Neurotrauma in Pakistan

Abstract

The incidence of head and spinal injury is on the rise in developing countries. The number of deaths and burden of disability may be reduced, if not completely stopped, through preventive measures after an epidemiological survey on trauma. The goal can be achieved to a significant extent through the use of guidelines from the countries that have achieved a reduction in the incidence of neurotrauma. To determine the incidence and outcome of neurotrauma in developing countries, a study was necessary using standardized assessment parameters for global interpretation. Such a study was conducted to determine the sociodemographic characteristics, morbidity, and mortality of patients with head and spinal injury admitted to various neurosurgical centers in Pakistan from July 1, 1995 to June 30, 1999. A total of 260,000 patients were admitted with head injury over a 4-year period. The majority of patients presented during second decade (i.e., 33.2%) followed by first and third decade. There were 195,000 (75%) males, and 65,000 (25%) females with a ratio of 3:1. Road traffic accident was the commonest cause of head trauma. Mild, moderate, and severe head injury was observed in 135,200 (52%), 78,000 (30%), and 46,800 (18%) patients, respectively. Conservative management was carried out in 176,800 (68%) patients. Surgery was required in 83,200 (32%), 50% of which had depressed skull fracture, simple or compound. Follow-up period varied from 2 months to 2 years with a mean of 11 months. Patient's outcome was assessed according to Glasgow Outcome Scale (GOS). Good outcome was observed in 174,200 (67%). The total mortality was 46,800 (18%). In this study, 2654 patients ranging in age from 5 to 70 years had spinal injuries. There were 1922 males (72%) and 732 (28%) females. British Medical Research Council Scale was used for assessment of motor power of patients with spinal trauma. Of these, 780 patients (29%) had complete spinal cord injury. Surgical intervention was performed in 1800 patients (68%) and the rest were managed conservatively.

Epidemiology of Traumatic Spinal Cord Injury in Developing Countries: A Systematic Review

“…Also, Iran has one of the highest mortality rates due to MVCs [74]. However, in 2 reports from Nepal [39] and Pakistan [50], falls accounted for more than 80% of SCI patients. Bangladesh has one of the highest SCI rates due to falls [12].…”

“…China [23] and Pakistan [50] reported the highest rate of cervical injury (71.5 and 68%, respectively). With respect to the classification of SCI (complete vs. incomplete), 19 countries reported complete and incomplete SCIs (table 1).…”

“…1) [8,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73] related to the 28 developing countries all around the world. Tables 1 and 2 show the study period, number of patients, age, sex, level of injury, completeness of SCI and etiology.…”

Surgical management of traumatic extra dural hematoma in children: Experiences and analysis from 24 consecutively treated patients in a developing country

“…According to an estimate, there is only one neurosurgeon for 1.37 million population and 35 neurosurgical centers in our country, which has a total population of more than 180 million. [22] An effective emergency transport system is lacking, especially in the rural areas. Some of our patients present after a major time delay without having been initially diagnosed or managed.…”

Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan

“…Two independent population-based surveys estimated the incidence of Road Traffic Injuries (RTIs) to be around 15 to 17 per 1 000 persons per year [4,5]. These injuries contributed significantly to the workload in hospitals, leading to direct costs to the Pakistani economy of over one billion US dollars [6,7]. …”