The estimated cost of surgically managed isolated traumatic head injury secondary to road traffic accidents

The Effectiveness of Brain Injury Family Intervention in Improving the Psychological Well-Being of Caregivers of Patients With Traumatic Brain Injury: Protocol for a Randomized Controlled Trial

BACKGROUND

Globally, traumatic brain injury (TBI) is recognized as one of the most significant contributors to mortality and disability. Most of the patients who have experienced TBI will be discharged home and reunited with their families or primary caregivers. The degree of severity of their reliance on caregivers varies. Therefore, the task of delivering essential care to the patients becomes demanding for the caregivers. A significant proportion of caregivers expressed considerable burden, distress, and discontentment with their lives. Therefore, it is critical to comprehend the dynamic of TBI and caregivers to optimize patient care, rehabilitation, and administration. The effectiveness of the Brain Injury Family Intervention (BIFI) program tailored for caregivers of patients with TBI has been widely proven in Western countries. However, the impact is less clear among caregivers of patients with TBI in Malaysia.

OBJECTIVE

This study aims to assess the effectiveness of BIFI in reducing emotional distress and burden of care, fulfilling the needs, and increasing the life satisfaction of caregivers of patients with TBI at government hospitals in Malaysia.

METHODS

This is a 2-arm, single-blinded, randomized controlled trial. It will be conducted at Hospital Rehabilitasi Cheras and Hospital Sungai Buloh. In total, 100 caregivers of patients with TBI attending the neurorehabilitation unit will be randomized equally to the intervention and control groups. The intervention group will undergo the BIFI program, whereas the control group will receive standard treatment. Caregivers aged ≥18 years, caring for patients who have completed >3 months after the injury, are eligible to participate. The BIFI program will be scheduled for 5 sessions as recommended by the developer of the module. Each session will take approximately 90 to 120 minutes. The participants are required to attend all 5 sessions. A total of 5 weeks is needed for each group to complete the program. Self-reported questionnaires (ie, Beck Depression Inventory, Positive and Negative Affect Schedule, Caregiver Strain Index, Satisfaction With Life Scale, and Family Needs Questionnaire) will be collected at baseline, immediately after the intervention program, at 3-month follow-up, and at 6-month follow-up. The primary end point is the caregivers' emotional distress.

RESULTS

The participant recruitment process began in January 2019 and was completed in December 2020. In total, 100 participants were enrolled in this study, of whom 70 (70%) caregivers are women and 30 (30%) are men. We are currently at the final stage of data analysis. The results of this study are expected to be published in 2024. Ethics approval has been obtained.

CONCLUSIONS

It is expected that the psychological well-being of the intervention group will be better compared with that of the control group after the intervention at 3-month follow-up and at 6-month follow-up.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20180809040746N1; https://irct.behdasht.gov.ir/trial/33286.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/53692.

Traffic safety and public health in China - Past knowledge, current status, and future directions

Transportation-related harms have developed into a social disease, threatening public safety and health in China. We aimed to increase the global understanding of traffic safety and public health in China from past knowledge, current status, and future directions by collecting, collating, and analyzing the Chinese traffic incidents reported in the published literature. A systematic search of China National Knowledge Infrastructure, Weipu, and published articles referenced in PubMed, Web of Science and ProQuest between January 1, 1988 and April 30, 2023 was performed. China encountered the first recorded traffic accident as early as three thousand years ago in the Shang Dynasty. An increase in vehicle capacity and velocity increased the traffic risks during the transition from rickshaws and livestock to motor vehicles in varying traffic environments. Humans are not only the decisive factor of a large number of vehicles, traffic routes, and environmental variables, but also the victims at the end and starting point of traffic accidents. Injuries (mechanical force, burns) and diseases (traffic-related air pollution, noise) caused by traffic activities not only threaten public health, but also cause risks to safe driving. Analysis of traffic activities and biomarkers promotes the treatment of traffic injuries in ethology and medicine. China prepared for the construction of healthy transportation in the "decade of road safety" toward an estimation of worldwide road traffic injuries in 2030. Improvement of traffic safety concerning public health under the "Outline of the National Comprehensive Three-dimensional Transportation Network Planning" in China will propel the realization of worldwide traffic environmental advancement.

Factors related to healthcare costs of road traffic accidents in Bucaramanga, Colombia

OBJECTIVE

To determine the factors related to overall healthcare costs of road traffic accidents in Bucaramanga, Colombia.

