Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads

The Impact of the Pandemic of COVID-19 on the Head Injury Fast-Track System and Surgical Outcome

Objective  This study aims to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the head injury fast-track system and surgical treatment outcomes. Materials and Methods  A retrospective review was conducted on patients who underwent emergency neurological procedures according to the head injury fast-track system. Data from April 2018 to April 2020 (pre-COVID) were compared with data from May 2020 to May 2022 (during COVID). Results  The analysis comprised 128 patients in the prepandemic group and 119 patients in the pandemic group, with 5 patients diagnosed with COVID infection during the pandemic. Acute subdural hematoma resulting from motorcycle accidents was the most common diagnosis in both groups (56.3 and 47.5%, respectively). The initial Glasgow coma scale (GCS) score was significantly lower during the pandemic compared to the prepandemic period ( p  = 0.025). Time metrics in the emergency department, including door to computed tomography (CT), emergency room (ER) exit, and incision times, were significantly longer in the pandemic group ( p  < 0.05). However, there were no statistically significant differences in in-hospital mortality rates (25.8 and 17.7%, respectively; p  = 0.12) or the percentage of patients with a favorable functional outcome (Glasgow outcome scale ≥4). At 1 month, a favorable functional outcome was observed in 51.6% of prepandemic patients and 57.1% of pandemic patients ( p  = 0.69), while at 6 months, the percentages were 56.8 and 64.5%, respectively ( p  = 0.23). Conclusions  Our study revealed significant delays in hospital processes for head injuries during the COVID-19 pandemic. However, we found no significant impact on mortality rates or functional outcomes of patients.

Epidemiology of Traumatic Brain Injury at a Tertiary Institution in Nigeria

INTRODUCTION

Traumatic brain injury (TBI) is devastating to the victims, and an understanding of its prevalence, the demography and the causes help reduce the incidence and outcome. Adequate knowledge of such helps in developing preventive and management protocols in the region. The study aims to document the presentation and challenges of TBI in our centre.

METHODS

A cross-sectional design was conducted at Lagos University Teaching Hospital, Nigeria. Only adult (≥18 years) patients were recruited consecutively from the emergency room following a diagnosis of TBI. Data were obtained with the aid of a study pro forma which recorded participants' sociodemographic information, pre-hospital indices and clinical examination/investigations. Imaging findings, surgical information and follow-up findings were also recorded. Data obtained were analysed using the IBM SPSS Statistics.

RESULTS

A total of 125 TBI patients with male:female of 8:1 were recruited over 12 months. The mean age was 40.8 years standard deviation ± 16.86. Only 9 patients (7.2%) had health insurance. Eighty-four (67.2%) patients had TBI from road traffic accidents (RTAs). Fall from heights, assaults, industrial accidents and gunshots contributed 16%, 9.6%, 5.6% and 1.6% of patients' injuries respectively. One hundred and fourteen (91.2%) were brought to the hospital by non-healthcare workers.

CONCLUSION

RTAs remain the most common cause of TBI. Majority of the populace cannot afford the cost of TBI management. The scope of national health insurance needs to be broadened to help victims at the points of need.

Further recommendations of the International Paediatric Brain Injury Society (IPBIS) for the post-acute rehabilitation of children with acquired brain injury

BACKGROUND

Paediatric acquired brain injury is a life-long condition which impacts on all facets of the individual's lived experience. The existing evidence base continues to expand and new fields of enquiry are established as clinicians and researchers uncover the extent of these impacts.

PRIMARY OBJECTIVE

To add to recommendations described in the International Paediatric Brain Injury Society's 2016 paper on post-acute care for children with acquired brain injury and highlight new areas of enquiry.

REVIEW OF INFORMATION

Recommendations were made based on the opinions of a group of experienced international clinicians and researchers who are current or past members of the board of directors of the International Paediatric Brain Injury Society. The importance of each recommendation was agreed upon by means of group consensus.

OUTCOMES

This update gives new consideration to areas of study including injuries which occur in pre-school children, young people in the military, medical referral, young offenders and the use of technology in rehabilitation.

Understanding Acquired Brain Injury: A Review

Any type of brain injury that transpires post-birth is referred to as Acquired Brain Injury (ABI). In general, ABI does not result from congenital disorders, degenerative diseases, or by brain trauma at birth. Although the human brain is protected from the external world by layers of tissues and bone, floating in nutrient-rich cerebrospinal fluid (CSF); it remains susceptible to harm and impairment. Brain damage resulting from ABI leads to changes in the normal neuronal tissue activity and/or structure in one or multiple areas of the brain, which can often affect normal brain functions. Impairment sustained from an ABI can last anywhere from days to a lifetime depending on the severity of the injury; however, many patients face trouble integrating themselves back into the community due to possible psychological and physiological outcomes. In this review, we discuss ABI pathologies, their types, and cellular mechanisms and summarize the therapeutic approaches for a better understanding of the subject and to create awareness among the public.

