Severe Pediatric TBI Management in a Middle-Income Country and a High-Income Country: A Comparative Assessment of Two Centers

Abstract

Background: Traumatic brain injury (TBI) is a global public health issue with over 10 million deaths or hospitalizations each year. However, access to specialized care is dependent on institutional resources and public health policy. Phoenix Children's Hospital USA (PCH) and the Neiva University Hospital, Colombia (NUH) compared the management and outcomes of pediatric patients with severe TBI over 5 years to establish differences between outcomes of patients managed in countries of varying resources availability.Methods: We conducted a retrospective review of individuals between 0 and 17 years of age, with a diagnosis of severe TBI and admitted to PCH and NUH between 2010 and 2015. Data collected included Glasgow coma scores, intensive care unit monitoring, and Glasgow outcome scores. Pearson Chi-square, Fisher exact, T-test, or Wilcoxon-rank sum test was used to compare outcomes.Results: One hundred and one subjects met the inclusion criteria. NUH employed intracranial pressure monitoring less frequently than PCH (p = 0.000), but surgical decompression and subdural evacuation were higher at PCH (p = 0.031 and p = 0.003). Mortality rates were similar between the institutions (15% PCH, 17% NUH) as were functional outcomes (52% PCH, 54% NUH).Conclusions: Differences between centers included time to specialized care and utilization of monitoring. No significant differences were evidenced in survival and the overall functional outcomes.

Traumatic Brain Injury Mortality and Correlates in Low- and Middle-Income Countries: A Meta-Epidemiological Study

“…10 Factors contributing to such disparity are multiple including limited access to neurosurgical services, technology, and fewer resources to create a multidisciplinary approach to care in the hospitals. 11,12 In addition, even in the presence of hospital technology, LMICs experience a limited amount of labor force to carry out other elements that are reported to influence outcomes after TBI such as intracranial pressure and cerebral perfusion monitoring. 13 Along these lines, it is important to note that 23 of 24 TBI clinical practice guidelines originate from HIC and only one from an LMIC, which scored as the lowest quality guideline among the others.…”

“…1,2 Low- and middle-income countries (LMICs), which contain 85% of the world's population and the highest prevalence of TBI, face some of the greatest barriers to organized reporting and data collection. 11 This challenge has recently been addressed by groups such as the Global Neurotrauma Outcomes and Global Neurosurgery collaborative who are working to collect TBI data across LMICs.…”

“…1 Patients suffering from TBI in LMICs have more than twice the likelihood of dying from severe TBI and an increased degree of morbidity after mild-to-moderate TBI compared with HICs. 11 Factors contributing to a poorer outcome include limited access to medical care at the time of injury and diminished resources within hospitals. This study aims to provide current data on TBI-related mortality in LMICs and assess the role of country-based socioeconomic and demographic parameters on outcomes after TBI.…”

“…1 Patients suffering from TBI in LMICs have more than twice the likelihood of dying from severe TBI and an increased degree of morbidity after mild-to-moderate TBI compared with HICs. 11 Factors contributing to a poorer outcome include limited access to medical care at the time of injury and diminished resources within hospitals. This study aims to provide current data on TBI-related mortality in ABBREVIATIONS: AFR, Africa Region; AMLR, Americas Region; EMR, European Region; EVD, external ventricular drain; GCS, Glasgow Coma Scale; GDP, gross domestic product; GNI, gross national income; HIC, high-income countries; LMIC, low-and middle-income Country; SEAR, South East Asian Region; SES, socioeconomic status; TBI, traumatic brain injury; WPR, Western Pacific Region.…”