A Survey of Traumatic Brain Injuries from Road Traffic Collisions in a Lower Middle-Income Country (original) (raw)
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The European Journal of Public Health, 2013
Background: Road traffic accidents (RTAs) have been identified by public health organizations as being of major global concern. Traumatic brain injuries (TBIs) are among the most severe injuries and are in a large part caused by RTA. The objective of this article is to analyse the severity and outcome of TBI caused by RTA in different types of road users in five European countries. Methods: The demographic, severity and outcome measures of 683 individuals with RTA-related TBI from Austria, Slovakia, Bosnia, Croatia and Macedonia were analysed. Five types of road users (car drivers, car passengers, motorcyclists, bicyclists and pedestrians) were compared using univariate and multivariate statistical methods. Short-term outcome [intensive care unit (ICU) survival] and last available long-term outcome of patients were analysed. Results: In our data set, 44% of TBI were traffic related. The median age of patients was 32.5 years, being the lowest (25 years) in car passengers. The most severe and extensive injuries were reported in pedestrians. Pedestrians had the lowest rate of ICU survival (60%) and favourable long-term outcome (46%). Drivers had the highest ICU survival (73%) and car passengers had the best long-term outcome (59% favourable). No differences in the outcome were found between countries with different economy levels. Conclusion: TBI are significantly associated with RTA and thus, tackling them together could be more effective. The population at highest risk of RTA-related TBI are young males (in our sample median age: 32.5 years). Pedestrians have the most severe TBI with the worst outcome. Both groups should be a priority for public health action.
Journal of Evidence Based Medicine and Healthcare, 2015
BACKGROUND Trauma is one of the leading causes of death and disability in the Indian Population. OBJECTIVE To evaluate and describe the epidemiological and clinical characteristics of patients with traumatic brain injury and their clinical outcomes following admission to a rural tertiary care teaching hospital in India. STUDY DESIGN Retrospective, cross-sectional, hospital based analysis of 1713 patients of Traumatic Brain Injury [TBI] admitted to the Department of Neurosurgery in a tertiary health centre in Jaipur from January 2014 to August 2015. METHOD The medical records of all eligible patients were reviewed and data collected on age, sex, mechanism of injury, severity of injury Glasgow Coma Scale (GCS) and Outcome (GOS) score, Computed Tomography (CT) scan results, modality of management and type of surgical intervention and outcome. RESULTS Among the 1713 patients admitted, age of patients varied >1 year to 92 years (mean age 21 years), majority of TBI's were reported in the age group 20-29 years (34.38%), followed by 30-39 years (26.97%), 40-49 years (16.70%), p value <0.05. Most of the patients were male (63.46%), mostly unmarried. Majority lived in suburban areas (51.26%) followed by rural (26.85%) and urban (21.89%). Patients were mostly from middle class (46.58%) and poor socioeconomic background (42.62%), upper class only accounted for 10.8% of the cases. In terms of occupation, servicemen and farmers accounted for the majority (54.73%). Patients were brought to the hospital mainly by known persons (68%) and rest by bystanders and policemen. The most common mechanism of injury was road traffic accidents (RTA) 1199 (69.99%), followed by assault 251 (14.65%), 15.35% accounted for fall from height and fall of object on head. Mean hospital stay was 7.6±9.3 days (range <1 day to 87 days). In our study, patients were classified by GCS as mild TBI in 983(57.38%) patients; moderate in 488 (28.48%) and severe in 242 (14.12). 1481 (86.46%) patients experienced loss of consciousness; 788 (46%) had one or more episodes of vomiting; 312 (18.21%) patients presented with bleeding from ear, nose or throat, seizures were noted in 282 (16.46%) patients and vertigo in 411 (23.99%). Clinical examination also revealed abnormal pupils in 208 (12.14%) patients, abnormal motor response in 211 (12.32%) patients, only 3-5% patients showed cranial nerve deficit, racoon eyes or battle's sign. CT scan revealed contusions (42.50%) and fractures (35.14%) were the most common findings followed by sub dural hematoma (32.87%), extradural hematoma (18.21%). 85% patients were managed conservatively and 27% managed surgically. The overall mortality was 149 (8.69%). In a 6 month follow-up, 54 patients were persistently vegetative, 37 were severely disabled (dependent for day to day activities). 1452 patients recovered to be healthy. CONCLUSION Traumatic brain injury is a serious challenge to the community. With rapid modernization, growth in the country has been sporadic, boosting only segments of the population. Presently, there is no adequate consensus on the magnitude of TBI. A multidisciplinary and multi-modal approach is necessary. Development of a computerized system, better reporting and documentation is essential to understand the true incidence of
