Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions

Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

OBJECTIVES

To evaluate the most up-to-date burden of traumatic brain injury (TBI) and spinal cord injury (SCI) and analyse their leading causes in different countries/territories.

DESIGN

An analysis of Global Burden of Disease (GBD) data.

SETTING

The epidemiological data were gathered from GBD Results Tool (1 January, 1990─31 December 2019) covering 21 GBD regions and 204 countries/ territories.

PARTICIPANTS

Patients with TBI/SCI.

MAIN OUTCOMES AND MEASURES

Absolute numbers and age-standardised rates/estimates of incidence, prevalence and years lived with disability (YLDs) of TBI/SCI by location in 2019, with their percentage changes from 1990 to 2019. The leading causes (eg, falls) of TBI/SCI in 204 countries/territories.

RESULTS

Globally, in 2019, TBI had 27.16 million new cases, 48.99 million prevalent cases and 7.08 million YLDs. SCI had 0.91 million new cases, 20.64 million prevalent cases and 6.20 million YLDs. Global age-standardised incidence rates of TBI decreased significantly by -5.5% (95% uncertainty interval -8.9% to -3.0%) from 1990 to 2019, whereas SCI had no significant change (-6.1% (-17.3% to 1.5%)). Regionally, in 2019, Eastern Europe and High-income North America had the highest burden of TBI and SCI, respectively. Nationally, in 2019, Slovenia and Afghanistan had the highest age-standardised incidence rates of TBI and SCI, respectively. For TBI, falls were the leading cause in 74% (150/204) of countries/territories, followed by pedestrian road injuries (14%, 29/204), motor vehicle road injuries (5%, 11/204), and conflict and terrorism (2%, 4/204). For SCI, falls were the leading cause in 97% (198/204) of countries/territories, followed by conflict and terrorism (3%, 6/204).

CONCLUSIONS

Global age-standardised incidence rates of TBI have decreased significantly since 1990, whereas SCI had no significant change. The leading causes of TBI/SCI globally were falls, but variations did exist between countries/territories. Policy-makers should continue to prioritise interventions to reduce falls, but priorities may vary between countries/territories.

Impact of a focused trauma course on retention of provider skills, knowledge and confidence at a regional hospital in the Dominican Republic

INTRODUCTION

Road traffic accidents are a public health epidemic, causing significant morbidity and mortality in low- and middle-income countries. The Dominican Republic (DR) ranks among the highest road traffic fatality rates in the world. There is no formalized trauma curriculum in the DR. A short trauma course was implemented at a San Pedro de Macoris, DR hospital with pre-, post- and retention evaluation of the knowledge, skills and confidence of the providers.

METHODS

A 4-day trauma course was developed for medical students and residents. On days 1 and 4, providers completed pre- and post-training assessments consisting of a 40-question written exam, 1 simulation case and a trauma confidence questionnaire. Simulation cases were evaluated using a critical actions checklist and a non-technical skills scale (TNOTECHS). Assessments were repeated in 2 months to evaluate for knowledge, skill and confidence retention. A repeated measures ANOVA model was used to evaluate pre-, post- and retention training differences in the written exam, non-technical skills and critical actions scores. Confidence scores were assessed using a cumulative logistic regression model.

RESULTS

A total of 65 people participated (36 medical students, 22 EM and 7 family medicine residents). Of the 65 participants, 39, 22 and 21 participants had complete scores for pre-post, pre-retention and post-retention comparisons respectively. Mean test scores for the written exam were 37.2, 63.5 and 52.2 for pre, post and retention results respectively. Comparisons between pre and post as well as pre and retention showed statistically significant differences (p=0.0001). Mean TNOTECHS total scores were 15.8, 21.3 and 20.8 for pre-, post- and retention results respectively with a significant difference found between pre- and post- training and pre- and retention training (p <0.05). Simulation mean checklist scores were 57.7%, 67.8% and 74.1% for pre-, post- and retention training respectively with a significant difference established between pre- and retention scores (p<0.05). Provider opinion that their ED patients received best care possible and patients' needs were identified and addressed showed statistically significant increases.

CONCLUSION

A short trauma course can improve trauma specific knowledge, skills and confidence with significant retention at two months. A longitudinal trauma curriculum may bolster retention.