Developing traumatic brain injury data bank: Prospective study to understand the pattern of documentation and presentation

Registry-based pilot epidemiological study of traumatic brain injury in a tertiary trauma care center in Kerala, India - Difficulties encountered during data collection warranting the need for standardized electronic database

Background:

Head injury is referred to as a “silent epidemic” globally. Studies regarding epidemiology of head injury are very few especially in Kerala and most have conflicting reports. Unlike developed countries, there is no well-established system for collecting and managing information on traumatic brain injury (TBI) in India, especially in Kerala. The present study shares the difficulties encountered and the insights acquired by conducting a registry-based epidemiological pilot study for collecting a baseline data of traumatic head injury patients in a tertiary care center in Kerala.

Methods:

The pilot study was conducted to know the efficiency of present reporting system of a tertiary hospital in Kerala. We tried to collect retrospective data from December 2018 to December 2019 in the department of neurosurgery. As there was no standardized protocol or electronic database for data collection in hospital, we made a sample proforma for data collection. The patient details were obtained from medical records (case sheets), resident doctor’s, and staff nurse’s notes which included demography, clinical details, and radiological findings which were analyzed.

Results:

We were not able to fill the full details regarding demography, prehospital data, and clinicoetiological details which are important as far as head injury management is considered. The hospital records were grossly inadequate for full retrieval of information. Inadequate case definition and lack of centralized electronic reporting mechanisms were some of the major difficulties we faced obviating the need for collecting, managing, and utilizing epidemiological data using an electronic database.

Conclusion:

We believe that the present pilot study will give an insight regarding the difficulties encountered in collecting data regarding TBI. This study will be the first of its kind in Kerala highlighting the importance of maintaining a proper head injury electronic registry. The data from this study would definitely guide future experimental operational research on these unexplored areas which will be relevant in head injury policy-making in Kerala as well as in India.

Clinicoepidemiologic Profile of Pediatric Traumatic Brain Injury: Experience of a Tertiary Care Hospital From Northern India

Traumatic brain injury is an important cause of acquired brain injury. The current study brings to light the clinicoepidemiologic profile of pediatric traumatic brain injury in India. Retrospective record analysis of children (aged ≤ 16 years) with traumatic brain injury presenting to an apex-trauma-center in North India over 4 years was done. Of more than 15 000 patients with a suspected head injury, 4833 were children ≤16 years old. Of these, 1074 were admitted to the inpatient department; 65% were boys with a mean age at presentation being 6.6 years. Most patients (85%) had a Glasgow Coma Scale score of 13 to 15 at presentation while Glasgow Coma Scale scores of ≤8 was seen in 10% of patients. Neuroimaging (computed tomography [CT]) abnormalities were seen in 12% of patients, with the commonest abnormality being skull fracture, followed by contusions, and extradural hemorrhage. Around 2% of patients required decompressive craniotomy whereas 3% of patients succumbed to their illness.Among the inpatients with pediatric traumatic brain injury, two-thirds were boys with a mean age at presentation of 7.6 years. Severity of traumatic brain injury varied as mild (64%), moderate (11%), and severe (25%). The most common mode of injury was accidental falls (59%) followed by road traffic and rail accidents (34%). Neuroimaging abnormalities were seen in half of inpatients with pediatric traumatic brain injury, with the commonest abnormality being skull fracture. Pediatric head injuries are an important public health problem and constitute a third of all head injuries. They are more common in boys, and the most common modes of injury are accidental falls, followed by road traffic accidents.

Global neurotrauma research challenges and opportunities

Traumatic injury to the brain or spinal cord is one of the most serious public health problems worldwide. The devastating impact of 'trauma', a term used to define the global burden of disease related to all injuries, is the leading cause of loss of human potential across the globe, especially in low- and middle-income countries. Enormous challenges must be met to significantly advance neurotrauma research around the world, specifically in underserved and austere environments. Neurotrauma research at the global level needs to be contextualized: different regions have their own needs and obstacles. Interventions that are not considered a priority in some regions could be a priority for others. The introduction of inexpensive and innovative interventions, including mobile technologies and e-health applications, focused on policy management improvement are essential and should be applicable to the needs of the local environment. The simple transfer of a clinical question from resource-rich environments to those of low- and middle-income countries that lack sophisticated interventions may not be the best strategy to address these countries' needs. Emphasis on promoting the design of true 'ecological' studies that include the evaluation of human factors in relation to the process of care, analytical descriptions of health systems, and how leadership is best applied in medical communities and society as a whole will become crucial.

Converting a paper proforma template to a user friendly electronic database to collect traumatic brain injury data

A structured reporting system which is based on a uniform template will permit uniform data collection and future statistics and will facilitate and validate independent or comparative audit of performance and quality of care. The successful establishment of a multi-center registry depends on the development of a concise data entry form, data entry system and data analysis to continuously maintain the registry. In the first phase we introduced the paper data collection form, in second phase this data form was converted to an electronic interface. In this second phase of the study the paper proforma which was developed in the first phase was converted into an electronic database by using the FileMaker Pro 13 Advanced®. The FileMaker Pro 13 Advanced® is capable to store the data, provides user friendly interface to enter data and can be converted the standalone runtime program to install in any other computer system. The next step is to explore the possibility whether it would be feasible to use this as a multicenter traumatic brain injury registry.

Developing a Traumatic Brain Injury Registry: Lessons Learned from Difficulties

Aim: The aim of present article is to share our experiences and lessons learned from a pilot study which was conducted to collect data to serve as a model in establishing a multi-center registry on traumatic brain injury patients.

Methods: The present study was conducted from December 2013 to June 2014 in the Department of Neurosurgery and Department of Accident and Emergency Medicine. All patients with the diagnosis of traumatic brain injury (as per the criteria laid by International Classification of Disease injury codes ICD 10) were enrolled in the study. Variables were identified as per the international norms and the data points were selected which included demographic details, pre-hospital characteristics, clinical details in emergency room, injury details, course during hospital stay, treatment and disposition. The data were categorized into master data, data related to pre-hospital events including pre-hospital care, data related to emergency room care offered in the emergency department, data related to hospital stay and patient course, outcome and follow up.

Results: A total of 231 patients were admitted with the diagnosis of traumatic brain injury. There were 79.1% male and 20.5% female patients. Mean age was 37.19 years (SD±17.02 years, range 4-87 years). Mean hospital stay was 3.66 days (SD±4.46 days, range-1-21 days). Data were collected daily for all the admitted patients on previous day fulfilling the inclusion criteria. The Proforma was easy to comprehend and it was easy to fill.

Conclusion: We found that a well-designed Proforma based under supervision data collection in a relatively low volume trauma center. We found that a well-designed Proforma based under supervision data collection in a relatively low volume trauma center and at regular intervals can be costeffective which can be managed by personnel with basic training.