, n=58 (7.8%) Evacuated mass lesion, n=240 (32.1%) Non-evacuated lesion, n=30 (4.0%) Brainstem lesion, n=50 (6.7%) Subarachnoid hemorrhage, n=267 (35.7%)	Face trauma, n=108 (14.4%) Cervical spine trauma, n=27 (3.6%) Dorsal-lumbar spine trauma, n=7 (0.9%) Thoracic trauma, n=141 (18.9%) Abdominal trauma, n=70 (9.4%) Limb trauma, n=204 (27.3%) (Pupil) Isochoric, n=283 (37.8%) (Pupil) Miotics, n=30 (4.0%) (Pupil) Anisocorics, n=347 (46.4%) (Pupil) Mydriatics, n=83 (11.1%)	Not informed	Not informed
Braga et al., 2008²³23. Braga FM, Netto AA, Rosso E, Santos D, De P, Braga B, et al. Avaliação de 76 casos de traumatismo crânio-encefálico por queda da própria altura atendidos na emergência de um hospital geral. Arq Catarinenses Med. 2008;37(4):35-9 [accessed on 27 Apr 2020]. Available at: Available at: https://www.acm.org.br/acm/revista/pdf/artigos/608.pdf https://www.acm.org.br/acm/revista/pdf/a... (Only TBI cases caused by falling from standing height were analyzed)	Not informed	Systemic arterial hypertension, n=9 (11.8%) Epilepsy, n=6 (7.9%) Alcoholism, n=4 (5.3%) Diabetes mellitus, n=3 (3.9) Heart failure, n=3 (3.9%) Alzheimer’s disease, n=3 (3.9%) HIV infection, n=3 (3.9%)	Not informed	n=11 (14.5%)
Faria et al., 2008³⁸38. De Faria JWV, Nishioka SDA, Arbex GL, Alarcão GG, De Freitas WB. Occurrence of severe and moderate traumatic brain injury in patients attended in a Brazilian Teaching Hospital: Epidemiology and dosage of alcoholemy. Arq Neuro-Psiquiatr. 2008;66(1):69-73 [accessed on 27 Apr 2020]. Available at: Available at: https://www.scielo.br/j/anp/a/HLJfnSwH6yMCTVmB4rY9Wqt/?format=pdf https://www.scielo.br/j/anp/a/HLJfnSwH6y...	Not informed	Not informed	Not informed	n=33 (39.3%)
Pereira et al., 2006²⁷27. Pereira CU, Duarte GC, Silva Santos EA. Avaliação epidemiológica do traumatismo craniencefálico no interior do Estado de Sergipe. Arq Bras Neurocir. 2006 Mar; 25(1): 8-16 [accessed on 27 Apr 2020]. Available at: Available at: https://pdfs.semanticscholar.org/ceb0/d93c7501a58de43a3d823454b970fb3f0389.pdf https://pdfs.semanticscholar.org/ceb0/d9...	Altered CT scan, n=75 (31.0%) out of 242 Altered plain radiography of the skull, n=4 (1.7%) out of 239	Altered conscious level, n=85 (18.1%) Vomiting and nausea, n=97 (20.6%) Sleepiness, n=51 (10.9%) Headache, n=40 (8.5%) Dizziness, n=18 (3.8%) Seizures, n=11 (2.3%) Otorrhagia, n=12 (2.6%) Epistaxis, n=8 (1.7%) Diplopia, n=2 (0.43%)	Not informed	Not informed
Melo et al., 2006²⁸28. Melo JRT, De Santana DLP, Pereira JLB, Ribeiro TF. Traumatismo craniencefálico em crianças e adolescentes na Cidade do Salvador - Bahia. Arq Neuro-Psiquiatr. 2006 Dec;64(4):994-6. https://doi.org/10.1590/S0004-282X2006000600020 https://doi.org/https://doi.org/10.1590/... (Study conducted on children and teenagers only)	Not informed	Not informed	Not informed	Not applicable
Melo et al., 2004²⁹29. Melo JRT, Da Silva RA, Moreira ED. Characteristics of patients with head injury at Salvador City (Bahia - Brazil). Arq Neuropsiquiatr. 2004 Sep;62(3A):711-4. https://doi.org/10.1590/s0004-282x2004000400027 https://doi.org/https://doi.org/10.1590/...	Not informed	1 lesioned organ, n=117 (66.1%) 2 lesioned organs, n=40 (22.6%) ≥3 lesioned organs, n=20 (11.3%)	Not informed	n=27 (4.9%)
Dantas Filho et al., 2004³⁹39. Dantas Filho VP, Falcão ALE, Sardinha LA da C, Facure JJ, Araújo S, Terzi RGG. Fatores que influenciaram a evolução de 206 pacientes com traumatismo craniencefálico grave. Arq Neuro-Psiquiatr. 2004 Jun;62(2A):313-8. https://doi.org/10.1590/S0004-282X2004000200022 https://doi.org/https://doi.org/10.1590/...	Marshall type I injury, n=15 (7.28%) Marshall type II injury, n=63 (30.58%) Marshall type III injury, n=33 (16.02%) Marshall type IV injury, n=13 (6.31%) Focal lesion (operated), n=72 (34.95%) Focal lesion (not operated), n=10 (4.85%)	Hypo-/Hypernatremia and Hypo-/hypercalcemia, n=130 (63.21%) Polyuria, n=32 (15.53%) Bronchopneumonia, n=119 (57.77%) Urinary infection, n=11 (5.34%) Sepsis, n=10 (4.85%) Sinusitis, n=6 (2.91%) Gastrointestinal bleeding, n=3 (1.46%) Hypoxia, n=81 (39.32%) Hypotension, n=39 (18.93%) Both hypoxia and hypotension, n=22 (10.68%)	Not informed	Not informed
