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McKimmie A, Keeves J, Gadowski A, Bagg MK, Antonic-Baker A, Hicks AJ, Hill R, Clarke N, Holland A, Veitch B, Fatovich D, Reeder S, Romero L, Ponsford JL, Lannin NA, O’Brien TJ, Cooper DJ, Rushworth N, Fitzgerald M, Gabbe BJ, Cameron PA. The Australian Traumatic Brain Injury Initiative: Systematic Review of Clinical Factors Associated with Outcomes in People with Moderate-Severe Traumatic Brain Injury. Neurotrauma Rep 2024; 5:0. [PMID: 39081663 PMCID: PMC11286001 DOI: 10.1089/neur.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
The aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) is to design a data dictionary to inform data collection and facilitate prediction of outcomes for moderate-severe traumatic brain injury (TBI) across Australia. The process has engaged diverse stakeholders across six areas: social, health, clinical, biological, acute interventions, and long-term outcomes. Here, we report the results of the clinical review. Standardized searches were implemented across databases to April 2022. English-language reports of studies evaluating an association between a clinical factor and any clinical outcome in at least 100 patients with moderate-severe TBI were included. Abstracts, and full-text records, were independently screened by at least two reviewers in Covidence. The findings were assessed through a consensus process to determine inclusion in the AUS-TBI data resource. The searches retrieved 22,441 records, of which 1137 were screened at full text and 313 papers were included. The clinical outcomes identified were predominantly measures of survival and disability. The clinical predictors most frequently associated with these outcomes were the Glasgow Coma Scale, pupil reactivity, and blood pressure measures. Following discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous studies evaluating associations between clinical factors and outcomes in patients with moderate-severe TBI. A small number of factors were reported consistently, however, how and when these factors were assessed varied. The findings of this review and the subsequent consensus process have informed the development of an evidence-informed data dictionary for moderate-severe TBI in Australia.
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Affiliation(s)
- Ancelin McKimmie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jemma Keeves
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Australia
| | - Adelle Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew K. Bagg
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Health Sciences, University of Notre Dame Australia, Fremantle, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Amelia J. Hicks
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Regina Hill
- Regina Hill Effective Consulting Pty Ltd, Melbourne, Australia
| | - Nyssa Clarke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Holland
- Faculty of Medicine and Health, The Children’s Hospital at Westmead Clinical School, University of Sydney School of Medicine, Westmead, Australia
| | - Bill Veitch
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Daniel Fatovich
- Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, Australia
| | - Sandy Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Jennie L. Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Terence J. O’Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - D. Jamie Cooper
- School of Public Health and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Department of Intensive Care and Hyperbaric Medicine, Melbourne, Australia
| | | | - Melinda Fitzgerald
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, Australia
| | - Belinda J. Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, United Kingdom
| | - Peter A. Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
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Halimi RA, Fuadi I, Alby D. The Use of Corticosteroid Randomisation after Significant Head Injury (CRASH) Prognostic Model as Mortality Predictor of Traumatic Brain Injury Patients Underwent Surgery in Low-Middle Income Countries. Anesthesiol Res Pract 2024; 2024:5241605. [PMID: 38948334 PMCID: PMC11213633 DOI: 10.1155/2024/5241605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/17/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
Background Traumatic brain injury (TBI) is a disruption to normal brain functions caused by traumas such as collisions, blows, or penetrating injuries. There are factors affecting patient outcomes that also have a predictive value. Limited data from low-middle income countries showed a high number of poor outcomes in TBI patients. The corticosteroid randomisation after significant head injury (CRASH) prognostic model is a predictive model that uses such factors and is often used in developed countries. The model has an excellent discriminative ability. However, there is still a lack of studies on its use in surgical patients in low-middle income countries. This study aimed to evaluate the CRASH model's validity to predict 14-day mortality of TBI patients who underwent surgery in low-middle income countries. Methods This retrospective analytical observational study employed total sampling including all TBI patients who underwent surgery with general anesthesia from January to December 2022. Statistical analysis was performed by applying Mann-Whitney and Fisher exact tests, while the model's discriminative ability was determined through the area under the curve (AUC) calculations. Results 112 TBI patients were admitted during the study period, and 74 patients were included. Independent statistical analysis showed that 14-day mortality risk, age, Glasgow Coma Scale score, TBI severity, pupillary response, and major extracranial trauma had a significant individual correlation with patients' actual mortality outcome (p < 0.05). The AUC analysis revealed an excellent mortality prediction (AUC 0.838; CI 95%). Conclusion The CRASH prognostic model performs well in predicting the 14-day mortality of TBI patients who underwent surgery in low-middle income countries.
