Acquired Brain Injury

Many academic papers have attested to the shortfall in services for people with an acquired brain injury in the UK generally and have explained ways in which they can easily fall through any "therapeutic net" and return to the community having had insufficient treatment and with insufficient support (McMillan and Oddy 2001). An important study on a cohort of patients with traumatic brain injury was published by Thornhill, Teasdale, Roy et al (2000). The study presented data on admissions to Greater Glasgow Hospitals with traumatic brain injury in the period of one year. A representative sample of 550 cases was followed up one year post injury (currently a five year follow up of this sample is underway). Earlier studies have tended to exclude people with a history of drug and alcohol problems, psychiatric or previous significant head injury. The importance of the Thornhill et al study is that it included all cases and this best reflects the actuality that clinicians are faced with on a day to day basis.

 They found 3000 admissions to Greater Glasgow hospitals following TBI per annum. Approximately 500 remained in hospital for 48 hours or longer (160 transferred to neurosurgery) and of these 400 had associated problems. More than half of those admitted more than 48 hours were discharged in a week or less (n = 276/515) 16% were admitted for more than 4 weeks (n = 84), (Thornhill et al 2000, Kay et al 2001). Only a small proportion of cases admitted for more than 48 hours were aged over 70 (<10%, n = 45). More than 40% of cases (estimated 1400 people) were disabled one year after injury (including more than 40% of minor brain injuries). Despite the high and persisting incidence of disability only 47% of disabled survivors received hospital follow up and a minority had rehabilitation (28%) or contact from Social Services (15%).

It is difficult to predict future epidemiological trends because they depend to an extent on governmental priorities and investments. However, we know that improved road safety and improving standards of hospital care have had a positive impact on incidence. However, there has been a trend towards increasing crime (including assaults) and drug abuse, both of which are linked to TBI statistics. It is unlikely that there will be a further significant positive effect of medical care in the next 5 years, and probably not in terms of drug related crime, social deprivation and alcohol abuse. It is unlikely therefore that these figures will decline over the next 5 years.