Severe neurotrauma in Switzerland: have short-term outcomes improved?

Neurotrauma has a high incidence in high-income countries (790 per 100,000 population per year) and can be considered a silent epidemic. Severe traumatic brain injury (TBI) is a major burden for societies and is associated with high costs for both immediate and long-term care. Population-based studies including patients with severe TBI are rare. A recent cohort study in Switzerland observed an incidence of 11 / 100,000 population / year. Mortality rate at 14 days post-injury was 30% in Switzerland and was associated with the severity of the injury and the age of the injured person. Thirty-five percent of patients were >65 years; in this subpopulation the incidence (22/100,000/year) and death rate (41%) were higher; this high proportion of elderly patients in this setting is new. A decrease in disability in the first year after TBI was observed in large multicentre cohort studies including the Swiss cohort study. There is some evidence that the speed of decrease of disability over time is associated with intensive neurorehabilitation. In conclusion, short-term outcome may have improved for younger patients over recent years, but this improvement may be masked by the higher proportion of elderly patients with less favourable outcomes. Additionally, we propose that clinical pathways from the prehospital period to rehabilitation could be improved, and in turn allow a higher level of positive outcomes not only in young but also in elderly patients.