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

  • Original Article - Brain trauma
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Abstract

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India

    Madhivanan Karthigeyan, Sunil Kumar Gupta, Pravin Salunke, Sivashanmugam Dhandapani, Lomesh Shankarrao Wankhede, Anurodh Kumar, Apinderpreet Singh, Sushanta Kumar Sahoo, Manjul Tripathi, Chandrashekhar Gendle, Raghav Singla, Ashish Aggarwal, Navneet Singla, Manju Mohanty, Sandeep Mohindra, Rajesh Chhabra & Manoj Kumar Tewari

  2. Department of Anesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India

    Kajal Jain

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Correspondence to Sunil Kumar Gupta.

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The procedures performed were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki Declaration and its later amendments. For this type of study, formal consent is not required.

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Karthigeyan, M., Gupta, S.K., Salunke, P. et al. Head injury care in a low- and middle-income country tertiary trauma center: epidemiology, systemic lacunae, and possible leads. Acta Neurochir 163, 2919–2930 (2021). https://doi.org/10.1007/s00701-021-04908-x

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