Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads

Karthigeyan, Madhivanan; Gupta, Sunil; Salunke, Pravin; Dhandapani, Sivashanmugam; Wankhede, Lomesh; Kumar, Anurodh; Singh, Ashutosh; Sahoo, Sushanta K.; Tripathi, Manjul; Gendle, Chandrashekhar; Singla, Rohit; Aggarwal, Ashish; Singla, Navneet; Mohanty, Manju; Mohindra, Sandeep; Chhabra, Rajesh; Tewari, Manoj Kumar; Jain, Kajal

doi:10.1007/s00701-021-04908-x

Cited by 12 publications

(5 citation statements)

References 39 publications

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“…The predominance of traumatic brain injury as a leading cause of ICU deaths among neurological patients as shown in this study has been reported in many studies locally and internationally (4,(14)(15)(16). It is important, therefore, to strengthen preventive measures of TBI especially those targeting reduction of road traffic accidents as suggested by Olajumoke et al, Karthigeyan et al and other researchers (4,(17)(18)(19). Deranged biochemical profiles, sepsis and some of the other abnormal clinical parameters found in our patients have been shown to be responsible for unfavourable outcomes among patients with critical illnesses and in neurosurgical ICU admissions in previous studies including PREDICT -a multicenter metropolitan ICU study in Australia, and by Ramesh et al in a neurosurgical ICU at a tertiary-care university hospital in India (20,21).…”

Section: Discussionsupporting

confidence: 63%

Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Rabiu¹,

Uthman²,

Folami³

2023

REJHS

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Background: Neurosurgical patients are the most critical ICU admissions. While advancements in neurosurgical ICUs (NICU) have improved outcomes of care globally, ICU mortality remains a major clinical issue in developing nations. This study evaluates ICU mortalities of neurosurgical patients in a general ICU setting at the UNIOSUN Teaching Hospital, Osogbo, Nigeria. Method: Case records of neurosurgery patients who died in the ICU of UNIOSUN Teaching Hospital, Osogbo, South-Western, Nigeria from June 2012 to May 2022 were reviewed. Simple descriptive statistics of data on demographics, clinical diagnoses, management and outcome were done. Results: Mortality rate was 38.9% (84 of 216 admissions). Males were 67(79.8%) and the mean age was 41.5years (Range: 2-85years). The average duration of ICU stay was 3.5days (Range: 30minutes-20days). Most patients had severe traumatic brain injury (TBI) (62, 73.8%). This was followed by cerebrovascular diseases (12, 14.3%) and brain tumours (6, 7.1%). Two had brain abscess. One patient each had mixed subacute/chronic subdural haematoma and severe cervical spondylotic myelopathy. Of the 69 whose case files were found, 7(10.1%) had a diagnosis of brainstem death before eventual 'final' death after an average of 13.5 additional hours on mechanical life support. The identified secondary causes of death included raised ICP, sepsis, primary surgical haemorrhage, seizures, acute kidney injury, malignant hypertension, poor glycaemic control and aggressive blood pressure lowering. Only 1 patient had autopsy. Conclusion: Most ICU mortalities among neurosurgical patients were from severe TBI. The establishment of NICU is necessary to improve outcome of care of neurosurgical patients.

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Section: Discussionsupporting

confidence: 63%

Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Rabiu¹,

Uthman²,

Folami³

2023

REJHS

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“…The clinical interventions required by these head-injured patients, and their associated costs, are critical factors for stakeholders, policymakers and funders to consider as they strategize and prioritize the needs of (14), Rwanda (11), and Nigeria (13,21,24,26), which show an increased and increasing burden of head injuries across the African continent and expose the vulnerability of Africa's growing populations to transport/road trafficrelated head injuries. Rapid global expansion, infrastructure development, and increasing motorization across the African continent have collided with extensive deterioration of national road infrastructures, which has resulted in a daily deluge of road-traffic-related cases of HI in most clinical facilities (24,26,27). Ironically, after their injuries, most patients in our study were transported across the same, suboptimal road infrastructures to the hospital facilities via taxis/commercial vehicles rather than ambulances, threatening their chances for survival.…”

