In 2022, the American Association of Neurological Surgeons (AANS) joined the newly constituted Traumatic Brain Injury (TBI) Forum sponsored by the National Academies of Sciences, Engineering and Medicine (NASEM), with Shelly D. Timmons, MD, PhD, FACS, FAANS, as designated representative. The AANS is an important stakeholder organization with interest in improving the survival, outcomes and quality of life after TBI; participation in this forum is of paramount importance to our membership and patients. As a member of the forum, the AANS will provide a key voice in influencing health care and payor policies, informing future health care delivery systems and impacting clinical care, research and education about TBI. The forum is building upon the recommendations published by NASEM in “Traumatic Brain Injury: A Roadmap for Accelerating Progress,” a consensus study report published in 2022 and available online at https://nap.nationalacademies.org/25394. Neurosurgeons Odette A. Harris, MD, MPH, FAANS, Geoffrey T. Manley, MD, PhD, FAANS, and David O. Okonkwo, MD, PhD, FAANS, participated in the development of this document and are active in the forum.
As many as 55.9 million people globally are estimated to experience a mild TBI (as defined by GCS) annually, with 5.48 million experiencing a severe TBI. It is further estimated that worldwide, more than 55 million people are living with the effects of a medically treated TBI worldwide.
According to 2017 CDC data, in the United States, approximately 224,000 people are admitted annually to a hospital due to TBI in one year; however, only 13-25% of patients with moderate, severe or penetrating TBI received inpatient rehabilitation in the U.S. according to a report of data from the early 2000s. Well-documented disparities in access to care, according to sex, geography (rural), race and ethnicity, result in consequential disparities in outcome. The number of caregivers supporting people with TBI is increasing, requiring missed work, abandoned careers and emotional and financial strains, among other challenges. Yet, support for caregivers is largely unavailable.
For decades, TBI has been described as a “silent epidemic.” As injuries sustained by warfighters in the late 20th and early 21st Century increasingly entered the public discourse, awareness has grown. Likewise, articles in the lay press about TBI in sports have called attention to prevention efforts, appropriate diagnosis and return to activity protocols. However, public understanding and policy related to the long-term sequelae of TBI have lagged. TBI is increasingly recognized as a chronic condition for many whose injuries leave them with permanent functional challenges, ongoing medical needs and requirements for psychosocial support. Unfortunately, there is often a lack of financial and structural support for services that could optimize recovery and community reintegration. Coupled with a lack of recognition within the medical community at large about the potential for post-acute treatment of a variety of TBI sequelae, patients and their families are too frequently faced with barriers preventing access to appropriate care.
Given the sheer direct financial costs associated with TBI, and even greater indirect costs to society and families, our societal investments in the study and care of TBI are under-proportioned. As one example, the U.S., National Institutes of Health funding for injury research is historically below predicted levels of support based upon disease burden. It is incumbent upon public and private stakeholders familiar with the impact of injury to advocate for the resources necessary to optimize outcomes after TBI.
The NASEM TBI Forum is thus addressing, through a series of workshops, projects and publications, the recommendations outlined in the Roadmap report, namely:
- Update the TBI Classification Scheme
- Manage TBI as a Chronic Condition
- Consolidate and Support Clinical Practice Guidelines
- Enhance Public and Professional Awareness
- Develop TBI Care Systems
- Enhance TBI Data and a Learning Health System
- Expand TBI research
- Consolidate Leadership for National TBI Care Improvement
Through the ongoing involvement in the NASEM TBI Forum, the AANS will continue to support clinicians on the frontline of TBI care and enhance the life experiences of those individuals and families affected by TBI for decades to come. As the only neurosurgical organization participating in the forum, the AANS will continue to disseminate the lessons learned and work product of the forum to our members and patients and will have meaningful input into our nation’s approach to this vulnerable population.
