Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from rural setup of a developing country

Abstract

Introduction:Traumatic brain injuries (TBI) are steadily increasing and are a major cause of mortality and morbidity, particularly in the young population, leading to the loss of life and productivity in the developing countries. Providing critical care to these patients with TBI is a challenge even in well-advanced centers in major cities of India. In the present study, we describe our experience of resource utilization in the management of TBI in a critical care unit (CCU) from a rural setup.Materials and Methods:All consecutive patients who were admitted from January 2007 to December 2009 in the CCU for the management of traumatic brain injury were included in the study. The case records of the patients were reviewed retrospectively, and data were collected on age, gender, severity of head injury, associated injuries, total CCU stay, total hospital stay, and outcome.Results:The total duration (days) of hospital stay was 8.96±6.16 days and a median of 8 days, and CCU stay was 3.77±6.34 days with a median of 2 days. No deaths occurred with mild head injury. A total of 73 (19.16%) deaths occurred in 381 admitted subjects in CCU. The risk of death among both the sexes is not significantly different, that is, odds ratio (OR) 1.032 [95% confidence interval (CI) 0.351–3.03], so also the risk of death among the different age groups is also not significant having OR, 0.978 (95% CI, 0.954–1.00). The severity of head injury (mild, moderate, and severe) and CCU stay parameters had significant difference with risk of death [OR, 3.22 (95% CI, 2.49–4.16) and OR, 2.50 (95% CI, 1.9–3.2)].Conclusions:Apparently it seems possible to use the existing health care structures in rural areas to improve trauma care. It becomes particularly relevant in poor resource, developing countries, where health care facilities and access to specialized care units are still far below the acceptable standard, there is a need to compare with the reference group to further support the evidence.

Head Injury-A Neglected Public Health Problem: A Four-Month Prospective Study at Jimma University Specialized Hospital, Ethiopia

“…Another reason for the low percentage of this group is their frequent habit of early self-discharge before proper records are taken. The overall mortality rate of 21.2% and the mortality rate of 57.9% in severe head injuries are similar to other studies conducted in Nigeria, Kenya, Benin and India (18, 19, 21, 23, 25). Initial GCS and pupilary reaction have been identified as valid outcome predictors in this study like in many other studies (17, 18).…”

“…Fractures other than skull fractures were identified as the most common further injury in this and other studies from Kenya (18) and India (25). For example, a motor impairment of a limb caused by an inadequately treated fracture can lead to a disability and reduction of workforce affecting a whole family.…”

“…This corresponds to various studies on trauma or head trauma in Africa [15, 18, 21, 22, 23, 24]. Agrawal et al suggested that this is because females, elderly people and children rather staying in the house and therefore getting less exposure to risk factors leading to injury [25]. The injury or death of young male members of the population causes social and economic difficulties because they are often the breadwinners of the whole family.…”

Causes of head injury in Dr. Hasan Sadikin General Hospital Bandung in 2015

“…2 The result in this study may be due to the less exposure to risk factors of HI in females as they prefer to stay in the house compared to males. 15 RTA was the highest cause of HI for both male and female in this study. This is different compared to a study in Scotland where falls is the highest cause of HI for both male and female.…”

An exploratory analysis of transfer times in a rural trauma system

“…Alternatively, if poorer outcomes are tied to nearby hospitals with shorter transport times, exploration of facility-specific performance issues may be indicated. Development of trauma systems that deliver timely care in rural areas of industrialized countries may also inform the development of trauma systems in developing nations, where resources are likely to be limited,[ 12 ] and patient transport times in excess. [ 13 ]…”