Head Injury Prevalence in a Population of Injured Patients Seeking Care in Ghana, West Africa

Background/Significance:

Much of the literature on head injury (HI) prevalence comes from high-income countries (HICs), despite the disproportionate burden of injuries in low to middle-income countries (LMICs). This study evaluated the HI prevalence in the Kintampo Injury Registry, a collaborative effort between Kintampo Health Research Centre (KHRC) in Ghana and the sidHARTe Program at Columbia University Mailman School of Public Health. In our first aim, we characterize the HI prevalence in the registry. In aim 2, we examine if there are any sex (male/female) differences in head injury outcomes in these populations for points of potential intervention.

Methods

Secondary analysis of data from the Kintampo Injury Registry which had 7,148 registered patients collected during January 2013 to January 2015. The definition of a case was adopted to ensure consistency with the International Statistical Classification of Diseases and Related Health Problems, revision 10 (ICD-10). A 3-page questionnaire was used to collect data from injured patients to include in the registry. The questions were designed to be consistent with the World Health Organization (WHO) guidelines on injury surveillance and were adapted from the questionnaire used in a pilot, multi-country injury study undertaken in other parts of Africa. The questionnaire collected information on the anatomic site of injury (e.g., head), mechanism of injury (e.g., road traffic injuries, interpersonal injuries (including domestic violence), falls, drowning, etc.), severity and circumstances of the injury, as well as precipitating factors, such as alcohol and drug use. The questionnaire consisted mainly of close-ended questions and was designed for efficient data entry. For the secondary data analyses for this manuscript, we only included those with “1st visit following injury” and excluded all transfers and follow-up visits (n = 834). We then dichotomized the remaining 6,314 patients to head injured and non-head injured patients based on responses to the variable “Nature of injury =Head Injury”. We used chi-square and Fisher's exact tests with p < 0.05 as cut-off for statistical significance. Logistic regression estimates were used for effect estimates.

Results

Of the 6,314 patients, there were 208 (3.3%) head-injured patients and 6,106 (96.7%) patients without head injury. Head-injured patients tended to be older (Mean age: 28.9 +/-13.7; vs. 26.1 +/- 15.8; p = 0.004). Seven in 10 head injured patients sustained their injuries via transport/road traffic accidents, and head-injured patients had 13 times the odds of mortality compared with those without head injuries (OR: 13.3; 95% CI: 8.05, 22.0; p < 0.0001) even though over half of them had mild or moderate injury severity scores (p < 0.001). Evaluation of sex differences amongst the head-injured showed that in age-adjusted logistic regression models, males had 1.4 times greater odds of being head injured (OR: 1.4; 95% CI: 1.04, 2.00; p = 0.03) and over twice the risk of mortality (OR: 2.7; 95% CI: 0.74, 10.00; p = 0.13) compared to females.

Conclusion

In these analyses, HI was associated with a higher risk of mortality, particularly amongst injured males; most of whom were injured in transport/road-traffic-related accidents. This study provides an impetus for shaping policy around head injury prevention in LMICs like Ghana.

Caregiver Characteristics of Adults with Acute Traumatic Brain Injury in the United States and Latin America

Objectives: To compare characteristics of caregivers of adults with acute traumatic brain injury (TBI) in the U.S. and Latin America (Mexico and Colombia). Design: Secondary data analysis of two cohorts. Cohort 1: English-speaking caregivers of adults with TBI in the U.S. (n = 80). Cohort 2: Spanish-speaking caregivers of adults with TBI in Mexico or Colombia (n = 109). Results: Similarities between the U.S. and Latin American caregiver groups, respectively, were: predominantly women (81.3%, 81.7%, respectively); spouses/domestic partners (45%, 31.2%); and motor vehicle accident (41.5%, 48.6%) followed by fall etiologies (40%, 21.1%). Differences between U.S. and Latin American caregivers were: age (49.5 years, 41.5 years, p < 0.001); employment status ((Χ52 = 59.63, p < 0.001), full-time employment (63.7%, 25.7%), homemaker (2.5%, 31.2%), and retired (17.5%, 1.8%)); violence-related etiology (2.5%, 15.6%); and severity of depressive symptoms (M = 7.9, SD = 5.8; M = 5.8, SD = 5.7; p = 0.014). Conclusions: TBI caregivers in the U.S. were older and employed full-time or retired more often than those in Latin America. Violence-related etiology was nearly five times more common in Latin America, raising concerns for potential implications of post-traumatic stress and family adjustment after injury. Although both groups likely could use mental health support, this was particularly true of the U.S. cohort, maybe due to differential demographics, mechanisms of injury, or family and community support.