Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores

Abstract

BackgroundThis study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting.MethodsAdult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited.A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury.ResultsOne hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become “economically dependent”. Selected trauma scores had poor discriminatory ability in predicting mortality.ConclusionsThis observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.

Neurosurgical Randomized Trials in Low- and Middle-Income Countries

“…Unfortunately, limited data suggest that LMIC patients have over twice the odds of dying following severe TBI in addition to a greater degree of disability. 24 , 25 This makes it increasingly important that adequate research funding, time, and policy proposals are appropriately allocated to essential neurosurgical care. It is not enough to rely on neurotrauma research from HICs and extrapolate results to develop guidelines in an LMIC.…”

The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: is it feasible?

“…Studies have shown that the readmission of TBI patients in the rst three years after injury is more than 20% [33,34]. Nearly 77% of severe TBI patients can be prevented from being hospitalized again with regards to accidental detubation and infection [35]. Unplanned readmission lead to a slow recovery of patients and a signi cant increase in medical expenses [36].…”

The pattern of hospital‐community‐home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: Is it feasible?

“…Studies have shown that the readmission of TBI patients in the first three years after injury is more than 20% 32,33 . Nearly 77% of severe TBI patients can be prevented from being hospitalised again with regards to accidental decannualtion of the tracheostomy and infection 34 . Unplanned readmission leads to slow recovery of patients and a significant increase in medical expenses 35 .…”