Patterns, Types, and Outcomes of Head Injury in Aseer Region, Kingdom of Saudi Arabia

Time to death and its predictors among traumatic brain injury patients admitted to East Amhara comprehensive specialized hospitals, Ethiopia: retrospective cohort study

BACKGROUND

Globally, 64-74 million individuals around the world are estimated to sustain traumatic brain injury every year. Moderate and severe traumatic brain injury can lead to a lifetime physical, cognitive, emotional, and behavioral changes. There were limited studies conducted in Ethiopia regarding to traumatic brain injury mortality.

METHODS

An institutional based retrospective cohort study was conducted on 429 randomly selected traumatic brain injury patients aged 18 to 64 years who were admitted to East Amhara Comprehensive Specialized Hospitals from January 1, 2016 to December 31, 2021. Kobo toolbox was applied for data collection and exported to Stata version 17 for data processing and analysis. To estimate death free time, a Kaplan Meier failure curve was used. The Cox proportional hazards regression model was used at the 5% level of significance to determine effect of predictor variables on time to death.

RESULT

A total of 429 traumatic brain injury patients aged 18 to 64 years were included with response rate of 91.3% and 145(33.8%) were dead. Open injuries (AHR = 0.25; 95% CI: 0.18-0.36), co-existing injuries (AHR = 0.40; 95% CI: 0.24-0.66), ICU admission (AHR = 0.42; 95% CI: 0.29-0.60), arrival within 4-24 h (AHR = 3.48; 95% CI: 2.01-6.03), arrival after 24 h (AHR = 6.69; 95% CI: 3.49-12.28), subdural hematoma (AHR = 2.72; 95% CI: 1.77-4.19), serum albumin < 3.5 g/dL (AHR = 0.66; 95% CI: 0.49-0.94), moderate (AHR = 0.56; 95% CI: 0.21-0.89), and mild traumatic brain injury (AHR = 0.43; 95% CI: 0.29-0.56) were predictors of traumatic brain injury mortality.

CONCLUSION

The finding of this study showed that the mortality was 1/3rd of the total patients. Open injuries, co-existing injuries, ICU admission, arrival time (4-24 h and > 24 h), subdural hematoma, serum albumin < 3.5 g/dL and severity of traumatic brain injury (mild and moderate) were predictors of traumatic brain mortality. Therefore, working on these factors to reduce the morality of traumatic brain injury patients is very important.

The microbiological profile of isolates recovered from ICU patients with traumatic brain injuries at a tertiary care center, Southern Region, Saudi Arabia

INTRODUCTION

Traumatic head injury THI is a Neurosurgical condition in which brain function is interrupted as a result of blunt (motor vehicle accidents MVA, falls, and assaults) or penetrating trauma. Nearly half of all injuries are caused by head trauma. Head traumas are a leading cause of death and organ loss in young people, where this population accounts for the vast majority of TBI patients.

METHODOLOGY

This retrospective cohort study was conducted at Asir Central Hospital, KSA with data from 2015 to 2019. Records of bacterial cultures and outcomes such as length of stay in the hospital were analyzed. In addition, treatment outcomes were also analyzed.

RESULTS

A total of 300 ICU patient samples (69 patients) were included. Patients' ages ranged from 13 to 87 years with a mean age of 32.4 ± 17.5 years old. The most frequently reported diagnosis was RTA (71 %), followed by SDH (11.6 %), The most isolated organisms from the recovered samples were Klebsiella pneumoniae (27 %), followed by Pseudomonas aeruginosa (14.7 %). Regarding susceptibility, Tigecycline was the most sensitive (44 %), followed by Gentamicin (43.3 %). A total of 36 (52.2 %) patients stayed for less than one month, 24 (34.8 %) stayed for 1-3 months, and 7 (10.1 %) stayed for 3-6 months. The mortality rate in our study population was (40.6 %) as 28 patients died.

CONCLUSION

The prevalence of pathogens in TBI needs to be determined in different institutions for the establishment of effective empiric antibiotic treatment following infections in traumatic brain injuries. This will ultimately help to improve treatment outcomes. In neurosurgical patients undergoing cranial procedures after trauma, a hospital-standardized antibiotic policy is effective in achieving low rates of bacterial infections especially MDR infections.

