[Current clinical trends in brain trauma--Japan Neurotrauma Databank]

Traumatic brain injury is one of the subjects that always arouse intense attention from emergency medicine. In the latter half of the 1960s, death by traffic accidents had drastically increased in Japan and, this period was called "the age of traffic war". Traumatic brain injury was considered to be one of the major causes of traffic death, and the need for neurosurgeons was widely recognized. It should be kept in mind that such a social condition acted as a trigger for the foundation of the Japan Society of Neurotraumatology (JSNT) in 1978. The 1970s were also remarkable because CT scan brought about radical changes in the diagnosis and management of brain diseases. Since the 1970s, CT scan has been rapidly and constantly advancing and is now considered an essential and reliable diagnostic technique, even in emergency medicine. In 1998, the Japan Neurotrauma Data Bank Committee (JNTDB) was established as a part of the JSNT. The aim of this committee is to conduct an epidemiologic research on the epidemiology of traumatic brain injuries in Japan. After conducting a pilot study in 1997, a nationwide investigation was conducted for 3 years from 1998 to 2001, at 10 emergency medical centers. The investigation is now referred to as "Project 1998". Subsequently, Project 2004 was performed over a period of 2 years, from 2004 to 2006, at 19 emergency medical centers. In April 2009, we initiated another investigation called Project 2009 at 23 emergency medical centers and it is planned to be completed in 2011. In 2000, JNST released the first version of the Guideline for Severe Brain Injury and aroused social attention widely. In 2006, the revised version was issued as the Guideline for Severe Brain Injury 2nd version. Since that we have been reviewing the guideline and are currently preparing for the 3rd version. This time, we report on actual incidences of traumatic brain injury in Japan. We have compared 1,002 cases from Project 1998 with other 1,101 cases from Project 2004. We think that it is essential for neurosurgeons engaging in emergency medicine to make a continuous effort to wards accumulating data regarding traumatic brain injury and improving the guideline.