Frontiers in Neurology, 2017
Objectives: Africa and other Asian low middle-income countries account for the greatest burden of the global road-traffic injury (RTI)-related head injury (HI). This study set out to describe the incidence, causation, and severity of RTI-related HI and associated injuries in a Nigerian academic neurosurgical practice. Methods: This is a retrospective cross-sectional analysis of RTI-related HI from a prospective HI registry in an academic neurosurgery practice in Nigeria. results: All-terrain RTI accounted for 80.6% (833/1,034) of HI over a 7-year study period. All age groups were involved, mean 33.06 years (SD 18.30), mode 21-30, 231/833 (27.7%). The male:female ratio was 631:202, ≈3:1. The road trauma occurred exclusively from motorcycle-and motor-vehicle crash (MCC/MVC), MCC caused 56.8% (473/833) of these; the victims were vulnerable road users (VRU) in 74%, and >90% belong in the low socioeconomic class. Using the Glasgow Coma Scale grading, the HI was moderate/severe in 52%; loss of consciousness occurred in 93%, the Abbreviated Injury Severity-head > 3 in 74%, and computed tomography (CT) Rotterdam score > 3 in 52%. Significant extracranial injuries occurred in many organ systems, 421/833 (50.5%) having Injury Severity Score (ISS) > 25. Surgical lesions included extensive brain contusions in 157 (18.8%); acute extradural hematoma in 34 (4.1%); acute subdural hematoma in 32 (3.8%); and traumatic intracerebral hemorrhage in 27 (3.2%), but only 97 (11.6%) received operative care for various logistic reasons. The in-hospital outcome was good in 71.3% and poor in 28.7%; the statistically significant (p < 0.001) determinants of this outcome profile were the severity of the HI, the CT Rotterdam score, and the ISS. conclusion: In this study from Nigeria, RTI-related HI emanates from significant trauma to vulnerable road users and are caused exclusively by motorcycles and motor vehicles.
International Journal of Critical Illness and Injury Science, 2014
Introduction: Trauma is one of the leading causes of morbidity and mortality in the world and in India. Objective: To describe 1) selected epidemiological and clinical characteristics of persons with traumatic brain injury (TBI) who died within 24 h after admission to the emergency departments (EDs) of two medical facilities in rural India and 2) the methods used to transport these patients from the locale of the injury incident to the study sites. Materials and Methods: Medical records of all injured patients regardless of age or sex who died within 24 h after admission to both EDs during January 31, 2007 through December 31, 2009 were reviewed and abstracted. Demographic variables and information on prehospital care, time and mechanism of injury, mode of transport to EDs, and primary hospital resuscitation were abstracted and analyzed. Results: Of the 113 injured patients in this study, 42 had TBI and died within 24 h of ED admission. All of these TBI patients were transported to the ED by relatives or bystanders in non-ambulance vehicles. Most of the patients with TBI (78.5%) were 21-50-years-old; and overall 90.0% were males. Persons working near or along busy roads struck by vehicles accounted for 80.9% of all TBI cases. Severe TBIs were present in 97.6% of the patients; of these, 92.8% had a Glasgow Coma Scale (GCS) score of 3 on arrival. Other concurrent injuries included superficial lacerations (85.7%), facial injuries (57.1%), and upper (35.7%) and lower (30.9%) extremity fractures. Common lesions recognized on computed tomography (CT) scan were acute subdural hematoma (21.4%), subarachnoid hemorrhage with diffuse cerebral edema (16.6%), and skull base fracture with diffuse cerebral edema (14.2%); in 21.4% of cases, the CT scan were reported normal. Conclusion: Most of the TBI patients who died within 24 h after admission to EDs in this study were not transported to EDs in emergency medical vehicles; most were of working age (ages 20-50 years); were male; and were day laborers working on busy interstate roads where they were hit by vehicles.
