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Papers by Abdul Hafid Bajamal

Research paper thumbnail of Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

The Lancet Neurology, 2022

Background: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a su... more Background: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development.
Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital’s 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation.
Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49).
Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices.

Research paper thumbnail of Classification and Radiological Diagnosis of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Neurospine

The aim of this review to determine recommendations for classification and radiological diagnosis... more The aim of this review to determine recommendations for classification and radiological diagnosis of thoracolumbar spine fractures. Recommendation was made through a literature review of the last 10 years. The statements created by the authors were discussed and voted on during 2 consensus meetings organized by the WFNS (World Federation Neurosurgical Societies) Spine Committee. The literature review was yielded 256 abstracts, of which 32 were chosen for full-text analysis. Thirteen papers evaluated the reliability of a classification system by our expert members and were also chosen in this guideline analysis. This literature review-based recommendation provides the classification and radiologic diagnosis in thoracolumbar spine fractures that can elucidate the management decision-making in clinical practice.

Research paper thumbnail of Three-dimensional (3D)-printed model reconstruction in pre-operative planning for wooden penetrating brain injury

Bioprinting, 2021

Objective: The advancements in technology have made the use of three-dimensional printed model re... more Objective: The advancements in technology have made the use of three-dimensional printed model reconstruction in neurosurgery receive special attention due to its role in the process of decision-making and pre-operative planning. Penetrating brain injuries (PBI) have a high risk of damage to the complex intracranial neuro-vascular structures. Due to its difficulty, 3D-printed model reconstruction could help neurosurgeons in the decision-making of PBI surgery strategy. Methods: The authors reported an 18-year-old male carpenter who was referred to the hospital due to a wooden PBI. We performed computed tomography (CT) scan, CT angiography (CTA), magnetic resonance venography (MRV), and magnetic resonance angiography (MRA). We then performed segmentations and integrations of the digital imaging and communications in medicine (DICOM) data. The digital reconstruction was then used for 3D printing, and the printed model was used for the foreign object extraction simulation for pre-operative planning. Results: There were no intra- and post-operative neurovascular complications after the craniotomy and wooden foreign body extraction procedure. Conclusion: This method was beneficial since it enhances the anatomical visualization of the location and trajectory of the foreign body. Moreover, the printed model allows for a more direct and realistic simulation for the foreign body extraction procedure.

Research paper thumbnail of Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

The Lancet Neurology, 2022

Background: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a su... more Background: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development.
Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital’s 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation.
Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49).
Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices.

Research paper thumbnail of Classification and Radiological Diagnosis of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Neurospine

The aim of this review to determine recommendations for classification and radiological diagnosis... more The aim of this review to determine recommendations for classification and radiological diagnosis of thoracolumbar spine fractures. Recommendation was made through a literature review of the last 10 years. The statements created by the authors were discussed and voted on during 2 consensus meetings organized by the WFNS (World Federation Neurosurgical Societies) Spine Committee. The literature review was yielded 256 abstracts, of which 32 were chosen for full-text analysis. Thirteen papers evaluated the reliability of a classification system by our expert members and were also chosen in this guideline analysis. This literature review-based recommendation provides the classification and radiologic diagnosis in thoracolumbar spine fractures that can elucidate the management decision-making in clinical practice.

Research paper thumbnail of Three-dimensional (3D)-printed model reconstruction in pre-operative planning for wooden penetrating brain injury

Bioprinting, 2021

Objective: The advancements in technology have made the use of three-dimensional printed model re... more Objective: The advancements in technology have made the use of three-dimensional printed model reconstruction in neurosurgery receive special attention due to its role in the process of decision-making and pre-operative planning. Penetrating brain injuries (PBI) have a high risk of damage to the complex intracranial neuro-vascular structures. Due to its difficulty, 3D-printed model reconstruction could help neurosurgeons in the decision-making of PBI surgery strategy. Methods: The authors reported an 18-year-old male carpenter who was referred to the hospital due to a wooden PBI. We performed computed tomography (CT) scan, CT angiography (CTA), magnetic resonance venography (MRV), and magnetic resonance angiography (MRA). We then performed segmentations and integrations of the digital imaging and communications in medicine (DICOM) data. The digital reconstruction was then used for 3D printing, and the printed model was used for the foreign object extraction simulation for pre-operative planning. Results: There were no intra- and post-operative neurovascular complications after the craniotomy and wooden foreign body extraction procedure. Conclusion: This method was beneficial since it enhances the anatomical visualization of the location and trajectory of the foreign body. Moreover, the printed model allows for a more direct and realistic simulation for the foreign body extraction procedure.