Algorithm of traumatic brain injury management at Indonesia in the COVID 19 pandemic ERA. Retrospective cohort study

The epidemiology of motorcycle-related acute traumatic brain injury: The NOMADEN study

Background

Although persisting to be a public health hazard in Indonesia, motorcycle-related traumatic brain injury (TBI) due to road traffic accidents (RTA) lacks comprehensive national data. We aim to study the epidemiological pattern of motorcycle-related TBI and analyze the determinants related to mortality in the only neurosurgical center in the rural province of North Maluku, Indonesia.

Methods

Using the North Maluku Database in Neurosurgery register, information regarding age, sex, health insurance, alcohol use, point of referral, degree of severity, brain computed tomography abnormalities, helmet use, surgery, injury-to-admission time (IAT), and relationship to the motorcycle were obtained from patients admitted to Chasan Boesoirie General Hospital, Ternate, in 2021-2022. Multivariable logistic regression analysis was performed to investigate associations with in-hospital mortality.

Results

Of all RTA-related TBI patients (n = 353), 91.8% (n = 324) were caused by motorcycle collision (mean age ± standard deviation of 30.5 ± 16.7 years old). The majority were motorcyclists (66.7%), male (64.8%), IAT >4 h (55.9%), financed by non-Jaminan Kesehatan Nasional mechanism (66.4%), not under alcohol influence (78.4%), referred from Ternate (55.2%), and suffered mild TBI (75%). Thirty patients (9.3%) succumbed to death. Moreover, 9.3% and 91.2% were ≤17 years old and helmetless. Glasgow coma scale and IAT were significantly associated with in-hospital mortality (odds ratio [95% confidence interval]: 0.58 [0.49-0.68] and 5.44 [1.00-30.34], respectively).

Conclusion

The young and productive males dominated the motorcycle-related TBI patients in North Maluku. Poor compliance with road traffic laws, as demonstrated by a considerable proportion of underage, alcohol-intoxicated, and helmetless patients, necessitated prompt actions from all related elements.

Platelet-to-lymphocyte ratio as a prognostic predictive marker on adults with traumatic brain injury: Systematic review

Background

The platelet-to-lymphocyte ratio (PLR) has emerged as a prognostic predictive marker in various diseases, but its role in traumatic brain injury (TBI) has not been fully elucidated. This study aims to evaluate the role of PLR as a prognostic predictive marker in adults with TBI.

Methods

This systematic review was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-analysis Guidelines 2020. A comprehensive search was performed using PubMed, Google Scholar, Scopus, Crossref, OpenAlex, Semantic Scholar, Library of Congress, and Jisc Library Hub Discover database to identify relevant studies published up to February 2023. Both prospective and retrospective observational studies written in English or Indonesian were included in the study. No restrictions were placed on the year and country of publication and duration of follow-up. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS), and the risk of bias was estimated using the Cochrane Risk of Bias Assessment Tool for Nonrandomized Research (Ro-BANS) tool. A narrative synthesis was also conducted to summarize the findings.

Results

We retrieved 1644 references using the search strategy, and 1623 references were excluded based on screening the title and abstract. The full text was retrieved for 20 articles and subjected to the eligibility criteria, of which 16 were excluded from the study. Four papers with a total of 1.467 sample sizes were included in the review. The median of NOS for study quality was 8-9, with the risk of selection bias using the Ro-BANS tool being low in all studies except for the blinding outcome assessments, which are all unclear. The study finding suggests that the PLR has the potential as an independent prognostic predictive marker in adult patients with TBI. In three studies, a high level of admission PLR may independently predict an increasing mortality risk in 30 days and adverse outcomes measured by the Glasgow outcome scale in 6 months following TBI. However, one study shows that PLR may have limited value as a predictor of mortality or favorable neurological outcomes compared to other hematological parameters. Further studies were needed to establish the clinical utility of PLR and fill the present gaps.

Conclusion

This systematic review provides evidence supporting the utilization of PLR as a prognostic predictive marker in adult patients with TBI. The PLR can mainly be utilized, especially in rural practice, as PLR is a simple, low-cost, and routinely performed hematological examination.