Patterns, mechanism of injury and outcome of pediatric trauma at a level 1 trauma centre: a descriptive retrospective analysis

Background

There is a gap in knowledge on the epidemiology of pediatric trauma in the developing countries. We aimed to describe the injury pattern, mechanism of injury (MOI), and outcomes of pediatric trauma in a level 1 trauma centre in one of the Arab Middle Eastern countries.

Methods

A retrospective analysis of pediatric injury data was conducted. All trauma patients (<18 years old) requiring hospitalization between 2012 and 2021 were included. Patients were categorized and compared based on the MOI, age-group and injury severity.

Results

A 3,058 pediatric patients (20% of the total trauma admissions) were included in the study. The incidence rate in 2020 was 86 cases per 100,000 pediatric population in Qatar. The majority were male (78%) and the mean age was 9.3 ± 5.7 years. Nearly 40% had head injuries. The in-hospital mortality rate was 3.8%. The median injury severity score (ISS) (interquartile range; IQR) was 9 (4-14) and Glasgow coma scale (GCS) was 15 (IQR 15-15). Almost 18% required Intensive Care admission. Road Traffic Injuries (RTI) were more frequent in 15-18 years old whereas ≤4 years group was mostly injured by falling objects. The case fatality rate was higher among females (5.0%), and in 15-18 years (4.6%) and <4 years (4.4%) group. Pedestrian injuries were more lethal among the MOI. One fifth had severe injury with a mean age of 11 ± 6 and 9.5% had ISS of ≥25. Predictors of severe injury were age (10 years old and above) and RTI.

Conclusion

Almost one-fifth of the trauma admissions at the level 1 trauma centre in Qatar is due to traumatic injuries among the pediatric population. Developing strategies that are based on understanding the age- and mechanism-specific patterns of traumatic injuries among the pediatric population remains crucial.

Traumatic Brain Injury Cases' Mortality Predictors, Association, and Outcomes in the Emergency Department at a Tertiary Healthcare Center in Saudi Arabia

Aim Incidence of traumatic brain injury (TBI) in Saudi Arabia has been estimated to be 116 per 1,00,000 population as incidence of TBI continues to rise in our region. We aim to study the demographics, mortality predictors, and factors influencing the outcome of TBI cases in a tertiary care center in Jeddah, Saudi Arabia.

Materials and Methods We retrospectively collected data from all consecutive patients treated at the Emergency Department of King Abdulaziz Medical City including all acute TBI adult cases (>18 years) from 2016 to 2019. Logistic regression models were used to identify significant predictors of mortality. A total of 423 individuals with TBI were enrolled in the study. Nearly, half of them were in age group of 18 to 29 (40.77). Most patients were males (76.83%).

Results Injuries were most commonly mild-to-moderate TBI (73.83%). Road traffic accident was the most common mechanism of injury (49.7%) followed by fall (39.5%). Most common mode of transportation was private cars (47.57%). Most patient required less than or equal to24hours of admission (61.23%). A total of 30 (7%) died in the hospital all of which were male with no death cases reported among females.

Conclusion In conclusion, this study reports a mortality rate related to TBI that is among the lowest in the region. Injuries were male predominant with more balanced male to female ratio. Patients who were delivered to the hospital via private cars had an improved survival. These finding should be interpreted in the context of retrospective noncontrolled study design, and further future studies are encouraged to consolidate these findings.

Pattern and In-Hospital Mortality of Thoracoabdominal Injuries Associated with Motor Vehicle Accident-Related Head Injury: a Single-Center Retrospective Study

Aim

To determine the pattern and in-hospital mortality of thoracoabdominal injuries associated with head injuries (HI) due to motor vehicle accidents. Settings and Design. A single-center retrospective study in a tertiary care hospital, level 1 trauma center in the southern region of Saudi Arabia.

Methods and Materials

Descriptive analysis was conducted to evaluate sex, age, types of head injury, associated thoracoabdominal injuries, particular admission day, duration of hospital stay, and discharge category, and associations between different variables and outcomes were analyzed.

