The following is a summary of “Head Trauma in Refugees and Asylum Seekers,” published in the May 2023 issue of Neurology by Saadi, et al.
Refugees and asylum seekers face a high risk of head trauma due to the challenging circumstances they experience, such as torture, war, interpersonal violence, and dangerous journeys. For a study, researchers sought to assess the global prevalence of head trauma in refugees and asylum seekers and describe its clinical characteristics within this population.
The PROSPERO International Prospective Register of Systematic Reviews registered the study protocol. A comprehensive search was conducted in PubMed/MEDLINE, PsycInfo, Web of Science, Embase, and Google Scholar databases to identify relevant studies. The inclusion criteria comprised English studies involving refugees or asylum seekers of any age and examined the prevalence or characteristics of head trauma.
Non-peer-reviewed studies were excluded. Data on head trauma prevalence, methods of ascertaining head trauma, severity, mechanism of injury, other trauma exposures, and comorbidities were collected.
Descriptive analyses and narrative syntheses were performed. A total of 22 studies met the inclusion criteria, with 13 reporting head trauma prevalence in 6,038 refugees and asylum seekers. Prevalence estimates ranged from 9% to 78%, and heterogeneity among studies precluded meta-analysis. Most studies were conducted in the United States (n = 9, 41%), followed by the Middle East (n = 5, 23%). Most participants were from the Middle East (n = 9, 41%), while those from Latin America were the least represented (n = 3, 14%). The studies predominantly included younger adult samples, primarily composed of men (pooled mean age = 29 years). Recruitment settings were mainly hospitals/clinics (n = 14, 64%), with a smaller number conducted in refugee camps (n = 3, 14%). The most common mechanism of injury reported was direct impact through beatings or blows to the head. There was significant variation among studies in how head trauma was defined and ascertained, with no study utilizing a validated screening tool specific to traumatic brain injury (TBI). TBI severity was also assessed inconsistently, with hospital-based samples capturing more moderate-to-severe head injuries. Mental health comorbidities were more frequently documented than physical health comorbidities. Only two studies included a comparison with local populations.
The study highlighted the vulnerability of refugees and asylum seekers to head trauma, although systematic approaches to screening were lacking. Increased attention to head trauma within displaced populations is crucial for optimizing equitable care for this growing vulnerable population.