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Affiliation(s)
- Radian A. Halimi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine Padjadjaran University/Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
| | - Iwan Fuadi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine Padjadjaran University/Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
| | - Dionisius Alby
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine Padjadjaran University/Hasan Sadikin Central General Hospital, Bandung, West Java, Indonesia
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Chen PY, Wei L, Su YK, Lin JH, Jang JW, Hou WH, Hsu LF, Chiu HY. Psychometric properties and factor structure of the traditional Chinese version of the Community Integration Questionnaire-Revised in traumatic brain injury survivors. Int J Rehabil Res 2024; 47:129-134. [PMID: 38587088 DOI: 10.1097/mrr.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This study aimed to translate and validate the traditional Chinese version of the Community Integration Questionnaire-Revised (TC-CIQ-R) in patients with traumatic brain injury (TBI). We included participants aged ≥20 years and diagnosed as having TBI for ≥6 months from neurosurgical clinics. The 18-item TC-CIQ-R, Participation Measure - 3 Domains, 4 Dimensions (PM-3D4D), Extended Glasgow Outcome Scale (GOSE), and Taiwanese Quality of Life After Brain Injury (TQOLIBRI) were completed. The sample included 180 TBI survivors (54% male, mean age 47 years) of whom 87% sustained a mild TBI. Exploratory factor analysis extracted four factors - home integration, social integration, productivity, and electronic social networking - which explained 63.03% of the variation, after discarding the tenth item with a factor loading of 0.25. For criterion-related validity, the TC-CIQ-R was significantly correlated with the PM-3D4D; convergent validity was exhibited by demonstrating the associations between the TC-CIQ-R and TQOLIBRI. Known-group validity testing revealed significant differences in the subdomain and total scores of the TC-CIQ-R between participants with a mean GOSE score of ≤6 and >7 (all P < 0.001). The TC-CIQ-R exhibited acceptable Cronbach's α values (0.68-0.88). We suggest the 17-item TC-CIQ-R as a valid tool for rehabilitation professionals, useful for both clinical practice and research in assessing community integration levels following TBI.
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Affiliation(s)
- Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung
- School of Medicine, College of Medicine, Chang-Gung University, Taoyuan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung
| | - Li Wei
- Taipei Neuroscience Institute
- Division of Neurosurgery, Department of Surgery, Wan Fang Hospital
- Graduate Institute of Injury Prevention and Control
| | - Yu-Kai Su
- Taipei Neuroscience Institute
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City
| | - Jiann-Her Lin
- Taipei Neuroscience Institute
- Neuroscience Research Center, Taipei Medical University
- Department of Neurosurgery, Taipei Medical University Hospital
- Division of Neurosurgery, Department of Surgery, School of Medicine
| | - Jing-Wen Jang
- School of Nursing, College of Nursing, Taipei Medical University
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Li-Fang Hsu
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
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Shakir M, Altaf A, Irshad HA, Hussain N, Pirzada S, Tariq M, Trillo-Ordonez Y, Enam SA. Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2023; 180:169-193.e3. [PMID: 37689356 DOI: 10.1016/j.wneu.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs. METHODS A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively. RESULTS A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified. CONCLUSIONS Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Nowal Hussain
- Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Mahnoor Tariq
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Naik A, Bederson MM, Detchou D, Dharnipragada R, Hassaneen W, Arnold PM, Germano IM. Traumatic Brain Injury Mortality and Correlates in Low- and Middle-Income Countries: A Meta-Epidemiological Study. Neurosurgery 2023; 93:736-744. [PMID: 37010323 DOI: 10.1227/neu.0000000000002479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND It is estimated that up to 69 million people per year experience traumatic brain injury (TBI) with the highest prevalence found in low- and middle-income countries (LMICs). A paucity of data suggests that the mortality rate after severe TBI is twice as high in LMICs than in high-income countries. OBJECTIVE To analyze TBI mortality in LMICs and to evaluate what country-based socioeconomic