Results

The cohort had a mean age of 26.9 ± 15.8 years, with a predominance of men (86.9%). Thoracoabdominal injuries were present in 6.8% of MVA-related HI, and 14.3% of victims expired during their hospital stay, mostly within the first 10 days. All expired patients had posttraumatic brain lesions. Moreover, there was a significant association between intensive care unit (ICU) admission and poor prognosis.

Conclusions

Existence of posttraumatic brain lesions and requirement of ICU admission are significant variables affecting outcomes in patients with motor vehicle-associated HI with concomitant thoracoabdominal trauma in this study. Patients who survived the first 10 days after trauma seemed to have a better prognosis. More efforts are needed to reduce the health burden of this lethal injury.

Pattern and Outcome of Traumatic Brain Injury, Addis Ababa, Ethiopia: A Cross-sectional Hospital-based Study

Background

Traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the world. This study assessed clinical characteristics and in-hospital outcomes among traumatic brain injury patients presenting to Addis Ababa Burn, Emergency, and Trauma hospital.

Methods

A cross-sectional hospital-based survey was conducted at AaBET hospital from January 01/2020 to April 30/2020. Data were collected using structured questionnaires from the trauma registry and patient chart. The collected data were analyzed using statistical software SPSS v 25.0.

Results

Among the 304 traumatic brain injury patients, 75% were males with a mean age of 30.4 + 15.7, and 59.2% came from the Oromia region. Road traffic injury was responsible for 45% of the cases, of which pedestrian struck accounts for 52.2% of the cases. Only 50 (16.4%) patients arrived below 02 hours. 201 (66.1%) patients had mild traumatic brain injury the rest had moderate to severe traumatic brain injury. Skullbone fracture (linear, DSF, & BSF) was the most common (n=157, 63.1%) followed by intracerebral lesions (DAI, brain contusion, & ICH) (n=140, 56.5%). Forty-three (14.1%) patients were intubated. 45(14.8%) cases had a neurosurgical intervention. The mortality rate of severe, moderate, & mild TBI were 25%, 8.0% & 2.0% respectively with an overall mortality of 5.6%.

Conclusion

This study showed road traffic injury was the commonest cause of traumatic brain injury which affected young age groups. There was a delayed presentation to AaBET hospital Emergency. The mortality rate was lower than other Ethiopian hospital studies.

Patterns and Impact of Traumatic Brain Injury at King Abdulaziz Medical City in Jeddah, Saudi Arabia: A Retrospective Cohort Study

Objectives

The objectives of this study are to explore the most common causes, patterns, and severities of head traumas, to evaluate the outcomes of traumatic head injury (TBI) patients followed in the clinic, and to calculate the prevalence of admitted cases.

Methods

In our retrospective cohort study, we included all the cases of adults above 18 years old diagnosed with head traumas (171 patients). The inclusion criteria were patients who presented to the emergency department at National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia from 2016 to 2020. Patients were categorized according to their Glasgow Coma Scale (GCS) score upon admission.

Results

Of the 171 patients in this study, 151 (88.3%) were males and 20 (11.7%) were females. The median age of our patients was 31 years. Most of the cases had no medical illnesses 124 (72.5%). The most common mechanism of injury was motor vehicle accidents (MVAs) in the majority of our cases (105, 61.4%), followed by falls from heights (34, 19.9%). The commonest computed tomography (CT) finding was subdural hematoma (47, 27.4%). The majority of the associated injuries were thoracic cases (43, 25.1%), followed by spinal (40, 23.4%). Most of the patients were admitted to NGHA (120, 70.2%), while the rest (51, 29.8%) were transferred from other hospitals. Of the total of 171 patients, 134 (78.4%) were treated conservatively. There were no associations between mortality nor length of stay and patients’ demographics, except for GCS on admission showed a significant p-value (<0.005).

Conclusion

In this study, it was found that the most common causes of TBI are MVAs followed by falls from heights. Therefore, preventive measures such as traffic safety rules need to be addressed.

