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Int J Surg
Int J Surg
JS9
International Journal of Surgery (London, England)
1743-9191
1743-9159
Lippincott Williams & Wilkins Hagerstown, MD

38768479
IJS-D-24-01848
10.1097/JS9.0000000000001659
00078
3
Correspondence
Letter to the Editor: Focusing on the prevention and secondary brain injury of traumatic brain injury: a heavy challenge for the brain
Xu Lingjia MM ahsulingchia@163.com

Pan Yunyun BD sxeypyy@163.com
b*
a Department of Neurology, Shaoxing Second Hospital
b Department of Emergency Internal Medicine, Shaoxing Second Hospital, Shaoxing, Zhejiang, People’s Republic of China
* Corresponding author. Address: Department of Emergency Internal Medicine, Shaoxing Second Hospital, Shaoxing 312000, Zhejiang, People’s Republic of China. Tel.: +86 138 195 206 57. E-mail: sxeypyy@163.com (Y. Pan).
9 2024
20 5 2024
110 9 58935894
3 5 2024
8 5 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

OPEN-ACCESSTRUE
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pmc Dear Editor,

Traumatic brain injury (TBI) is a huge public health challenge, with high morbidity and mortality not only leading to loss of personal health and disability but also a heavy burden on families, social health care systems, and the economy.

We reviewed recent studies published by Ye et al.1 and Muili et al.2 in International Journal of Surgery. Ye and his team employed bibliometrics and Latent Dirichlet Allocation analyses to examine publications focusing on TBI. In summary, the hotspots in TBI research encompassed four main areas: ‘clinical findings,’ ‘molecular mechanisms,’ ‘epidemiology,’ and ‘prognosis.’ Among these, the epidemiology of TBI garnered the most attention. This is because approaches to reducing the incidence of TBI through prevention are emerging as crucial strategies to alleviate the societal burden of this condition in the future.

The study by Muili et al., aimed to provide a comprehensive overview of the current state of TBI management in Sub-Saharan Africa, focusing on the unique challenges and potential opportunities for improvement. The findings highlighted several key challenges, including limited resources, inadequate infrastructure, and a lack of trained healthcare professionals. In addition, the study identified potential opportunities to improve the management of TBI in Sub-Saharan Africa. These included strengthening healthcare infrastructure, pre-hospital emergency care and transportation systems, and increasing public awareness and education about TBI. However, in light of Ye’s research and his team’s findings, it was crucial to focus on preventing TBI. Here are some key strategies for TBI prevention: Enhance road safety measures and enforce traffic regulations strictly to lower the incidence of traffic accidents. Always wear a helmet while engaging in activities such as cycling and motorcycling. Use appropriate safety gear when participating in high-risk sports to minimize the risk of sports-related injuries. Adopt safety measures to reduce the likelihood of falls, including the removal of hazards at home, the use of anti-slip mats and grab bars, and the installation of railings and grab bars outdoors. We believe that these measures are also suitable for preventing TBI in Sub-Saharan Africa. However, implementing these preventive measures necessitates the collaborative support of various stakeholders, including the government, the economy, and the public, and is not a simple or immediate task. Therefore, the treatment of TBI should also be given significant attention.

There are numerous contradictions in the management of TBI that require resolution. Specific focus should be directed toward the prevention and management of secondary brain injuries following TBI, which include cerebral ischemia and hypoxic injuries, inflammatory responses, metabolic dysfunctions, and cerebral edema – all of which contribute to a poor prognosis. Consequently, special emphasis should be placed on developing neurocritical care to maintain an optimal state of cerebral blood flow perfusion, balance intracranial pressure with cerebral blood flow and metabolism, and thereby alleviate secondary brain injury3,4.

Overall, TBI presents a significant medical challenge that imposes serious family and social burdens. Understanding the epidemiology of TBI allows for the reduction of its incidence through preventive measures. Furthermore, comprehending the pathophysiological mechanisms, diagnostic methods, and treatment strategies for TBI, as well as the prevention of complications, can significantly enhance the clinical outcomes of patients.

Ethical approval

Not applicable.

Consent

Not applicable.

Sources of funding

This study was supported by the Medical and Health Science and Technology Project of Zhejiang Province (Grant No. 2024KY492).

Author contribution

L.X.: writing; Y.P.: study design.

Conflicts of interest disclosure

There are no conflicts of interest.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Lingjia Xu and Yunyun Pan.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Provenance and peer review

Not applicable.

Acknowledgements

Assistance with the study: none.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 20 May 2024
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References

1 Ye Z Li Z Zhong S . The recent two decades of traumatic brain injury: a bibliometric analysis and systematic review. Int J Surg (London, England) 2024. [Epub ahead of print]. doi:10.1097/JS9.0000000000001367
2 Muili AO Kuol PP Jobran AWM . Management of traumatic brain injury in Africa: challenges and opportunities. Int J Surg (London, England) 2024. [Epub ahead of print]. doi: 10.1097/JS9.0000000000001391
3 Godoy DA Murillo-Cabezas F Suarez JI . “THE MANTLE” bundle for minimizing cerebral hypoxia in severe traumatic brain injury. Crit Care (London, England) 2023;27 :13.
4 Meyfroidt G Bouzat P Casaer MP . Management of moderate to severe traumatic brain injury: an update for the intensivist. Intensive Care Med 2022;48 :649–666.35595999