and demographic parameters influence TBI outcomes. METHODS Four databases were searched for the period January 1, 2002, to January 1, 2022, for studies describing TBI outcomes in LMICs. Multivariable analysis was performed using multivariable linear regression, with the outcome as the pooled mortality by country and the covariates as the adjusted parameters. RESULTS Our search yielded 14 376 records of which 101 were included in the final analysis, totaling 59 197 patients and representing 31 LMICs. The pooled TBI-related mortality was 16.7% (95% CI: 13.7%-20.3%) without significant differences comparing pediatrics vs adults. Pooled severe TBI-related mortality was significantly higher than mild. Multivariable analysis showed a significant association between TBI-related mortality and median income ( P = .04), population percentage below poverty line ( P = .02), primary school enrollment ( P = .01), and poverty head ratio ( P = .04). CONCLUSION TBI-related mortality in LMICs is 3-fold to 4-fold higher than that reported in high-income countries. Within LMICs, parameters associated with poorer outcomes after TBI include factors recognized as social determinants of health. Addressing social determinants of health in LMICs might expedite the quest to close the care delivery gap after TBI.
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Affiliation(s)
- Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign , Illinois , USA
| | - Maria M Bederson
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign , Illinois , USA
| | - Donald Detchou
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign , Illinois , USA
| | - Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis , Minnesota , USA
| | - Wael Hassaneen
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign , Illinois , USA
- Department of Neurosurgery, Carle Foundation Hospital, Urbana , Illinois , USA
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign , Illinois , USA
- Department of Neurosurgery, Carle Foundation Hospital, Urbana , Illinois , USA
| | - Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York , New York , USA
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Teh J, Mazlan M, Danaee M, Waran RJ, Waran V. Outcome of 1939 traumatic brain injury patients from road traffic accidents: Findings from specialist medical reports in a low to middle income country (LMIC). PLoS One 2023; 18:e0284484. [PMID: 37703233 PMCID: PMC10499241 DOI: 10.1371/journal.pone.0284484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/31/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE Road traffic accident (RTA) is the major cause of traumatic brain injury (TBI) in developing countries and affects mostly young adult population. This research aimed to describe the factors predicting functional outcome after TBI caused by RTA in a Malaysian setting. METHODS This was a retrospective cross-sectional study conducted on specialist medical reports written from 2009 to 2019, involving patients who survived after TBI from RTA. The functional outcome was assessed using the Glasgow Outcome Scale-Extended (GOSE). Factors associated with good outcome were analysed via logistic regression analysis. Multivariate logistic regression analysis was used to derive the best fitting Prediction Model and split-sample cross-validation was performed to develop a prediction model. RESULTS A total of 1939 reports were evaluated. The mean age of the study participants was 32.4 ± 13.7 years. Most patients were male, less than 40, and with average post RTA of two years. Good outcome (GOSE score 7 & 8) was reported in 30.3% of the patients. Factors significantly affecting functional outcome include age, gender, ethnicity, marital status, education level, severity of brain injury, neurosurgical intervention, ICU admission, presence of inpatient complications, cognitive impairment, post-traumatic headache, post traumatic seizures, presence of significant behavioural issue; and residence post discharge (p<0.05). After adjusting for confounding factors, prediction model identified age less than 40, mild TBI, absence of post traumatic seizure, absence of behaviour issue, absence of cognitive impairment and independent living post TBI as significant predictors of good functional outcome post trauma. Discrimination of the model was acceptable (C-statistic, 0.67; p<0.001, 95% CI: 0.62-0.73). CONCLUSION Good functional outcome following TBI due to RTA in this study population is comparable to other low to middle income countries but lower than high income countries. Factors influencing outcome such as seizure, cognitive and behavioural issues, and independent living post injury should be addressed early to achieve favourable long-term outcomes.
