The study, led by researchers at Oregon Health & Science University and published in Nature Medicine, is one of the first large international investigations to compare traumatic brain injury patterns, clinical care and outcomes across countries at different levels of human development. The research team analyzed data from more than 2,000 patients treated at 100 hospitals in 29 countries between 2019 and 2022. Medical students helped collect standardized information, creating a broad dataset that allowed researchers to examine how injury causes and medical outcomes differed across national settings.

Motor vehicle crashes represented the largest single cause of traumatic brain injury across the global study population, but the pattern was far from uniform. The researchers found that the source of injury changed substantially depending on a country’s infrastructure, age distribution, transportation systems and access to emergency medical care. In wealthier countries, for example, ground-level falls were a major cause of traumatic brain injury among older adults. In other regions, crashes involving cars, motorcycles and other vehicles affected younger people and accounted for a larger proportion of severe injuries.

That contrast matters because traumatic brain injury is not a single disease with a universal solution. It is a broad clinical condition in which an external force disrupts normal brain function, damaging tissue directly or causing secondary injury through swelling, bleeding, reduced oxygen delivery and increased pressure inside the skull. A patient’s outcome can depend not only on the original impact but also on how quickly the injury is recognized, whether imaging and surgery are available, and how long it takes to reach a hospital capable of providing intensive neurological care.

“ You can’t solve a global brain injury crisis in operating rooms alone,” said senior author Ahmed Raslan, chair of neurological surgery at OHSU’s School of Medicine. The study indicates that prevention and emergency systems must be treated as part of brain-injury medicine. Road design, traffic enforcement, protective equipment and rapid ambulance networks can influence survival before a patient ever reaches a neurosurgeon. Once an injury occurs, minutes and hours can determine whether bleeding or swelling becomes irreversible.

One of the study’s most surprising observations was that countries classified as less developed appeared to have lower recorded rates of traumatic brain injury than more industrialized nations. The finding does not necessarily mean that fewer injuries occur in those countries. Instead, the researchers say it may reflect a serious measurement problem: people with catastrophic injuries in remote or impoverished areas may die before reaching a hospital and therefore never appear in hospital-based research. In some settings, the journey to emergency care can take days rather than hours, making the medical record an incomplete picture of the true burden.

This phenomenon, known as selection or survival bias, can make hospital data misleading. A hospital registry mainly captures people who survive long enough to receive treatment, while the most severely injured patients may disappear from the dataset before admission. The researchers’ comparison across human development index strata—an assessment incorporating indicators such as income, education and national economic conditions—therefore provides both useful information and a warning. Apparent differences in injury rates may reflect differences in transportation, reporting and access to care as much as differences in actual risk.

Lead author Joseph Nugent, a fourth-year resident neurosurgeon at OHSU, said his earlier work as a paramedic shaped the study’s emphasis on prevention. During his time in Baltimore, he transported many patients with traumatic brain injuries to hospitals, an experience that reinforced the limits of relying on specialist treatment after an injury has already occurred. He said that skilled neurosurgeons can accomplish a great deal, but public-health interventions may offer the greatest opportunity to prevent severe injury and improve outcomes across entire populations.

The appropriate intervention will depend on local circumstances. In Oregon, ground-level falls are the most common cause of traumatic injury treated at OHSU Hospital, making home safety, strength and balance programs, medication reviews and support for frail older adults potentially important tools. In countries where young people face a high risk of motorcycle or automobile crashes, priorities may include safer road engineering, helmet use, speed control, seat-belt enforcement and better emergency dispatch. The study’s central message is that policymakers should use local injury data rather than import a single global strategy.

The researchers describe their work as a foundation for a more precise international approach to traumatic brain injury. Future studies will need to improve data collection outside hospitals, include deaths that occur before admission and determine which prevention programs produce the largest reductions in disability and mortality. The project was supported by the National Center for Advancing Translational Sciences at the U.S. National Institutes of Health. By linking neurosurgery with transportation policy, emergency medicine and public health, the study argues that the global brain-injury crisis may be reduced most effectively before the first scan, ambulance ride or operation begins.

Subject of Research: People

Article Title: Traumatic brain injury outcomes across human development index strata in 29 countries

News Publication Date: 19-Aug-2026

Web References: https://www.nature.com/articles/s41591-026-04600-6; https://news.ohsu.edu/2023/11/16/ohsu-hosts-screening-event-launches-study-to-reduce-the-risk-of-ground-level-falls

References: Nature Medicine. DOI: 10.1038/s41591-026-04600-6

Keywords: traumatic brain injury, brain injuries, traumatic injury, public health, neurosurgery, road safety, helmet use, ground-level falls, emergency medical care, injury prevention

From 2017 to 2024, a total of 173 unplanned home or out-of-hospital deliveries were documented, with premature births—defined as those occurring before 37 weeks of gestation—accounting for approximately 9%. The most extreme case involved an infant born at just 26 weeks, weighing a mere 845 grams, emphasizing the precarious nature of these situations. Alarmingly, the mortality rate was high, with one-quarter of preterm infants succumbing shortly after birth, underscoring the urgency of improving pre-hospital neonatal care protocols.