The incidence and severity of injury in children hospitalised for traumatic brain injury in Kashmir
Injuries are a focus of public health practice because they pose a serious health threat, occur frequently, and are preventable. They are the neglected epidemic of modern society. 2,18 Head injuries are the most serious and preventable major public health problem and a frequent cause of morbidity and mortality in young people and children. In developing countries accident rates are increasing as traffic increases, and they greatly exceed those of Injury, Int. Summary A large number of people experience traumatic brain injury each year, often with severe consequences. This is a public health problem that requires ongoing surveillance to follow trends in the incidence, risk factors, causes, and outcomes of these injuries. In 2003, a prospective study of all children below 15 years admitted to hospitals with a diagnosis of head injury was conducted in the Accident & Emergency Department of Sher-e-Kashmir Institute of Medical Sciences, Srinagar (India) to determine the incidence and severity of accidental head injury among children and the circumstances of injury. The highest incidence of head injury was seen at ages 6-10 years. Head injury rates were higher in males than in females. The leading causes include falls and motor vehicle accidents. More than 50% falls occurred in the age group of 4-6 years. Ninety per cent patients, who recovered, were discharged within 16-24 h after admission. Lack of supervision, non-implementation of safety measures and poor implementation of traffic rules leads to many injuries. The ability of the health care system to deal with increasing trauma in Jammu & Kashmir is limited. Nevertheless, prevention can be low cost strategy to overcome this problem. The results of epidemiological studies are affected by factors like demography, geographic region and socioeconomic status. This study emphasizes the need for intensified effort for prevention, minimising risk factors, strict legislative measures, observing traffic rules, implementation of safety measures, establishing appropriate trauma care at district level, adult supervision, and creating awareness. #
Traumatic Brain Injuries in a Well-Defined Population: Epidemiological Aspects and Severity
Journal of Neurotrauma, 2007
The aim was to describe epidemiological and medical aspects of 449 cases of traumatic brain injury (TBI) from a well-defined geographical area with a population of 137,000 inhabitants. An episode of disturbed consciousness was a prerequisite for inclusion in the study. The incidence of TBI was 354/100,000 inhabitants. Median age was 23 years, range 0-91 years; 55% were men and 45% were women; 33% children 0-14 years, 50% adults 15-64 years, and 17% elderly persons 65-91 years old. Severity classification was based on Glasgow Coma Scale (GCS) on arrival; mild TBI 97% (GCS 13-15), moderate 1% (GCS 9-12), and severe 2% (GCS 3-8). The most common injury events were falls (55%) and vehicle-related events (30%). The percentage of falls was high among children and elderly persons but among adults vehicle-related injury events were also prominent. At least 17% of all patients were under the influence of alcohol, especially adult male bicyclists. CT was performed on 163 cases (36%) revealing 34 cases with intracranial hemorrhage (ICH) which is 21% of the examined or 8% of all the injured. The rate of ICH increased with increasing age (from 3% among children to 17% among the elderly persons) and also increased with decreasing GCS from 6% in the group of mild TBI to 60% among those with severe TBI. Attention should be directed to acute management of mild TBI in order to detect potentially dangerous ICH as well as to preventive actions against falls and vehicle related accidents.
Journal of Neurosciences in Rural Practice, 2016
Traumatic brain injury (TBI), a significant public health problem, is a leading cause of disability and mortality in all regions of the globe despite advancement in prevention and treatments. Its global incidence is rising, and it is predicted to surpass many diseases as a major cause of death and disability by the year 2020. [1] TBI is the main cause of one-third to one-half of all trauma deaths and the leading cause of disability in people under forty, severely disabling 15-20/100,000 populations per year. [2] The World Health Organization estimates that almost 90% of deaths due to injuries occur in low-and middle-income countries (LAMICs), where 85% of population live, and this situation will continue to represent an important global health problem in the upcoming years. [3,4] TBI is a leading cause of mortality, morbidity, disability, and socioeconomic losses in India as well. It is estimated that nearly 1.5-2 million persons are injured, and 1 million die every year in India. [5] India and other developing countries are facing the major challenges of prevention, prehospital care, and rehabilitation in their
This Commission covers a range of topics that need to be addressed to confront the global burden of TBI and reduce its effects on individuals and society: epidemiology (section 1); health economics (section 2); prevention (section 3); systems of care (section 4); clinical management (section 5); characterisation of TBI (section 6); outcome assessment (section 7); prognosis (section 8); and new directions for acquiring and implementing evidence (section 9). summarises key messages from the Commission and provides recommendations to advance clinical care and research in TBI.
Epidemiological study of traumatic brain injury in a tertiary care centre in South India
International Surgery Journal, 2020
Background: This study investigated the epidemiological pattern of traumatic brain injury (TBI) in our hospital, so as to juxtapose with available statistics and formulate recommendations for patient betterment.Methods: The Government Medical College, Thiruvananthapuram was the setting of this cross-sectional longitudinal study and included all patients admitted with clinical/radiological evidence of TBI over a period of three months (October 2019 to December 2019). Details regarding mechanism of injury and the socioeconomic background of the subjects were collected during the stay in hospital, by means of a semi structured questionnaire. SPSS software was used to analyze the data collected.Results: Out of 658 patients included in the study, majority of the subjects belonged to the age group 30-60 years. About 80% of subjects were males. 63% were manual laborers. Majority of the patients had about 10-15 days’ stay in the hospital. Road traffic accidents were the most common mechanis...