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Affiliation(s)
- Justina Teh
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Rehabilitation Medicine, Hospital Tuanku Ja’afar Seremban, Seremban, Negeri Sembilan, Malaysia
| | - Mazlina Mazlan
- Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ria Johanna Waran
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Vicknes Waran
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Schenck HE, Joackim P, Lazaro A, Wu X, Gerber LM, Stieg PE, Härtl R, Shabani H, Mangat HS. Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania. BRAIN & SPINE 2023; 3:101738. [PMID: 37383438 PMCID: PMC10293321 DOI: 10.1016/j.bas.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Quality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research question What is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and Methods Data on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. Results Sixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and Conclusion Ability to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.
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Affiliation(s)
| | - Pascal Joackim
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Halinder S. Mangat
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Smith BG, Whiffin CJ, Esene IN, Karekezi C, Bashford T, Mukhtar Khan M, Fontoura Solla DJ, Indira Devi B, Paiva WS, Servadei F, Hutchinson PJ, Kolias AG, Figaji A, Rubiano AM. Neurotrauma clinicians’ perspectives on the contextual challenges associated with traumatic brain injury follow up in low-income and middle-income countries: A reflexive thematic analysis. PLoS One 2022; 17:e0274922. [PMID: 36121804 PMCID: PMC9484678 DOI: 10.1371/journal.pone.0274922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a major global health issue, but low- and middle-income countries (LMICs) face the greatest burden. Significant differences in neurotrauma outcomes are recognised between LMICs and high-income countries. However, outcome data is not consistently nor reliably recorded in either setting, thus the true burden of TBI cannot be accurately quantified. Objective To explore the specific contextual challenges of, and possible solutions to improve, long-term follow-up following TBI in low-resource settings. Methods A cross-sectional, pragmatic qualitative study, that considered knowledge subjective and reality multiple (i.e. situated within the naturalistic paradigm). Data collection utilised semi-structured interviews, by videoconference and asynchronous e-mail. Data were analysed using Braun and Clarke’s six-stage Reflexive Thematic Analysis. Results 18 neurosurgeons from 13 countries participated in this study, and data analysis gave rise to five themes: Clinical Context: What must we understand?; Perspectives and Definitions: What are we talking about?; Ownership and Beneficiaries: Why do we do it?; Lost to Follow-up: Who misses out and why?; Processes and Procedures: What do we do, or what might we do? Conclusion The collection of long-term outcome data plays an imperative role in reducing the global burden of neurotrauma. Therefore, this was an exploratory study that examined the contextual challenges associated with long-term follow-up in LMICs. Where technology can contribute to improved neurotrauma surveillance and remote assessment, these must be implemented in a manner that improves patient outcomes, reduces clinical burden on physicians, and does not surpass the comprehension, capabilities, or financial means of the end user. Future research is recommended to investigate patient and family perspectives, the impact on clinical care teams, and the full economic implications of new technologies for follow-up.
