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The main causes of brain and spinal cord injury Although the data is very comprehensive, Dr James points out that it doesn’t make it any easier to distil results into simple statements. You still need to consider all relevant variables at once, such as age patterns and trends with time. Generally however, across most regions of the world, the most predominant cause of TBI and SCI is falls, followed by motor vehicle accidents. One exception is the higher rates of TBI and SCI found in regions with a lot of conflict. “It’s a complicated topic and I think that falls are an interesting cause in particular because, in some sense, falls are one of the original causes of health loss in the population. Anyone can fall – it doesn’t matter if you’re young or old, healthy or sick, male or female – and suffer really traumatising injuries.” The challenge of prevention Since everyone is at risk of falls, the task of preventing them is far from straightforward. In the elderly you might focus on their environment and medications, while a focus on risk-taking and alcohol consumption might be more relevant for young adults. “When I consider elderly people, I’m worried about their built environment. I’m worried about whether they have hand rails next to their bathrooms. Are they on medications that can cause them to have low blood pressure and cause a fall? Are they walking around without a walker? “Conversely, we see a really high burden of TBI in certain other age groups, such as younger people aged from 15 to 30. I think that is probably more related to risk-taking, including people becoming intoxicated and acting in risky ways.” Recently, there has been a lot more emphasis in the global community on the risk of alcohol. While the main focus is on diseases like alcoholic cirrhosis, Dr James sees a need to communicate the severity of other alcohol-related injuries, such as falls and motor vehicle accidents. “As roads are built and people start driving, there is an increase in the number of road injuries causing TBI and SCI. As the economy catches up, healthcare systems are built and safe driving laws are passed, which can be associated with a decline or plateau in incidence rates.” “I think that education about the more severe injuries that can happen with intoxication is a really important consideration for the public health community, the global health community and the medical community.” The effect of economic development Over the past three decades, many countries have experienced rapid increases in GDP and other income measures. Dr James’ team has begun to investigate the effect this has had on TBI and SCI rates. Imagine a country where there aren’t many roads, and vehicle ownership is low, then suddenly there is a lot of economic development. As roads are built and people start driving, there is an increase in the number of road injuries causing TBI and SCI. As the economy catches up, healthcare systems are built and safe driving laws are passed, which can be associated with a decline or plateau in incidence rates. “It is good to see that while economic development can initially increase the incidence of road injuries, ultimately healthcare and infrastructure can catch up and ideally curtail the increase in some areas.” Next steps for the study TBI has a large spectrum of severity, but only the moderate-to-high end of the spectrum is generating data. A lot of less-severe concussions go undocumented. For example, children playing sport and people who have been in a minor car accident or had a minor fall. When someone hits their head and has a bit of a headache, but they’re not having seizures, passing out or experiencing neurological deficits, the data isn’t collected because they didn’t seek medical help. “With our current study design we don’t identify the patients who never sought medical care for a head injury. Including these people is a very important direction for our study going forward, since there is now emerging research about how traumatic brain injury can be a risk factor for Alzheimer’s disease and other dementia conditions.” Headlines 13