METHODS

A descriptive cross-sectional study was conducted through the analysis of road traffic accident records that took place in 2019 in Bucaramanga, Colombia. Cost quartiles in dollars were compared using Pearson's chi-squared and Fisher's exact tests. Odds ratios were also calculated in logistic regression.

RESULTS

3,150 road accidents were reported in 2019 involving 7,038 people, of which 812 had information related to healthcare costs in health care institutions. The median cost was 56.59 USD (RI = 29.35-140.15), average cost of 290.11 USD ± 731.22 (95%CI: 239.74-340.48). A higher possibility to be in the 4th quartile was found when persons were under 18 years of age (OR = 4.88; 95%CI: 1.30-18.32) or 46-60 years (OR = 3.66; 95%CI: 1.01-13.30), the type of vehicle involved is motorcycle (OR = 2.79; 95%CI: 1.25-6.24), bicycle (OR = 7.66; 95%CI: 2.70-21.68), having a head injury (OR = 4.50; 95%CI: 2.61-7.76) and hypothetical drunk driving (OR = 12.44; 95%CI: 2.01-76.87).

CONCLUSIONS

Relevant factors in healthcare costs were riding a motorcycle or bicycle, having a head injury, being under 18 years of age or 46 to 60 years of age and hypothetical drunk driving. It is important to implement prevention measures based on identified factors to reduce road accident rate and therefore, its socioeconomic costs.

Neural alterations in working memory of mild-moderate TBI: An fMRI study in Malaysia

Working memory (WM) encompasses crucial cognitive processes or abilities to retain and manipulate temporary information for immediate execution of complex cognitive tasks in daily functioning such as reasoning and decision-making. The WM of individuals sustaining traumatic brain injury (TBI) was commonly compromised, especially in the domain of WM. The current study investigated the brain responses of WM in a group of participants with mild-moderate TBI compared to their healthy counterparts employing functional magnetic resonance imaging. All consented participants (healthy: n = 26 and TBI: n = 15) performed two variations of the n-back WM task with four load conditions (0-, 1-, 2-, and 3-back). The respective within-group effects showed a right hemisphere-dominance activation and slower reaction in performance for the TBI group. Random-effects analysis revealed activation difference between the two groups in the right occipital lobe in the guided n-back with cues, and in the bilateral occipital lobe, superior parietal region, and cingulate cortices in the n-back without cues. The left middle frontal gyrus was implicated in the load-dependent processing of WM in both groups. Further group analysis identified that the notable activation changes in the frontal gyri and anterior cingulate cortex are according to low and high loads. Though relatively smaller in scale, this study was eminent as it clarified the neural alterations in WM in the mild-moderate TBI group compared to healthy controls. It confirmed the robustness of the phenomenon in TBI with the reproducibility of the results in a heterogeneous non-Western sample.

The effect of the presence or absence of skull fractures on intracranial lesion development in road traffic accidents

OBJECTIVE

The aim of this study was to investigate the effect of the presence or absence of skull fractures on the development of intracranial lesions in cases of head trauma associated with traffic accidents.

MATERIALS AND METHODS

A retrospective review was made of the medico-legal reports of 774 cases with injuries sustained in a traffic accident and which applied for expert examination as forensic cases at the Department of Forensic Medicine of our University between 1 January 2014 and 31 December 2019. A total of 162 cases (20.1%) were identified which were radiologically diagnosed with at least one skull fracture or intracranial lesion. These cases were evaluated in terms of age, gender, type of accident, and localization of skull fractures and/or intracranial lesions, and they were compared statistically to determine whether the presence or absence of skull fractures affected the development of intracranial lesions.

RESULTS

The 162 cases evaluated comprised 120 males and 42 females with a mean age of 25.1 ± 16.4 years. Intracranial lesions were accompanied by skull fractures in 77 cases, skull fracture alone was determined in 18 cases, and intracranial lesion alone in 67 cases. Skull fractures were mostly (64.5%) seen in the 1-20 years age group, and the intracranial lesions (90%) were mostly seen in the ≥41 years age group. Linear and diastatic fracture rates were highest in the temporal and frontal regions. The intracranial lesion/case ratio was 1.5/1 in cases without skull fracture, and 1.2/1 in cases with skull fracture.

CONCLUSION

The results of this study showed that the rate of linear or diastatic fractures was higher in females, which was associated with skull thickness. Skull fractures were found to occur most between the ages of 1 and 20 years, and the presence of skull fractures was determined to reduce the incidence of intracranial lesions by decreasing intracranial pressure.