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Affiliation(s)
- Brandon G. Smith
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (BGS); (AGK)
| | - Charlotte J. Whiffin
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Ignatius N. Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Tom Bashford
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Muhammad Mukhtar Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Northwest School of Medicine & Northwest General Hospital & Research Centre, Peshawar, Pakistan
| | - Davi J. Fontoura Solla
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Bhagavatula Indira Devi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - Wellingson S. Paiva
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Neurology, University of São Paulo, São Paulo, Brazil
| | - Franco Servadei
- Humanitas Research Hospital-IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Peter J. Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Angelos G. Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital and University of Cambridge, Cambridge, United Kingdom
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- * E-mail: (BGS); (AGK)
| | - Anthony Figaji
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Red Cross Children’s Hospital & University of Cape Town, Cape Town, South Africa
| | - Andres M. Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Neurosciences Institute, El Bosque University, Bogotá, Colombia
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Knettel BA, Knettel CT, Sakita F, Myers JG, Edward T, Minja L, Mmbaga BT, Vissoci JRN, Staton C. Predictors of ICU admission and patient outcome for traumatic brain injury in a Tanzanian referral hospital: Implications for improving treatment guidelines. Injury 2022; 53:1954-1960. [PMID: 35365345 PMCID: PMC9167761 DOI: 10.1016/j.injury.2022.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
Traumatic brain injuries (TBI) are a critical global health challenge, with disproportionate negative impact in low- and middle-income countries (LMICs). People who suffer severe TBI in LMICs are twice as likely to die than those in high-income countries, and survivors experience substantially poorer outcomes. In the hospital, patients with severe TBI are typically seen in intensive care units (ICU) to receive advanced monitoring and lifesaving treatment. However, the quality and outcomes of ICU care in LMICs are often unclear. We analyzed secondary data from a cohort of 605 adult patients who presented to the Emergency Department (ED) of a Tanzanian hospital with a moderate or severe TBI. We examined patient characteristics and performed two binary logistic regression models to assess predictors of ICU admission and patient outcome. Patients were often young (median age = 32, SD = 15), overwhelmingly male (88.9%), and experienced long delays from time of injury to presentation in the ED (median=12 h, SD = 168). A majority of patients (87.8%) underwent surgery and 55.6% ultimately had a "good recovery" with minimal disability, while 34.0% died. Patients were more likely to be seen in the ICU if they had worse baseline symptoms and were over age 60. TBI surgery conveyed a 37% risk reduction for poor TBI outcome. However, ICU patients had a 3.91 times higher risk of poor TBI outcome as compared to those not seen in the ICU, despite controlling for baseline symptoms. The findings point to the need for targeted interventions among young men, improvements in pre-hospital transportation and care, and continued efforts to increase the quality of surgical and ICU care in this setting. It is unlikely that poorer outcome among ICU patients was indicative of poorer care in the ICU; this finding was more likely due to lack of data on several factors that inform care decisions (e.g., comorbid conditions or injuries). Nevertheless, future efforts should seek to increase the capacity of ICUs in low-resource settings to monitor and treat TBI according to international guidelines, and should improve predictive modeling to identify risk for poor outcome.
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Affiliation(s)
- Brandon A Knettel
- Duke University School of Nursing, Duke Global Health Institute, 307 Trent Drive, Durham, NC 27710, United States.
| | - Christine T Knettel
- Department of Emergency Medicine, University of North Carolina School of Medicine, Raleigh Emergency Medicine Associates, UNC REX Healthcare, Raleigh, NC, United States
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Justin G Myers
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | | | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Kilimanjaro, Christian Medical University College, Duke Global Health Institute, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University Division of Global Neurosurgery and Neurology, Durham, NC, United States
| | - Catherine Staton
- Division of Emergency Medicine, Duke School of Medicine, Duke Global Health Institute, Duke University, Durham, NC, United States
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10
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Warman PI, Seas A, Satyadev N, Adil SM, Kolls BJ, Haglund MM, Dunn TW, Fuller AT. Machine Learning for Predicting In-Hospital Mortality After Traumatic Brain Injury in Both High-Income and Low- and Middle-Income Countries. Neurosurgery 2022; 90:605-612. [PMID: 35244101 DOI: 10.1227/neu.0000000000001898] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/05/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Machine learning (ML) holds promise as a tool to guide clinical decision making by predicting in-hospital mortality for patients with traumatic brain injury (TBI). Previous models such as the international mission for prognosis and clinical trials in TBI (IMPACT) and the corticosteroid randomization after significant head injury (CRASH) prognosis calculators can potentially be improved with expanded clinical features and newer ML approaches. OBJECTIVE To develop ML models to predict in-hospital mortality for both the high-income country (HIC) and the low- and middle-income country (LMIC) settings. METHODS We used the Duke University Medical Center National Trauma Data Bank and Mulago National Referral Hospital (MNRH) registry to predict in-hospital mortality for the HIC and LMIC settings, respectively. Six ML models were built on each data set, and the best model was chosen through nested cross-validation. The CRASH and IMPACT models were externally validated on the MNRH database. RESULTS ML models built on National Trauma Data Bank (n = 5393, 84 predictors) demonstrated an area under the receiver operating curve (AUROC) of 0.91 (95% CI: 0.85-0.97) while models constructed on MNRH (n = 877, 31 predictors) demonstrated an AUROC of 0.89 (95% CI: 0.81-0.97). Direct comparison with CRASH and IMPACT models showed significant improvement of the proposed LMIC models regarding AUROC (P = .038). CONCLUSION We developed high-performing well-calibrated ML models for predicting in-hospital mortality for both the HIC and LMIC settings that have the potential to influence clinical management and traumatic brain injury patient trajectories.
