Controversies in Traumatic Brain Injury: Neurotrauma Experience in Bandung Indonesia
Keywords:
Controversies TBI, multimodal treatment, prehospital systems, head injury, road traffic accidents.Abstract
Objective: Despite progress in the management TBI, several controversies and questions such as the best use of technological advances and the data obtained from multimodality monitoring, the use of mannitol and hypertonic saline, decompressive craniectomy and barbiturate coma, therapeutic hypothermia, anemia and the role of blood transfusion, and venous thromboembolism prophylaxis in TBI. Our Hospital implementing the multimodal treat- ment for TBI patients.
Materials and Methods: This is a multicenter study, conducted at Spine Research Working Group, Division of Neurospine, Pain and Peripheral Nerve Department of Neurosurgery, Faculty of Medicine Universitas Pad- jadjaran – Dr. Hasan Sadikin Hospital, Bandung, Division of Neurotrauma, Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran – Dr. Hasan Sadikin Hospital, Bandung, Indonesia. The duration of study 1 year from Jan. 2011 to Dec. 2012.
Results: In our hospital, within 1 year, the total number of cases of TBI were 2069, or 173 cases / month. The caused of TBI is dominated by traffic accident 1498 (73%) from total cases. Male were more dominant 1537 (74%) compare to female 532 (26%). There were 1488 (72%) cases of mild head injury, 401 (19%) of moderate head injury and 180 (9%) cases of severe head injury. Among the traffic accidents motorbike accidents were predominant, 1132 (55%) cases, followed by pedestrian 322 (16%) cases, falling down 293 (14%) cases, cars 44 (0.2%) cases, crimes 27 (0.1%) cases and others like house family abuse and so on, in 251 (14.7%) cases respec- tively. Time interval from the occurrence site to the hospital was < 4 hours 1008 cases and the rest are > 4 hours. Clinically, we found 1953 (94%) with pupil equal. The mortality rate caused by Traumatic Brain Injury (TBI) in Indonesia on 2011 is 6.2 – 11.2% which is two times compare to the international literature (3 – 8%). Most of them are young adult. However there are still controversies in term of management of TBI.
Conclusion: There have been many controversies in the management of TBI. It is depend on the resource and experience of the trauma centre itself. Nevertheless it has to be focus on patient priority and outcomes.
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