Pattern and Outcomes of Injuries among Trauma Patients in Gedeo Zone, Dilla, South Ethiopia: A 5 Years Retrospective Analysis

Background

Injury has become a life threatening community health problem associated with significant mortality and morbidity worldwide. The aim of this study was to assess the burden of injury in Dilla University Hospital.

Methods

Institution-based retrospective cross-sectional study was conducted from January 2015 to June 2019. Data was collected using questionnaire adapted from WHO injury surveillance guideline. Bivariate and multivariate logistic regressions were performed to determine the factors associated with hospital mortality.

Results

Road traffic accident was the commonest cause of injury 178(47.3%) followed by interpersonal violence 113(30.1%). Revised trauma score (RTS) < 10 (AOR=2.5; 95% CI, 1.8–25.6), Glasgow coma scale (GCS) (AOR =0.3; 95% CI, 0.13–0.5), length of hospitalization (LOS) 1–7 days (AOR=0.1; 95% CI, 0.01–0.8) and time of arrival >24hr were predictors of mortality in a patient with injury.

Conclusion

Lower extremity injury was common and mostly associated with RTA. Pre-hospital emergency medical service system and trauma registry need to be established to decrease the burden of injury.

Secular Trend, Seasonal Variation, Epidemiological Pattern, and Outcome of Traumatic Head Injuries Due to Road Traffic Accidents in Aseer, Saudi Arabia

Road traffic accidents (RTAs) are a leading cause of traumatic head injury (THI) and are regarded as a public health problem in Saudi Arabia. This hospital-based retrospective study aims to provide data on the frequency, type, and distribution of RTA-related THIs over the past decade; demonstrate their time trend and seasonality; and decipher age and sex differences in RTA-related THIs and their outcome. The results showed a decline in the number of RTA-related THIs between 2010 and 2019. The patients had a mean age of 26.16 ± 16.27 years, and the male-to-female ratio was 10.8:1. Head injury with multiple lesions was the most common diagnosis, followed by cerebral contusion and skull fracture (32.1%, 12.9%, and 11.2%, respectively). Subdural hematoma (SDH) and skull fracture were significantly more common in patients aged ≥60 years (standard residual > 1.96), and significantly less common in those aged ≤17 years (standard residual < 1.96), compared to other age groups. Males experienced significantly more SDHs than females (standard residual = −2.8, p = 0.029). The length of hospital stay was positively correlated with age (Spearman’s rho = 0.057, p = 0.046). No seasonal variation was found.

Traumatic spinal cord injury in southern Saudi Arabia: Patterns, time to surgery and outcomes

Introduction:

Spinal cord injury (SCI) is an unbearable neurological disorder. which has a destructive socioeconomic effect of affected individual, their families and the healthcare systems. Stressful spinal cord damages are caused by road traffic misfortunes, violence, sports or falls.

Methods:

Retrospective study of 112 spinal cord injured patient admitted to Aseer Central hospital (ACH) between the years 2016 and 2018.

Results:

The present study includes 112 cases of TSCI patients who admitted to Asser Central Hospital and surgically treated, with mean age 32.1 ± 14.12 years. Males were the mostly affected by almost 90.2%. Lower level of education is seen in 69.6% of patients; while only 30.3% of patients had university education or higher. Motor vehicle accidents (MVA) and falls are the only two causes of spinal cord injuries in this study; however, MVA was the cause of SCI in (79.5%) and 20.5% for falls.

Conclusions:

MVAs are the most source of spinal cord injuries in Southern Saudi Arabia with high male predominance. Despite the lack of significance between shorter time to surgery, and improvement in ASIA score, it was found that shorter time to surgery plays an important role in reducing the post-operative intensive care unit and ward stay, potentially reducing possible long stay related complications and eventually reducing health care cost.

Factors affecting functional outcomes of traumatic brain injury rehabilitation at a rehabilitation facility in Saudi Arabia

Objectives:

To identify the factors that affect disability after inpatient rehabilitation (IPR) in persons with traumatic brain injury (TBI).

