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

• Published in: Acta neurochirurgica Vol. 163; no. 10; pp. 2919 - 2930
• Main Authors: Karthigeyan, Madhivanan, Gupta, Sunil Kumar, Salunke, Pravin, Dhandapani, Sivashanmugam, Wankhede, Lomesh Shankarrao, Kumar, Anurodh, Singh, Apinderpreet, Sahoo, Sushanta Kumar, Tripathi, Manjul, Gendle, Chandrashekhar, Singla, Raghav, Aggarwal, Ashish, Singla, Navneet, Mohanty, Manju, Mohindra, Sandeep, Chhabra, Rajesh, Tewari, Manoj Kumar, Jain, Kajal
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.10.2021; Springer Nature B.V
• Subjects: Brain trauma; Epidemiology; Head injuries; Interventional Radiology; Low income groups; Mathematical models; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Original Article - Brain trauma; Risk factors; Surgical Orthopedics; Trauma; Task sharing; Traumatic brain injury; Tertiary; Lower–middle-income countries; Registry; Trauma; Neurotrauma; Hub and spoke
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-021-04908-x

Background 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. Methods 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. Results 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. Conclusions 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.