Epidemiology and prevention of head injuries: literature review

AIM AND OBJECTIVES: To identify evidence-based reports on the epidemiology of head injuries to develop guidelines for primary prevention activities by public health nurses. BACKGROUND: Head injury is a major cause of morbidity, mortality, disability and lost years of productive life in the population under 40-45 years of age. Prevention strategies such as legislation on car seat belts, drink driving and health and safety at work have led to reductions in its incidence. As well as the personal repercussions for those injured and their families, there are resource implications for healthcare provision. There is a potential role for public health nurses in reducing this burden. METHODS: A search of MEDLINE, PubMed, Science Direct, BNI and CINAHL was carried out for the period 1990-2005 using the keywords: head injury, brain injury, traumatic brain injury, head trauma, incidence, prevalence, epidemiology and prevention of head injuries. RESULTS: Comparison of the data is difficult because of the use of different definitions of injury, criteria for severity, geographical bases and timeframes. Those at greatest risk seem to be young men and older people. The former are more implicated in traffic and work accidents and in physical violence, while older people are more susceptible to traffic accidents as pedestrians and to falls. The incidence in lower socio-economic groups is greater. CONCLUSIONS: The evidence-base for the primary prevention of head injury is weak. Standardized definitions and classification systems need to be used in future epidemiological studies to permit comparisons across studies. RELEVANCE TO CLINICAL PRACTICE: There is a role for public health nurses in developing primary prevention campaigns in schools and local communities. Key target groups are young men and older people and campaigns need to tackle the particular issues relevant to these groups.