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Affiliation(s)
- Pranav I Warman
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Andreas Seas
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Nihal Satyadev
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Syed M Adil
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Brad J Kolls
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Timothy W Dunn
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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11
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Ding K, Sur PJ, Mbianyor MA, Carvalho M, Oke R, Dissak-Delon FN, Signe-Tanjong M, Mfopait FY, Essomba F, Mbuh GE, Etoundi Mballa GA, Christie SA, Juillard C, Chichom Mefire A. Mobile telephone follow-up assessment of postdischarge death and disability due to trauma in Cameroon: a prospective cohort study. BMJ Open 2022; 12:e056433. [PMID: 35383070 PMCID: PMC8984008 DOI: 10.1136/bmjopen-2021-056433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In Cameroon, long-term outcomes after discharge from trauma are largely unknown, limiting our ability to identify opportunities to reduce the burden of injury. In this study, we evaluated injury-related death and disability in Cameroonian trauma patients over a 6-month period after hospital discharge. DESIGN Prospective cohort study. SETTING Four hospitals in the Littoral and Southwest regions of Cameroon. PARTICIPANTS A total of 1914 patients entered the study, 1304 were successfully contacted. Inclusion criteria were patients discharged after being treated for traumatic injury at each of four participating hospitals during a 20-month period. Those who did not possess a cellular phone or were unable to provide a phone number were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The Glasgow Outcome Scale-Extended (GOSE) was administered to trauma patients at 2 weeks, 1 month, 3 months and 6 months post discharge. Median GOSE scores for each timepoint were compared and regression analyses were performed to determine associations with death and disability. RESULTS Of 71 deaths recorded, 90% occurred by 2 weeks post discharge. At 6 months, 22% of patients still experienced severe disability. Median (IQR) GOSE scores at the four timepoints were 4 (3-7), 5 (4-8), 7 (4-8) and 7 (5-8), respectively, (p<0.01). Older age was associated with greater odds of postdischarge disability (OR: 1.23, 95% CI: 1.07 to 1.41) and mortality (OR: 2.15, 95% CI: 1.52 to 3.04), while higher education was associated with decreased odds of disability (OR: 0.65, 95% CI: 0.58 to 0.73) and mortality (OR: 0.38, 95% CI: 0.31 to 0.47). Open fractures (OR: 1.73, 95% CI: 1.38 to 2.18) and closed fractures (OR: 1.83, 95% CI: 1.42 to 2.36) were associated with greater postdischarge disability, while higher Injury Severity Score (OR: 2.44, 95% CI: 2.13 to 2.79) and neurological injuries (OR: 4.40, 95% CI: 3.25 to 5.96) were associated with greater odds of postdischarge mortality. CONCLUSION Mobile follow-up data show significant morbidity and mortality, particularly for orthopaedic and neurologic injuries, up to 6 months following trauma discharge. These results highlight the need for reliable follow-up systems in Cameroon.
