Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads
| Autor: | Navneet Singla, Ashish Aggarwal, Kajal Jain, Pravin Salunke, Chandrashekhar Gendle, Apinderpreet Singh, Sushanta K. Sahoo, Raghav Singla, Anurodh Kumar, Manoj K Tewari, Sunil Gupta, Manju Mohanty, Madhivanan Karthigeyan, Sivashanmugam Dhandapani, Manjul Tripathi, Sandeep Mohindra, Lomesh Wankhede, Rajesh Chhabra |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Developing country 030218 nuclear medicine & medical imaging Cohort Studies 03 medical and health sciences 0302 clinical medicine Trauma Centers Environmental health Epidemiology medicine Craniocerebral Trauma Humans Prospective Studies Registries Disease burden business.industry Trauma center Head injury Accidents Traffic medicine.disease Observational Studies as Topic Cohort Surgery Observational study Neurology (clinical) Neurosurgery business 030217 neurology & neurosurgery |
| Zdroj: | Acta neurochirurgica. 163(10) |
| ISSN: | 0942-0940 |
| Popis: | Although head injury (HI) from low- and middle-income countries (LMIC) heavily contributes to the global disease burden, studies are disproportionately less from this part of the world. Knowing the different epidemiological characteristics from high-income nations can target appropriate prevention strategies. This study aims to provide a comprehensive overview of the clinico-epidemiological data of HI patients, focusing on the existing challenges with possible solutions from a developing nation’s perspective. This is a prospective, registry-based, observational study of HI in an Indian tertiary trauma-care center over 4 years. Various clinico-epidemiological parameters, risk factors, and imaging spectrum were analyzed in a multivariate model to identify the challenges faced by LMIC and discuss pragmatic solutions. The study included a large-volume cohort of 14,888 patients. Notably, half of these patients belonged to mild HI, despite most were referred (90.3%) cases. Only one-third (30.8%) had severe HI. Less than a third reached us within 6 h of injury. Road traffic accidents (RTA) accounted for most injuries (61.1%), especially in the young (70.9%). Higher age, males, RTA, helmet non-usage, drunken driving, systemic injuries, and specific imaging features had an independent association with injury severity. The study represents the much-needed, large-volume, epidemiological profile of HI from an LMIC, highlighting the suboptimal utilization of peripheral healthcare systems. Strengthening and integrating these facilities with the tertiary centers in a hub and enhanced spoke model, task sharing design, and efficient back-referrals promise effective neurotrauma care while avoiding overburden in the tertiary centers. Better implementation of road safety laws also has the potential to reduce the burden of HI. |
| Databáze: | OpenAIRE |
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