This study sheds light on an often-overlooked aspect of emergency care: the adequacy of preparation, equipment, and training for medical personnel when confronted with rare but high-stakes events such as premature deliveries in non-hospital settings. The involvement of specialized neonatal transport teams and adherence to standardized emergency procedures are identified as critical factors that could mitigate morbidity and mortality.

One of the pivotal discoveries of the investigation was the variable approach to neonatal resuscitation and stabilization. Among the infants who did not survive, resuscitation attempts were absent in half the cases, highlighting a potential gap in emergency protocols or situational decision-making under duress. Conversely, successful pre-hospital intubation and ventilation in some instances demonstrate the life-saving potential of advanced neonatal interventions when appropriately executed.

Temperature regulation emerged as a vital prognostic facet frequently overlooked in initial emergency management. Of the premature infants admitted to hospitals, only a fraction had their admission temperatures recorded, with many presenting hypothermia, a condition known to exacerbate neonatal complications. Given that thermal instability can precipitate respiratory and metabolic distress, its management is now recognized as an essential component of neonatal emergency protocols.

The report emphasized the current limitations of emergency teams’ pediatric expertise. While most emergency physicians excel in adult care, fewer possess specialized training in neonatology. Recognizing this shortfall, the study advocates for regular, targeted training sessions focusing on neonatal emergencies and incorporation of paediatric-specific equipment into all emergency vehicles to ensure readiness for similar incidents.

Helena Leonhartsberger, a dual-trained paramedic and medical student specializing in neonatology, spearheaded the research after firsthand exposure to an out-of-hospital birth during her early paramedic training. Her experience catalyzed a deeper inquiry into how such critical events are managed and how systemic improvements can be instituted to better prepare emergency responders for the unpredictable landscape of premature labor outside hospital settings.

The research team, led by Professor Bernhard Schwaberger of the Medical University of Graz, meticulously analyzed factors such as gestational age, newborn weight, survival rates, and interventions performed in the pre-hospital setting. The median gestational age at birth was 35 weeks with a corresponding median birth weight of approximately 2390 grams, illuminating the spectrum of prematurity and the diverse care requirements these neonates necessitate immediately after birth.

Importantly, the study identifies a significant gap in documentation practices, particularly regarding vital signs and thermoregulation in neonates transported to hospitals. The median recorded temperature was below the normal physiological range, and temperatures as low as 31.5°C were noted—temperatures that fall markedly below the threshold for effective neonatal resuscitation and require urgent corrective measures.

Experts outside the study have underscored the global relevance of these findings. Dr. Felix Lorang, an emergency medicine specialist from Germany, highlighted that premature deliveries in uncontrolled environments require adherence to “High-Acuity Low Occurrence” (HALO) procedures. These protocols are vital for ensuring emergency teams are equipped not only with the correct technical skills but also with the necessary logistical support to manage infants born in unpredictable circumstances.

The broader implications of this research extend beyond the borders of Austria. Plans are underway to expand the geographic scope of data collection to identify differences in regional preparedness and practices, which could ultimately inform international standards. The integration of neonatal-specific equipment, such as portable incubators and advanced airway management tools, alongside comprehensive training programs, may be instrumental in reducing adverse outcomes in preterm out-of-hospital births worldwide.

Moreover, the study calls attention to public education on the risks associated with unplanned home births. While planned home deliveries can be safe under stringent conditions with professional oversight, unexpected or premature labor can rapidly devolve into emergency scenarios. Amplifying awareness among expectant mothers and families about the signs of premature labor and the importance of emergency preparedness may serve as a crucial adjunct to medical interventions.

In conclusion, this groundbreaking study presents a compelling case for systemic enhancements in the pre-hospital care of premature infants born unexpectedly outside a hospital setting. Through standardized protocols, continual medical education, and the deployment of specialized equipment, emergency medical services can better navigate the demanding scenarios posed by these births. The ultimate goal remains unwavering: to safeguard the health and survival of both mothers and their most vulnerable newborns, regardless of where delivery occurs.

Subject of Research: People

Article Title: Pre-hospital emergency care for preterm infants after unplanned out-of-hospital deliveries: a retrospective case series from Styria, Austria (2017–2024)

News Publication Date: 29-Sep-2025

References:
[1] Abstract no: OA122, “Pre-hospital emergency care for preterm infants after unplanned out-of-hospital deliveries: a retrospective case series from Styria, Austria (2017–2024)” by Helena Leonhartsberger, Pre-hospital session, Monday 29 September, 11:00-12:30 hrs CEST, Schubert 4 room

Image Credits: Helena Leonhartsberger

Keywords:
Premature birth, Obstetrics, Emergency medicine, Health care delivery, Home care, Emergency rooms, Hospitals, Midwifery, Prenatal care, Postnatal care, Miscarriage, Pregnancy complications