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Affiliation(s)
- Kevin Ding
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | - Patrick J Sur
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
- Riverside School of Medicine, University of California, Riverside, California, USA
| | | | - Melissa Carvalho
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | - Rasheedat Oke
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - Florentine Y Mfopait
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | - Frank Essomba
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | - Golda E Mbuh
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
| | | | - S Ariane Christie
- Department of Trauma and Acute Care Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity, University of California Los Angeles, Los Angeles, California, USA
| | - Alain Chichom Mefire
- Department of Surgery, University of Buea Faculty of Health Sciences, Buea, Cameroon
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12
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Abstract
PURPOSE OF REVIEW Critical care registries are synonymous with measurement of outcomes following critical illness. Their ability to provide longitudinal data to enable benchmarking of outcomes for comparison within units over time, and between units, both regionally and nationally is a key part of the evaluation of quality of care and ICU performance as well as a better understanding of case-mix. This review aims to summarize literature on outcome measures currently being reported in registries internationally, describe the current strengths and challenges with interpreting existing outcomes and highlight areas where registries may help improve implementation and interpretation of both existing and new outcome measures. RECENT FINDINGS Outcomes being widely reported through ICU registries include measures of survival, events of interest, patient-reported outcomes and measures of resource utilization (including cost). Despite its increasing adoption, challenges with quality of reporting of outcomes measures remain. Measures of short-term survival are feasible but those requiring longer follow-ups are increasingly difficult to interpret given the evolving nature of critical care in the context of acute and chronic disease management. Furthermore, heterogeneity in patient populations and in healthcare organisations in different settings makes use of outcome measures for international benchmarking at best complex, requiring substantial advances in their definitions and implementation to support those seeking to improve patient care. SUMMARY Digital registries could help overcome some of the current challenges with implementing and interpreting ICU outcome data through standardization of reporting and harmonization of data. In addition, ICU registries could be instrumental in enabling data for feedback as part of improvement in both patient-centred outcomes and in service outcomes; notably resource utilization and efficiency.
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Affiliation(s)
- Abi Beane
- Mahidol Oxford Tropical Medicine Research Unit, Oxford University, UK
| | - Jorge I.F. Salluh
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
- Postgraduate program, Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Oxford University, UK
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13
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Gozt A, Hellewell S, Ward PGD, Bynevelt M, Fitzgerald M. Emerging Applications for Quantitative Susceptibility Mapping in the Detection of Traumatic Brain Injury Pathology. Neuroscience 2021; 467:218-236. [PMID: 34087394 DOI: 10.1016/j.neuroscience.2021.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/16/2022]
Abstract
Traumatic brain injury (TBI) is a common but heterogeneous injury underpinned by numerous complex and interrelated pathophysiological mechanisms. An essential trace element, iron is abundant within the brain and involved in many fundamental neurobiological processes, including oxygen transportation, oxidative phosphorylation, myelin production and maintenance, as well as neurotransmitter synthesis and metabolism. Excessive levels of iron are neurotoxic and thus iron homeostasis is tightly regulated in the brain, however, many details about the mechanisms by which this is achieved are yet to be elucidated. A key mediator of oxidative stress, mitochondrial dysfunction and neuroinflammatory response, iron dysregulation is an important contributor to secondary injury in TBI. Advances in neuroimaging that leverage magnetic susceptibility properties have enabled increasingly comprehensive investigations into the distribution and behaviour of iron in the brain amongst healthy individuals as well as disease states such as TBI. Quantitative Susceptibility Mapping (QSM) is an advanced neuroimaging technique that promises quantitative estimation of local magnetic susceptibility at the voxel level. In this review, we provide an overview of brain iron and its homeostasis, describe recent advances enabling applications of QSM within the context of TBI and summarise the current state of the literature. Although limited, the emergent research suggests that QSM is a promising neuroimaging technique that can be used to investigate a host of pathophysiological changes that are associated with TBI.
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Affiliation(s)
- Aleksandra Gozt
- Curtin University, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Bentley, WA Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA Australia
| | - Sarah Hellewell
- Curtin University, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Bentley, WA Australia
| | - Phillip G D Ward
- Australian Research Council Centre of Excellence for Integrative Brain Function, VIC Australia; Turner Institute for Brain and Mental Health, Monash University, VIC Australia
| | - Michael Bynevelt
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, WA Australia
| | - Melinda Fitzgerald
- Curtin University, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Bentley, WA Australia; Perron Institute for Neurological and Translational Science, Nedlands, WA Australia.
