244 Traumatic Brain Injury Related Paediatric Mortality and Morbidity in Low- And Middle-Income Countries: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Bandyopadhyay ◽  
M Kawka ◽  
K Marks ◽  
G Richards ◽  
E Taylor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Meta Analysis ◽  
Road Traffic Accidents ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Aim Three million cases of paediatric traumatic brain injury (pTBI) occur annually, the majority of which occur in low-and-middle-income countries (LMICs). However, there is a paucity of data on the outcomes of pTBI available. We aimed to systematically review and synthesise the reported morbidity and mortality from pTBI in the published literature about LMICs. Method A systematic review and meta-analysis were conducted. MEDLINE, EMBASE, Global Health, and Global Index Medicus were searched for relevant articles from January 2000 to May 2020. Observational or experimental studies on pTBI (individuals between the ages of 0 to 16 years) in LMICs were included. Morbidity data were descriptively analysed, and a random-effects model was used to pool mortality rates. PROSPERO ID: CRD42020171276. Results We included 145 studies from 38 countries representing 174073 patients with pTBI. Males were twice (95% CI: 1.6 – 2.4) as likely to have a pTBI than females. Where available, mild TBI represented ≥ 60% of all pTBI cases in most reports (n = 24/43, 56%). The commonest cited cause of pTBI was road traffic accidents (n = 16643/43083, 39%), followed by falls (n = 10927/43083, 25%). 4385 patients (n = 4385/18092, 24%) had a reduction from normal function on discharge. On average, there were 6.7 deaths per 100 cases of pTBI. Conclusions Only 38 LMICs have published data on the volume and burden of pTBI in their country. Limited data available suggests that young male children are at a high-risk of pTBIs in LMICs, particularly from road traffic accidents.

Letter to the Editor Regarding “Traumatic Brain Injury–Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic Review”

2022 ◽  
Vol 157 ◽  
pp. 254-255 ◽  
Author(s):  
Randy Eliecer Frias-Bechara ◽  
Julio Cesar Arce ◽  
Kamal Jasser Buchaar-Olivero ◽  
Andrés Felipe Palacios-Martínez ◽  
Maria Paz Bolaño-Romero
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Middle Income Countries ◽  
Letter To The Editor ◽  
Low And Middle Income

scholarly journals An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

2019 ◽  
Vol 47 (5) ◽  
pp. E6 ◽  
Author(s):  
Cyrus Elahi ◽  
Thiago Augusto Hernandes Rocha ◽  
Núbia Cristina da Silva ◽  
Francis M. Sakita ◽  
Ansbert Sweetbert Ndebea ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Road Traffic ◽  
Referral Hospital ◽  
Middle Income ◽  
Middle Income Countries ◽  
Poor Outcome ◽  
Severity Of Injury ◽  
Severe Tbi ◽  
Low And Middle Income

OBJECTIVEThe purpose of this study was to determine if patients with traumatic brain injury (TBI) in low- and middle-income countries who receive surgery have better outcomes than patients with TBI who do not receive surgery, and whether this differs with severity of injury.METHODSThe authors generated a series of Kaplan-Meier plots and performed multiple Cox proportional hazard models to assess the relationship between TBI surgery and TBI severity. The TBI severity was categorized using admission Glasgow Coma Scale scores: mild (14, 15), moderate (9–13), or severe (3–8). The authors investigated outcomes from admission to hospital day 14. The outcome considered was the Glasgow Outcome Scale–Extended, categorized as poor outcome (1–4) and good outcome (5–8). The authors used TBI registry data collected from 2013 to 2017 at a regional referral hospital in Tanzania.RESULTSOf the final 2502 patients, 609 (24%) received surgery and 1893 (76%) did not receive surgery. There were significantly fewer road traffic injuries and more violent causes of injury in those receiving surgery. Those receiving surgery were also more likely to receive care in the ICU, to have a poor outcome, to have a moderate or severe TBI, and to stay in the hospital longer. The hazard ratio for patients with TBI who underwent operation versus those who did not was 0.17 (95% CI 0.06–0.49; p < 0.001) in patients with moderate TBI; 0.2 (95% CI 0.06–0.64; p = 0.01) for those with mild TBI, and 0.47 (95% CI 0.24–0.89; p = 0.02) for those with severe TBI.CONCLUSIONSThose who received surgery for their TBI had a lower hazard for poor outcome than those who did not. Surgical intervention was associated with the greatest improvement in outcomes for moderate head injuries, followed by mild and severe injuries. The findings suggest a reprioritization of patients with moderate TBI—a drastic change to the traditional practice within low- and middle-income countries in which the most severely injured patients are prioritized for care.

scholarly journals Association Between Vision Impairment And Traffic Safety Outcomes In Low And Middle-Income Countries: Protocol For A Systematic Review

2020 ◽  
Author(s):  
Mapa Mudiyanselage Prabhath Nishantha Piyasena ◽  
Mike Clarke ◽  
Greame MacKenzie ◽  
Ving Fai Chan ◽  
Victoria Odette Olvera-Herrera ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traffic Safety ◽  
Road Traffic ◽  
Meta Analysis ◽  
Evidence Base ◽  
Middle Income ◽  
Middle Income Countries ◽  
Safety Outcomes ◽  
Vision Function ◽  
Low And Middle Income

Abstract Background: Road traffic injuries are a major public health concern. The burden and road traffic fatality rate are especially high in low-and middle-income countries and the socioeconomic impact is profound. Although many authors have studied the correlation between vision and traffic safety, there is no robust evidence base that could be used in advocacy. This systematic review will test the hypothesis that interventions to improve vision function are associated with good traffic safety outcomes.Methods: Cochrane guidance on conducting a systematic review and Preferred Reporting Items for Systematic Review and Meta-Analysis - Protocols (PRISMA-P) were used to inform the preparation of this protocol and the Cochrane guidance and the main PRISMA guidance will inform the conduct and reporting of the review. We will search MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), CINAHL (EBSCO host), Web of Science, Cochrane Database of Systematic Reviews (CDSR) and The Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library. We will include studies of any design which either attempt to access traffic safety outcomes of any kind among persons with any vision deficit or examine vision among persons who use roads. The primary outcome for this review is any measure of traffic safety or surrogate outcomes. Study selection, data extraction and evaluation of risk of bias will be done by two reviewers. A meta-analysis or narrative data synthesis will be conducted, depending on study quality and homogeneity.Discussion: The results of this review will include summary estimates of vision and the effects of interventions to improve vision function, that are associated with traffic safety outcomes in LMICs. This systematic review will fill a gap in the evidence base with policy implications that will be useful for a wide audience and may improve vision of the drivers in LMICs, leading to better traffic safety outcomes.

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