Section: Discussionmentioning

confidence: 92%

“…Mode of arrival may not impact those with "mild" or moderate head injuries (who were often discharged without consequence). However, for those with more severe head injuries, ambulance transport could improve their chances for survival by reducing the "golden hour" (27,28). In our study, a more significant proportion of head-injured patients arrived at the hospital dead or unconscious, and head-injured patients had 13 times the odds of mortality compared to those without head injuries (OR: 13.3; 95% CI: 8.05, 22.0; p < 0.0001) yet ambulance use was greater in the head-injured than the non-head injured group.…”

Section: Discussionmentioning

confidence: 99%

Head Injury Prevalence in a Population of Injured Patients Seeking Care in Ghana, West Africa

et al. 2022

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Background/Significance:Much of the literature on head injury (HI) prevalence comes from high-income countries (HICs), despite the disproportionate burden of injuries in low to middle-income countries (LMICs). This study evaluated the HI prevalence in the Kintampo Injury Registry, a collaborative effort between Kintampo Health Research Centre (KHRC) in Ghana and the sidHARTe Program at Columbia University Mailman School of Public Health. In our first aim, we characterize the HI prevalence in the registry. In aim 2, we examine if there are any sex (male/female) differences in head injury outcomes in these populations for points of potential intervention.MethodsSecondary analysis of data from the Kintampo Injury Registry which had 7,148 registered patients collected during January 2013 to January 2015. The definition of a case was adopted to ensure consistency with the International Statistical Classification of Diseases and Related Health Problems, revision 10 (ICD-10). A 3-page questionnaire was used to collect data from injured patients to include in the registry. The questions were designed to be consistent with the World Health Organization (WHO) guidelines on injury surveillance and were adapted from the questionnaire used in a pilot, multi-country injury study undertaken in other parts of Africa. The questionnaire collected information on the anatomic site of injury (e.g., head), mechanism of injury (e.g., road traffic injuries, interpersonal injuries (including domestic violence), falls, drowning, etc.), severity and circumstances of the injury, as well as precipitating factors, such as alcohol and drug use. The questionnaire consisted mainly of close-ended questions and was designed for efficient data entry. For the secondary data analyses for this manuscript, we only included those with “1st visit following injury” and excluded all transfers and follow-up visits (n = 834). We then dichotomized the remaining 6,314 patients to head injured and non-head injured patients based on responses to the variable “Nature of injury =Head Injury”. We used chi-square and Fisher's exact tests with p < 0.05 as cut-off for statistical significance. Logistic regression estimates were used for effect estimates.ResultsOf the 6,314 patients, there were 208 (3.3%) head-injured patients and 6,106 (96.7%) patients without head injury. Head-injured patients tended to be older (Mean age: 28.9 +/-13.7; vs. 26.1 +/- 15.8; p = 0.004). Seven in 10 head injured patients sustained their injuries via transport/road traffic accidents, and head-injured patients had 13 times the odds of mortality compared with those without head injuries (OR: 13.3; 95% CI: 8.05, 22.0; p < 0.0001) even though over half of them had mild or moderate injury severity scores (p < 0.001). Evaluation of sex differences amongst the head-injured showed that in age-adjusted logistic regression models, males had 1.4 times greater odds of being head injured (OR: 1.4; 95% CI: 1.04, 2.00; p = 0.03) and over twice the risk of mortality (OR: 2.7; 95% CI: 0.74, 10.00; p = 0.13) compared to females.ConclusionIn these analyses, HI was associated with a higher risk of mortality, particularly amongst injured males; most of whom were injured in transport/road-traffic-related accidents. This study provides an impetus for shaping policy around head injury prevention in LMICs like Ghana.

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“…Falls account for an increasing number of TBIs as the population ages [53] (70% of all TBIs in people over 65 [53]); almost half of all TBI-related hospitalizations in the U.S. are now related to falls, surpassing motor vehicle accidents [54]. Epidemiological studies in other parts of the world reflect a similar shift in the etiology of TBI toward falls in concert with an increasingly aging population [55,56], though motor vehicle accidents continue to be the most common mechanism of TBI in LMICs [57]. This is consistent with our findings that, while falls were the second most common cause of injury in both cohorts, they were far more common in the U.S. than in Latin America.…”

Section: Discussionmentioning

confidence: 99%

Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America

Juengst

Perrin

Klyce

et al. 2022

IJERPH

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Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.

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Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads

Cited by 12 publications

References 39 publications

Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Intensive care unit deaths among neurosurgery patients in a tertiary hospital in South Western Nigeria

Head Injury Prevalence in a Population of Injured Patients Seeking Care in Ghana, West Africa

Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America

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