Methods:

This retrospective study identified 140 patients aged ≥16 years who were admitted to the TBI rehabilitation unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between 2015 and 2017. The collected data included demographic variables, TBI cause, coma duration, time from injury to IPR, LOS, and Functional Independence Measure (FIM) scores at IPR admission and discharge.

Results:

Majority of the patients were young males. The TBI was caused by motor vehicle accidents (MVA) in 95% of patients. The mean coma duration, time from injury to IPR admission, and LOS were 47±38, 264±357, and 75±52 days, respectively. The factors that were found to have an association with FIM change were time from injury to IPR admission (p=0.003, r=-0.250), admission FIM score (p=0.003, r=-0.253), and discharge FIM score (p<0.001, r=0.390). Employed patients had high FIM scores at admission (p=0.029, r=0.184) and discharge (p=0.003, r=0.252).

Conclusion:

Reduction in disability at discharge was positively associated with the severity of disability at admission and negatively with the time duration from injury to IPR admission, indicating a need to reduce time before admittance to an IPR setup. The high incidence of MVA causing TBI in a young male population strongly points to a need for appropriate measures of prevention.

Outcome of Severe Traumatic Brain Injury at KSMC: Functional Outcomes of ICP Monitor Insertion-Two Years' Experience

PURPOSE

To evaluate functional outcomes of severe traumatic brain injuries after insertion of intracranial pressure (ICP) monitor at King Saud Medical City (KSMC) and their correlation to each other.

PATIENTS AND METHODS

A retrospective observational study for all adult patients (age >18 years) who were diagnosed with severe head injury and underwent ICP insertion at KSMC. Patients diagnosed between 2017 and 2019 were included. Data for measured outcomes, Glasgow outcome scale (GOS), Karnofsky Performance Score (KPS) and length of stay (LOS) and prognostic factors, data like: age, gender and primary Glasgow coma score (GCS) was obtained from patients' files and direct communication with patients or their caregivers. We also compared patients who underwent ICP monitoring alone with those who underwent ICP with decompressive craniectomy (DC). Follow-up period ranged from 6-24 months.

RESULTS

Seventy-four patients were included in this cohort study. Outcome measurements for patients with decompression and ICP were lower than those with ICP alone. KPS and GOS showed strong correlation (p<0.01) in whole cohort and in both subgroups (ICP alone and ICP with DC). KPS showed significant correlation with length of stay (p=0.026).

CONCLUSION

ICP monitoring is valid tool in management of severely head injured patients. Patients who underwent DC had a worse outcome. KPS can be used as alternative tool to measure functional outcome in severe traumatic brain injury.

Mobile phones and "inattention" injuries: the risk is real

OBJECTIVE

Mobile phones though indispensable have a flip side, in that they adversely affecting our ergonomics and mobility. They share an etiologic burden on the changed profile of inattention injuries and now have proven to be a necessary evil in the changing lifestyles. We aim to evaluate the role of mobile phones as a causative factor in these head and neck injuries.

METHODOLOGY

We evaluated various injury statistics published throughout the world that attributed the concurrence of neurological injuries to portable handheld communication devices. We evaluated the dangers posed by simultaneous engagement on phone and mobility and examined the impact on walking and field of view. We have also reviewed the current management strategies to combat this new mode of injury. The recent sensation Pokemon Go has been discussed as a case study of a spike in the incidence of injuries due to mobile phone use.

RESULTS

Age>35 yrs is a risk factor for mobile phone use and injuries as they have a higher chance of being distracted (81%) when compared to millennials (70% distracted). The highest incidence was that of head injuries being 33.1% of the estimated total followed by face, including eyelid, eye area, and nose (32.7%); and neck (12.5%). The most common injury diagnoses included laceration (26.3% of estimated total), contusion/abrasion (24.5%), and internal organ injury (18.4%). A heightened sense of self-protection and a multitasking attitude remains at the core of the trouble despite having knowledge of the required behavior.

CONCLUSIONS

The health hazard of mobile phone use driving or walking needs to be highlighted with special emphasis on public education, law adherence, and technological solutions to mitigate the risk. The onus lies on the public as any technological advance would only work on the multitasking strategy and the price would be paid by the vulnerable road users.