Managing Traumatic Brain Injury During the Coronavirus Disease 2019 Pandemic-A Case-Matched Controlled Analysis of Immediate Outcomes

OBJECTIVE

The primary objective of this study was to evaluate the outcome of patients with traumatic brain injury (TBI) during the coronavirus disease 2019 (COVID-19) pandemic and to compare their outcome with case-matched controls from the prepandemic phase.

METHODS

This is a retrospective case-control study in which all patients with TBI admitted during COVID-19 pandemic phase (Arm A) from March 24, 2020 to November 30, 2020 were matched with age and Glasgow Coma Scale score-matched controls from the patients admitted before March 2020 (Arm B).

RESULTS

The total number of patients matched in each arm was 118. The length of hospital stay (8 days vs. 5 days; P < 0.001), transit time from emergency room to operation room (150 minutes vs. 97 minutes; P = 0.271), anesthesia induction time (75 minutes vs. 45 minutes; P = 0.002), and operative duration (275 minutes vs. 180 minutes; P = 0.002) were longer in arm A. Although the incidence of fever and pneumonia was significantly higher in arm A than in arm B (50% vs. 26.3%, P < 0.001 and 27.1% vs. 1.7%, P < 0.001, respectively), outcome (Glasgow Outcome Scale-Extended) and mortality (18.6% vs. 14.4% respectively; P = 0.42) were similar in both the groups.

CONCLUSIONS

The outcome of the patients managed for TBI during the COVID-19 pandemic was similar to matched patients with TBI managed at our center before the onset of the COVID-19 pandemic. This finding suggests that the guidelines followed during the COVID-19 pandemic were effective in dealing with patients with TBI. This model can serve as a guide for any future pandemic waves for effective management of patients with TBI without compromising their outcome.

Basic and clinical research publications of Indonesian neurosurgeons: Where are we?

Background

With changes in European and the US academia and education systems, research has become a measurement to define academic productivity, as it is a crucial component in the process of becoming a well-trained neurosurgeon. In this recent study, we aimed to reveal the current status and challenges facing neurosurgical research in Indonesia.

Methods

An open-access PubMed MEDLINE database search was performed to reveal all articles published by Indonesian Neurosurgeons from 1980 to July 2021. The detail was extracted to the following parameters: academia center or city of the study, year of publication, study type, topic, journal, institution and Q status, first author, article citation, international collaboration, and the working field. These data were processed and examined.

Results

During 1980 and July 2021, a total of 242 PubMed-indexed papers were published from Indonesia. The number of publications started increasing significantly from 2010 to 2021, with an average of 19 papers per year since 2010. Most of the studies came from Bandung (22.7%), with Universitas Padjadjaran as the center of the study. According to the paper type, the majority of the articles were basic and clinical research (45.5%). The most common study type was case reports (33.5%). Neurotrauma (21.9%) was the most frequent topic followed by neuro-oncology (21.07%) and spine trauma (11.98%).

Conclusion

Published articles in the neurosurgery field in Indonesia has shown a higher, promising trend. Despite many challenges faced in the process, there was significant progress in the past few decades compared to the previous ones. A comprehensive deliberate plan and multidisciplinary effort that focuses on overcoming the problems regarding defining academic productivity is needed for further improvement of neurosurgical care in Indonesia.

The Impact of the COVID-19 Pandemic on Traumatic Brain Injury Management: Lessons Learned Over the First Year

The COVID-19 pandemic has had widespread consequences on health care systems around the world. It resulted in extensive changes to the referral patterns, management, and rehabilitation of surgical conditions. We aimed to evaluate the effect the COVID-19 pandemic has had on traumatic brain injury (TBI) specifically. We reviewed the literature published on COVID-19 and TBI referrals, management, and rehabilitation. Significant changes were seen in the referral patterns of TBIs worldwide, explained by changes in societal behaviors and changes in the mechanism of injury. Implementation of strict infection control measures and COVID-19 screening was commonplace, with some reporting changes to operating room protocols. TBI was more likely to be conservatively managed. Rehabilitation services were restricted, with a greater shift towards telemedicine to provide rehabilitative therapy remotely.