Comparing the Outcomes of Early and Late Tracheostomy in Severe Traumatic Brain Injury Patient

Background

Patients with severe traumatic brain injury (TBI) were expected to have poor Glasgow Coma Scale (GCS) recovery and prolonged intubation. Therefore, an early tracheostomy procedure was indicated for all severe TBI. In view of growing concern regarding the safety and outcome of early tracheostomy on these patients, it was deemed valid and needed to be addressed.

Methods

This study was conducted to compare the outcomes of early and late tracheostomies in severe TBI. Only severe TBI patients who were admitted to the Neurosurgery High Dependency Unit (NHDU), Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia and who had underwent a tracheostomy were recruited. Three main outcomes noted: duration on ventilation, length of NHDU stay and rate of ventilator associated pneumonia (VAP).

Results

Out of 155 patients, 72 (46.5%) were in early tracheostomy group (ETG) and 83 (53.5%) were in late tracheostomy group (LTG). The majority of the participants, 95 (61.3%) were ethnic Malays. The mean duration on ventilator use was 2.65 days (1.57) for ETG and 5.63 days (2.35) for LTG. While, mean NHDU stay was 4.75 days (1.98) for ETG and 9.77 days (2.70) for LTG. Upon independent t-test, early duration of tracheostomies had shown significant outcome in reducing length of NHDU stay, (P < 0.001) and had shortening participants’ time on mechanical ventilator (P < 0.001). Then, based on forward multiple logistic regression test, there were significant association between comorbid (P = 0.003) and tracheostomy (P = 0.020) towards presence of VAP when adjusted for other variables.

Conclusion

In this study it was found that early tracheostomy was significant in shortening the duration on ventilator, reducing the length of NHDU stay and reducing the rate of VAP.

In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment

Background

The in-hospital treatment of patients with traumatic brain injury (TBI) is considered to be expensive, especially in patients with severe TBI (s-TBI). To improve future treatment decision-making, resource allocation and research initiatives, this study reviewed the in-hospital costs for patients with s-TBI and the quality of study methodology.

Methods

A systematic search was performed using the following databases: PubMed, MEDLINE, Embase, Web of Science, Cochrane library, CENTRAL, Emcare, PsychINFO, Academic Search Premier and Google Scholar. Articles published before August 2018 reporting in-hospital acute care costs for patients with s-TBI were included. Quality was assessed by using a 19-item checklist based on the CHEERS statement.

Results

Twenty-five out of 2372 articles were included. In-hospital costs per patient were generally high and ranged from $2,130 to $401,808. Variation between study results was primarily caused by methodological heterogeneity and variable patient and treatment characteristics. The quality assessment showed variable study quality with a mean total score of 71% (range 48% - 96%). Especially items concerning cost data scored poorly (49%) because data source, cost calculation methodology and outcome reporting were regularly unmentioned or inadequately reported.

Conclusions

Healthcare consumption and in-hospital costs for patients with s-TBI were high and varied widely between studies. Costs were primarily driven by the length of stay and surgical intervention and increased with higher TBI severity. However, drawing firm conclusions on the actual in-hospital costs of patients sustaining s-TBI was complicated due to variation and inadequate quality of the included studies. Future economic evaluations should focus on the long-term cost-effectiveness of treatment strategies and use guideline recommendations and common data elements to improve study quality.

Cost-Effectiveness of Tele-Video-Consultation for the Neuro-Surgical Emergency Management at the General Hospitals in Italy

Background: Neuro-surgical emergencies are serious (long-term disability and high mortality) and costly to the national health services. Tele-medicine intervention can facilitate to reduce this gap. Our study aims to evaluate the cost-effectiveness of tele-video-consultation intervention for the management of neuro-surgical emergencies in the general hospitals. Methods: We retrieved health service data from the tele-consultation service, online tele-medicine database portal and hospital patient registry, between January 2009 and December 2012 and evaluated cost-effectiveness of the tele-video-consultation intervention from an Italian National Health Service perspective. Results: Seventy-five percent of the tele-consultations were completed within 15 min and 90% within 30 min. The average costs were €2,326 in the intervention group and €4,173 in the care as usual group. The intervention avoided 73% potential transfer (saving of 139,916 km travel distance during a 4-years period). The incremental cost-saving per transfer avoided from the tele-medicine intervention was €365. Conclusions: Tele-medicine intervention could be worth investing from the Italian National Health Service perspective.