Gusmão et al., 2002²²22. Gusmão SS, Pittella JEH. Hypoxic brain damage in victims of fatal road traffic accident: prevalence, distribution and association with survival time and other head and extracranial injuries. Arq Neuro-Psiquiatr. 2002 Sep;60(3B):801-6. https://doi.org/10.1590/S0004-282X2002000500022 https://doi.org/https://doi.org/10.1590/... (Only evaluated fatal patients)	Diffuse axonal injury, n=96 (80.0%) Intracranial hypertension, n=47 (39.2%) Skull fracture, n=63 (52.5%) Hypoxic brain injury: (19.2%)	Limb fractures, n=46 (38.3%) Thoracic trauma, n=42 (35%) Abdominal trauma, n=44 (36.7%) Both thoracic and abdominal trauma, n=32 (26.7%) Pneumonia, n=10 (8.3%) Purulent meningitis, n=3 (2.5%)	Not informed	Not informed
Koizumi et al., 2001⁴⁰40. Koizumi MS, Jorge MHPM, Nóbrega LRB, Waters C. Crianças internadas por traumatismo crânio-encefálico, no Brasil, 1998: causas e prevenção. Inf Epidemiol Sus. 2001 Jun;10(2):93-101. https://doi.org/10.5123/S0104-16732001000200004 https://doi.org/https://doi.org/10.5123/... (Only evaluated children)	Skull fractures, n=1,800 (11%)	Not informed	<1 day, n=333 (2.0%) 1 to 3 days, n=12,100 (73.9%) 4 to 7 days, n=2.825 (17.3%) 8 to 29 days, n=1.023 (6.2%) ≥30 days, n=95 (0.6%)	Not applicable
Koizumi et al., 2000²⁰20. Koizumi MS, Lebrão ML, Prado De Mello-Jorge MH, Primerano V. Morbidity and mortality due to traumatic brain injury in São Paulo city, Brazil, 1997. Arq Neuro-Psiquiatr. 2000 Mar;58(1):81-9. https://doi.org/10.1590/S0004-282X2000000100013 https://doi.org/https://doi.org/10.1590/...	Fracture of skull vault, n=45 (1.2%) Basilar skull fracture, n=32 (0.9%) Other skull fractures, n=22 (0.6%) Multiple fractures of skull/face, n=4 (0.1) Brain concussion, n=1038 (28.6%) Cerebral laceration and contusion, n=192 (5.3%) Hemorrhage, n=509 (14.0%) Traumatic intracranial lesion of other types, n=1793 (49.3%)	Not informed	Most predominant hospital stay duration is of 1 to 7 days hospitalized (n=2,637; 72.5%).	Not informed
Colli et al., 1997¹⁶16. Colli BO, Sato T, Oliveira RS de, Sassoli VP, Cibantos Filho JS, Manço ARX, et al. Características dos pacientes com traumatismo craniencefálico atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Vol. 55, Arq Neuro-Psiquiatr. 1997;55(1):91-100. https://doi.org/10.1590/S0004-282X1997000100015 https://doi.org/https://doi.org/10.1590/...	Plain radiography of the skull: 18.0% (24% of 73%) presented fractures. CT scan: 4.2% (30% of 14%) presented brain lesions	Scalp lesion: 66.2% Headache (21.4% of children) Vomit: 17% (approximately in adult and children) Headache: 17% (approximately) Alteration of consciousness (some time after TBI): 24.4% Alteration of consciousness (immediately afterwards): 87% Soft tissue lesion: 17.9% Face lesion: 15.4%* *Full text was not retrievable. Figure 7 was missing	Not informed	17% of adults (approximately)*
Gennari et al., 1995¹⁷17. Gennari TD, Koizumi MS. Determination of trauma severity level by means of the injury severity score. Rev Saude Publica. 1995 Oct;29(5):333-41. https://doi.org/10.1590/S0034-89101995000500001 https://doi.org/https://doi.org/10.1590/...	Not informed	Penetrating trauma, n=32 (32%) Blunt trauma, n=68 (68%)	Not informed	Not informed
Masini et al., 1994³⁰30. Masini M. Perfil Epidemiológico do traumatismo cranioencefálico no Distrito Federal em 1991. J Bras Neurocir. 1994 Dec;5(2):61-8. https://doi.org/10.22290/jbnc.v5i2.129 https://doi.org/https://doi.org/10.22290...	Chronic subdural hematoma, n=54 (1) Acute extradural hematoma, n=40 (0.7%) Acute subdural hematoma, n=40 (0.7%) General fractures and basilar skull fracture, n=58 (1%) Cerebral contusion, n=56 (1%) Firearm projectile induced lesion: 19 (0.4%) Intracerebral hematoma: 9 (0.2%)	Not informed	n=64 (64%) were discharged <24 hours. n=16 (16%) stayed longer than 7 days.* *Independent 100 people sample 71.6% patients	Not informed
Maset et al., 1993¹⁸18. Maset A, Andrade A, Martucci SC, Frederico LM. Epidemiologic Features of Head Injury in Brazil. Arq Bras Neurocir. 1993 Dec;12(4):293-302.	Not informed	Not informed	Average hospital stays: 4.65 days 71.6% patients stayed for a maximum of 4 days. 24.9% patients stayed for 2 days. 1.7% patients stayed for a period greater than 20 days.	Not informed

[1] Correspondence: Aline Silva de Miranda; Email: mirandas.aline@gmail.com.

Brasil

Brasil

Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature

Traumatismo cranioencefálico no Brasil: um estudo epidemiológico e uma revisão sistemática da literatura

ABSTRACT