Emergency Department Outcome of Patients with Traumatic Brain Injury – A Retrospective Study from Pakistan.
Introduction: Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality in both adults and children. As with other severe injuries, the outcome of TBIs is also gravely related to the quality of emergency care. Effective emergency care significantly contributes to reduced morbidity and mortality. This study was ensued to evaluate the characteristics of TBIs in Pakistan and their outcomes in the emergency department (ED).
Methods: This retrospective review included records of all TBI patients seen in the Neurosurgical ED of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from 1st September 2019 till 7th December 2019.
Results: During the study period, 5,546 patients with TBI were seen in the ED; an estimated 56.5 patients per day. There were 4,054 (73.1%) male and 1,492 (26.9%) female patients. Most of these (26%) were of age <10 years. The most common culprit of TBI was road traffic accidents (RTAs) (n=2,163; 39%) followed by accidental fall (n=1,785; 32.2%). Head injury was mostly mild (n=4,034; 72.8%) and only 265 (4.7%) had a severe injury. Only 10% (n=549) patients were admitted for further treatment, 16% were managed in the ED then discharged, and 67% were immediately discharged from the ED after the first examination and necessary management. The ED mortality rate of TBIs was 2.2% (n=123/5,546) in our study. All of these cases had severe head injuries.
Conclusion: Major culprits of TBI are RTAs and accidental falls. TBIs are mostly mild-to-moderate and the ED mortality rate is low.
2. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018 Apr 1;1:1-8. 10.3171/2017.10.JNS17352.
3. Centers for Disease C, Prevention. CDC grand rounds: reducing severe traumatic brain injury in the United States. MMWR Morb Mortal Wkly Rep. 2013;62(27):549–552.
4. Fu TS, Jing R, McFaull SR, Cusimano MD. Health & economic burden of traumatic brain injury in the emergency department. Can J Neurol Sci. 2016 Mar;43(2):238-47. 10.1017/cjn.2015.320
5. Collaborators MC. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008 Feb 21;336(7641):425-9. 10.1136/bmj.39461.643438.2
6. Celso B, Tepas J, Langland-Orban B, Pracht E, Papa L, Lottenberg L, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma. 2006;60(2):371–378. 10.1097/01.ta.0000197916.99629.eb
7. Samanamalee S, Sigera PC, De Silva AP, Thilakasiri K, Rashan A, Wadanambi S, et al. Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores. BMC Anesthesiol. 2018 Dec;18(1):4. 10.1186/s12871-017-0463-7
8. De Silva MJ, Roberts I, Perel P, Edwards P, Kenward MG, Fernandes J, et al. Patient outcome after traumatic brain injury in high-, middle-and low-income countries: analysis of data on 8927 patients in 46 countries. Int J Epidemiol. 2008 Sep 9;38(2):452-8. 10.1093/ije/dyn189
9. Swadron SP, LeRoux P, Smith WS, Weingart SD. Emergency neurological life support: traumatic brain injury. Neurocritical care. 2012;17(Suppl 1):S112–121. 10.1007/s12028-012-9760-7
10. Van den Brand CL, Karger LB, Nijman S, Hunink MG, Patka P, Jellema K. Traumatic brain injury in the Netherlands, trends in emergency department visits, hospitalization and mortality between 1998 and 2012. Eur J Emerg Med. 2018 Oct 1;25(5):355-61. 10.1097/MEJ.0000000000000457
11. Umerani MS, Abbas A, Sharif S. Traumatic brain injuries: experience from a tertiary care centre in Pakistan. Turkish Neurosurg. 2014;24(1):19-24. 10.5137/1019-5149.JTN.7080-12.1
12. Reynolds TA, Stewart B, Drewett I, Salerno S, Sawe HR, Toroyan T, et al. The impact of trauma care systems in low-and middle-income countries. Ann Rev Public Health. 2017 Mar 20;38:507-32. 10.1146/annurev-publhealth-032315-021412
13. Shamim S, Razzak JA, Jooma R, Khan U. Initial results of Pakistan's first road traffic injury surveillance project. Int J Inj Contr Saf Promot. 2011;18(3):213-7. 10.1080/17457300.2011.555559.
14. Ali M, Usman M. Traumatic brain injury: A common neurosurgical entity. J Postgrad Med Inst. 2013;27(4):445-9
15. Bhatti JA, Stevens K, Mir MU, Hyder AA, Razzak JA. Emergency care of traumatic brain injuries in Pakistan: a multicenter study. BMC emergency medicine. 2015 Dec;15(2):S12. 10.1186/1471-227X-15-S2-S12
16. Ali Raja I, Habib Vohra A, Ahmed, MB, BS M. Neurotrauma in Pakistan. World J Surg. 2001 Sep 1;25(9):1230-7. 10.1007/s00268-001-0087-3
17. Fu TS, Jing R, Fu WW, Cusimano MD. Epidemiological trends of traumatic brain injury identified in the emergency department in a publicly-insured population, 2002-2010. PloS One. 2016 Jan 13;11(1):e0145469. 10.1371/journal.pone.0145469
18. Shekhar C, Gupta LN, Premsagar IC, Sinha M, Kishore J. An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India). J Emerg Trauma Shock. 2015 Jul;8(3):131. 10.4103/0974-2700.160700
Copyright (c) 2021 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.