Systematic Review and Meta-Analysis of Traumatic Brain Injury in First Responders.
The Journal of head trauma rehabilitation · 2026-07-14 · Meta-analysis
Abstract
OBJECTIVE: To conduct a systematic review and meta-analysis of studies examining the proportion of first responders (law enforcement and corrections officers, firefighters, and emergency medical services personnel) with traumatic brain injury (TBI). METHODS: This review is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was a priori registered in PROSPERO. Eligible observational and interventional studies reporting the proportion of first responders with TBI (lifetime history; job/career-related; job/training-related; event-related) were identified and data were abstracted by 2 independent reviewers (with disagreements resolved by a third reviewer) from systematic searches in 5 databases (PubMed, Embase, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], and Web of Science). Random-effects meta-analyses were performed when population-based denominators were available with between-study heterogeneity evaluated using I2. Risk of bias was assessed using an adapted Newcastle-Ottawa Scale. RESULTS: Twenty-three studies met inclusion criteria, with 5 contributing data to meta-analyses. Studies were heterogeneous in the method of TBI ascertainment, with some defining TBI from self-reported validated or unvalidated survey responses and others using medical or job-related administrative data to define TBI. Furthermore, definitions and language regarding the injury were heterogeneous between studies, with some studies referring to TBI (with or without loss of consciousness) and others referring to concussion or head injury/trauma. Among law enforcement and corrections officers, the pooled prevalence of lifetime TBI was 58.8% (95% confidence interval [CI]: 48.0%-69.6%; I2 = 91.5%), and the proportion with job/career-related TBI was 17.2% (95% CI: 5.8%-28.6%; I2 = 97.2%). Firefighters were found to have high self-reported lifetime TBI prevalence (62%-77%), although data were limited. Emergency medical service data were sparse and largely restricted to administrative or event-related reports. CONCLUSION: Traumatic brain injury is common among first responders, but studies are heterogeneous. Standardized TBI definition, surveillance, routine screening, and longitudinal occupational health monitoring are needed to address cumulative injury risk and inform prevention and policy.