title: Epidemiology and clinical characteristics of traumatic brain injury in Lebanon: A systematic review.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a debilitating medical and emerging public health problem that is affecting people worldwide due to a multitude of factors including both domestic and war-related acts. The objective of this paper is to systematically review the status of TBI in Lebanon - a Middle Eastern country with a weak health system that was chartered by several wars and intermittent outbursts of violence - in order to identify the present gaps in knowledge, direct future research initiatives and to assist policy makers in planning progressive and rehabilitative policies.
  
  
  METHODS
  OVID/Medline, PubMed, Scopus databases and Google Scholar were lastly searched on April 15, 2016 to identify all published research studies on TBI in Lebanon. Studies published in English, Arabic or French that assessed Lebanese patients afflicted by TBI in Lebanon were warranting inclusion in this review. Case reports, reviews, biographies and abstracts were excluded. Throughout the whole review process, reviewers worked independently and in duplicate during study selection, data abstraction and methodological assessment using the Downs and Black Checklist.
  
  
  RESULTS
  In total, 11 studies were recognized eligible as they assessed Lebanese patients afflicted by TBI on Lebanese soils. Considerable methodological variation was found among the identified studies. All studies, except for two that evaluated domestic causes such as falls, reported TBI due to war-related injuries. Age distribution of TBI victims revealed two peaks, young adults between 18 and 40 years, and older adults aged 60 years and above, where males constituted the majority. Only three studies reported rates of mild TBI. Mortality, rehabilitation and systemic injury rates were rarely reported and so were the complications involved; infections were an exception.
  
  
  CONCLUSIONS
  Apparently, status of TBI in Lebanon suffers from several gaps which need to be bridged through implementing more basic, epidemiological, clinical and translational research in this field in the future.
authors.affiliation: Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center Faculty of Medicine, Beirut Arab University Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut Faculty of Medicine, American University of Beirut Medical Center Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University Faculty of Medicine-Hariri School of Nursing, American University of Beirut, Beirut, Lebanon Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy Department of Emergency Medicine, American University of Beirut Medical Center Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
authors.forename: Hussein
authors.initials: H
authors.lastname: Abou-Abbass
authors.forename: Hisham
authors.initials: H
authors.lastname: Bahmad
authors.forename: Hiba
authors.initials: H
authors.lastname: Ghandour
authors.forename: Jawad
authors.initials: J
authors.lastname: Fares
authors.forename: Rayyan
authors.initials: R
authors.lastname: Wazzi-Mkahal
authors.forename: Basel
authors.initials: B
authors.lastname: Yacoub
authors.forename: Hala
authors.initials: H
authors.lastname: Darwish
authors.forename: Stefania
authors.initials: S
authors.lastname: Mondello
authors.forename: Hayat
authors.initials: H
authors.lastname: Harati
authors.forename: Mazen J
authors.initials: MJ
authors.lastname: El Sayed
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.forename: Firas
authors.initials: F
authors.lastname: Kobeissy
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000628:therapy; D054625:Healthcare Disparities; D006801:Humans; D007861:Lebanon / Q000453:epidemiology