Traumatic brain injury (TBI) is a silent epidemic. In developed and developing countries it's a growing consequence of motor vehicle accidents, falls (an ageing population means this is very much on the rise), war and, in the United States, gunshot wounds.
TBI is the leading global cause of mortality of young adults, and a major cause of death and disability across all ages. Globally, 50 million people acquire a traumatic brain injury each year.
Now, The Lancet Neurology has taken the unprecedented step of producing a single issue devoted to TBI, bringing together experts from around the world to coordinate the way it's diagnosed, measured and treated.
Because despite thousands of clinical trials and improvements in imaging technologies, there have been no major advances in the treatment of TBI in more than two decades.
TBI costs the global economy $400 billion a year and, in Australia, in 2009, it cost $8.6 billion a year.
Because falls, car and motorbike accidents, and – sadly – wars, are not going to go away, The Lancet issue has been launched to shine a light on what is a global issue, particularly in countries such as India and China where pre-hospital care is frequently poorly developed.
The Lancet, together with the International Initiative for Traumatic Brain Injury Research, has brought together large collaborative groups from the US, Europe and Canada to describe TBI patient characteristics and outcomes, and then to identify management strategies that are associated with the best outcomes.
The concept is to efficiently screen current international practice in TBI management, which we know is highly variable, and identify any improvements in care (which may slip through the net in smaller populations). The apparently better options will then be tested in clinical trials.
In 2000, Victoria introduced a state-wide Advanced Trauma System, which is recognised globally as one of the most effective and coordinated, and has been a model for other states in Australia.
Whenever someone is involved in a major car accident, farming incident or fall and suffers significant trauma, they're airlifted straight to either The Alfred or Royal Melbourne Hospital, rather than to a local hospital before being triaged to a major hospital, as happens in other countries.
When it comes to traumatic injury – not just to the brain, but in half of all trauma cases there's brain injury, and it’s the brain injury treatment that is the limiting factor in the patient's recovery – we know that timing is everything if we're to keep the patient alive and ensure they have a chance at recovery.
When you see a helicopter flying over Melbourne, chances are it's bringing one of the 2400 critically ill trauma patients dealt with in this system each year.
From the moment the ambulance is first called, to the time the patient enters intensive care in the hospital, to their rehabilitation, they will be seen by world-class nurses, doctors, paramedics, physiotherapists, psychologists and numerous health professionals.
When you see a helicopter flying over Melbourne, chances are it's bringing one of the 2400 critically ill trauma patients dealt with in Victoria's Advanced Trauma System each year.
Since Victoria introduced the Advanced Trauma System, 80 per cent of all major trauma patients are treated at the Alfred or RMH, or, in paediatric cases, the Royal Children’s Hospital. This has resulted in a steady decline in mortality rates, with fewer-than-expected deaths according to international benchmarks; positive trends in preventable deaths; and reduced lengths of stay in hospitals.
It's because of this world-class system, co-funded by the Victorian Department of Health and the TAC, that we've been involved in The Lancet program that has just been launched in Brussels.
In a world where people are at increasing risk of TBI, Victorians should be proud of the fact they have a system available that's recognised the world over for being one of the best, and from which other countries want to learn.
Professor Jamie Cooper AO is Director of the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University; Director of the NHMRC Centre of Research Excellence for Patient Blood Management in Critical Illness and Trauma (Blood-CRE), Monash University; Director of Critical Care Research in the School of Public Health and Preventive Medicine (SPHPM), Monash University; and Interim Director of the Department of Intensive Care at The Alfred Hospital, Melbourne.