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

Naik, Anant; Bederson, Maria; Detchou, Donald K E; Dharnipragada, Rajiv; Hassaneen, Wael; Arnold, Paul M.; Germano, Isabelle M.

doi:10.1227/neu.0000000000002479

Cited by 11 publications

(5 citation statements)

References 32 publications

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“…Each year, 50 million TBIs occur in LMICs, compared to 18 million in high-income countries ( 7 ). Within LMICs, TBI is a significant cause of hospitalization, death, and disability ( 8 , 9 ), and the mortality rate from TBIs is 3–4 times higher than the reported rate in high-income countries ( 10 ). Additionally, LMICs have greater odds of disability and twice as much death from severe TBI ( 5 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Extended tests for evaluating post-traumatic brain injury deficits in resource-limited settings: methods and pilot study data

Semework,

Laeke,

Aklilu

et al. 2024

Front. Neurol.

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IntroductionTraumatic brain injury (TBI) is one of the leading causes of all injury-related deaths and disabilities in the world, especially in low to middle-income countries (LMICs) which also suffer from lower levels of funding for all levels of the health care system for patients suffering from TBI. These patients do not generally get comprehensive diagnostic workup, monitoring, or treatment, and return to work too quickly, often with undiagnosed post-traumatic deficits which in turn can lead to subsequent incidents of physical harm.MethodsHere, we share methods and results from our research project to establish innovative, simple, and scientifically based practices that dramatically leverage technology and validated testing strategies to identify post-TBI deficits quickly and accurately, to circumvent economic realities on the ground in LMICs. We utilized paper tests such as the Montreal cognitive assessment (MoCA), line-bisection, and Bell’s test. Furthermore, we combined modifications of neuroscience computer tasks to aid in assessing peripheral vision, memory, and analytical accuracies. Data from seventy-one subjects (51 patients and 20 controls, 15 females and 56 males) from 4 hospitals in Ethiopia are presented. The traumatic brain injury group consists of 17 mild, 28 moderate, and 8 severe patients (based on the initial Glasgow Comma Score). Controls are age and education-matched subjects (no known history of TBI, brain lesions, or spatial neglect symptoms).ResultsWe found these neurophysiological methods can: 1) be implemented in LMICs and 2) test impairments caused by TBI, which generally affect brain processing speed, memory, and both executive and cognitive controls.DiscussionThe main findings indicate that these examinations can identify several deficits, especially the MoCA test. These tests show great promise to assist in the evaluation of TBI patients and support the establishment of dedicated rehabilitation centers. Our next steps will be expansion of the cohort size and application of the tests to other settings.

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Section: Introductionmentioning

confidence: 99%

Extended tests for evaluating post-traumatic brain injury deficits in resource-limited settings: methods and pilot study data

Semework,

Laeke,

Aklilu

et al. 2024

Front. Neurol.

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“…Traumatic brain injury (TBI) affect nearly 69 million people per year, often resulting in long-lasting disability and mortality ( 1 ). Despite the pervasiveness of this issue, effective treatments for TBI are limited.…”

Section: Introductionmentioning

confidence: 99%

Relationship between sodium level and in-hospital mortality in traumatic brain injury patients of MIMIC IV database

Wang,

Li,

Sun

et al. 2024

Front. Neurol.

