Association of traumatic brain injury severity and time to definitive care in three low-middle-income European countries

BackgroundLow-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries.MethodsA prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country.ResultsAmong 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9–11) or severe injury (GCS 0–8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care.ConclusionsImplementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries.

Download Full-text

76 Traumatic brain injury surveillance in three low-middle income countries

10.1136/injuryprev-2020-savir.18 ◽

2020 ◽

Author(s):

Corinne Peek-Asa

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Injury Surveillance ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries

Download Full-text

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

British Journal of Surgery ◽

10.1093/bjs/znab258.002 ◽

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.

Download Full-text

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

Neurosurgical FOCUS ◽

10.3171/2019.7.focus19316 ◽

2019 ◽

Vol 47 (5) ◽

pp. E6 ◽

Cited By ~ 1

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.

Download Full-text