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BackgroundAn association between prognosis and high sodium levels in Traumatic Brain Injury (TBI) patients in Intensive Care Units (ICUs) has been noted, but limited research exists on the ideal sodium level in these patients or the impact on early mortality, using the MIMIC-IV database.MethodsA retrospective survey was conducted on TBI patients from the MIMIC-IV database. Patients were divided into two categories based on their highest serum sodium level within 24 h of admission exceeding 145 mmol/L: those with hypernatremia, and those with moderate-to-low sodium levels. Collected covariates encompasses demographic, clinical, laboratory, and intervention variables. A multivariate logistic regression model was implemented to forecast in-hospital mortality.ResultsThe study included 1749 TBI patients, with 209 (11.5%) experiencing in-hospital deaths. A non-linear test exposed an L-shaped correlation between sodium level and in-hospital mortality, with mortality rates increasing after a turning point at 144.1 mmol/L. Compared to the moderate-to-low group’s 9.3% mortality rate, the hypernatremia group had a significantly higher mortality rate of 25.3% (crude odds ratio = 3.32, 95% confidence interval: 2.37 ~ 4.64, p < 0.001). After adjusting for all covariates, the hypernatremia group continued to show a significant correlation with higher mortality risk (adjusted odds ratio = 2.19, 95% confidence interval: 1.38 ~ 3.47, p = 0.001). This trend remained consistent regardless of the analyses stratification.ConclusionThe study reveals an L-shaped relationship between sodium levels and in-hospital deaths, with a pivotal point at 144.1 mmol/L. TBI patients displaying hypernatremia were independently linked to higher in-hospital mortality, underlining the need for further studies into targeted management of sodium levels in these patients.

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“…Notably, acute neurological injury is particularly prevalent in low-(LICs) and middle-income countries (MICs), 9,10 where neurocritical care resources and expertise can be limited. In fact, there is substantial research suggesting a need to improve mechanical ventilation practices in MICs.…”

Section: Introductionmentioning

confidence: 99%

Impact of country income level on outcomes in acute brain injured patients requiring invasive mechanical ventilation: a secondary analysis of the ENIO study

Feng,

Diaz-Cruz,

Cinotti

et al. 2024

Preprint

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BACKGROUND/OBJECTIVES: Invasive mechanical ventilation (IMV) can present complex challenges for patients with acute brain injury (ABI) in middle income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in neurocritical care patients. METHODS: A secondary analysis was performed on a registry of neurocritical care patients admitted to 73 intensive care units (ICUs) in 18 countries from 2018-2020. Patients were classified as high (HIC) or middle income country (MIC). The primary outcome was ICU mortality. Secondary outcomes were days to first extubation, tracheostomy, extubation failure, ICU length of stay, and hospital mortality. Multivariable analyses were adjusted for clinically pre-selected covariates such as age, sex, body mass index, neurological severity, comorbidities, and ICU management. Extubation and tracheostomy outcomes were also adjusted for arterial blood gas values and extubation day ventilatory settings. RESULTS: Of 1,512 patients (median age=54 years, 66% male), 1,170 (77%) were from HICs, and 342 (23%) were from MICs. Median age was significantly lower in MICs (35 (26-52) vs 58 (45-68) years in HICs). Neurosurgical procedures (47.7% vs 38.2%) and decompressive craniectomy (30.7% vs 15.9%) were more common in MICs, while intracranial pressure monitoring (12.0% vs 51.5%) and external ventricular drain (7.6% vs 35.6%) were less common. Compared to HICs, patients from MICs had 2.27 times the odds of ICU mortality (p=0.009, 95% CI=1.22, 4.21). Frequency of extubation failure was lower in MICs but not significant after adjustment. Patients from MICs had 3.38 times the odds of tracheostomy (p=<0.001, 95%CI=2.28-5.01), 5.59 days shorter mean ICU stay (p<0.001, 95%CI=-7.82, -3.36), and 1.96 times the odds of hospital mortality (p=0.011, 95%CI=1.17, 3.30). CONCLUSIONS: In an international registry of patients with ABI requiring IMV, MICs had higher odds of ICU mortality, tracheostomy, and hospital mortality compared to HICS, likely due to differences in neurocritical care resources and decision-making.

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

Cited by 11 publications

References 32 publications

Extended tests for evaluating post-traumatic brain injury deficits in resource-limited settings: methods and pilot study data

Extended tests for evaluating post-traumatic brain injury deficits in resource-limited settings: methods and pilot study data

Relationship between sodium level and in-hospital mortality in traumatic brain injury patients of MIMIC IV database

Impact of country income level on outcomes in acute brain injured patients requiring invasive mechanical ventilation: a secondary analysis of the ENIO study

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