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14
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Bossers SM, van der Naalt J, Jacobs B, Schwarte LA, Verheul R, Schober P. Face-to-Face Versus Telephonic Extended Glasgow Outcome Score Testing After Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:E134-E138. [PMID: 33201032 DOI: 10.1097/htr.0000000000000622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Extended Glasgow Outcome Scale (GOS-E) is used for objective assessment of functional outcome in traumatic brain injury (TBI). In situations where face-to-face contact is not feasible, telephonic assessment of the GOS-E might be desirable. The aim of this study is to assess the level of agreement between face-to-face and telephonic assessment of the GOS-E. SETTING Multicenter study in 2 Dutch University Medical Centers. Inclusion was performed in the outpatient clinic (face-to-face assessment, by experienced neurologist), followed by assessment via telephone of the GOS-E after ±2 weeks (by trained researcher). PARTICIPANTS Patients ±6 months after TBI. DESIGN Prospective validation study. MAIN MEASURES Interrater agreement of the GOS-E was assessed with Cohen's weighted κ. RESULTS From May 2014 until March 2018, 50 patients were enrolled; 54% were male (mean age 49.1 years). Median time between trauma and in-person GOS-E examination was 158 days and median time between face-to-face and telephonic GOS-E was 15 days. The quadratic weighted κ was 0.79. Sensitivity analysis revealed a quadratic weighted κ of 0.77, 0.78, and 0.70 for moderate-severe, complicated mild, and uncomplicated mild TBI, respectively. CONCLUSION No disagreements of more than 1 point on the GOS-E were observed, with the κ value representing good or substantial agreement. Assessment of the GOS-E via telephone is a valid alternative to the face-to-face interview when in-person contact is not feasible.
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Affiliation(s)
- Sebastiaan M Bossers
- Department of Anesthesiology, Amsterdam University Medical Center, Location VUmc, Amsterdam, the Netherlands (Drs Bossers, Schwarte, Verheul, and Schober); and Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (Drs van der Naalt and Jacobs)
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15
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Yin X, Wu J, Zhou L, Ni C, Xiao M, Meng X, Zhu X, Cao Q, Li H. The pattern of hospital-community-home (HCH) nursing in tracheostomy patients with severe traumatic brain injury: Is it feasible? Int J Clin Pract 2021; 75:e13881. [PMID: 33283421 DOI: 10.1111/ijcp.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tracheostomy is very common in patients with severe traumatic brain injury (TBI), long-term nursing care are needed for those patients. We aimed to evaluate the effects of hospital-community-home (HCH) nursing in those patients. METHODS This study was a before-after study design. Patients were divided into control groups (traditional nursing care) and HCH group(HCH nursing care). Tracheostomy patients with severe TBI needing long-term care were included. All patients underwent a two-month long follow-up. Glasgow coma score (GCS), Karnofsky, Self-Anxiety Scale (SAS) from caregiver and Barthel assessment at the discharge and two months after discharge were evaluated. The tracheostomy-related complications were recorded and compared. RESULTS A total of 60 patients were included. There were no significant differences between the two groups in the GCS, Karnofsky, SAS from caregiver and Barthel index at discharge((all P > .05); the GCS, Karnofsky and Barthel index were all significantly increased after two-month follow-up for the two groups (all P < .05), and the GCS, Karnofsky and Barthel index at two-month follow-up in HCH group were significantly higher than that of the control group(all P < .05), but the SAS from caregiver at two-month follow-up in HCH group was significantly less than that of the control group(P = .009). The incidence of block of artificial tracheal cannula and readmission in HCH group were significant less than that of control group (all P < .05). CONCLUSION HCH nursing care is feasible in tracheostomy patients with severe TBI, future studies are needed to further evaluate the role of HCH nursing care.
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Affiliation(s)
- Xiangyi Yin
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Jie Wu
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Lihui Zhou
- Department of General Surgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Chunyan Ni
- Department of Nursing, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Minyan Xiao
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Xianlan Meng
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Xiaowen Zhu
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Qing Cao
- Department of Neurosurgery, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
| | - Huifen Li
- Department of Nursing, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou City, China
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16
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Banerdt JK, Mateyo K, Wang L, Lindsell CJ, Riviello ED, Saylor D, Heimburger DC, Ely EW. Delirium as a predictor of mortality and disability among hospitalized patients in Zambia. PLoS One 2021; 16:e0246330. [PMID: 33571227 PMCID: PMC7877643 DOI: 10.1371/journal.pone.0246330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To study the epidemiology and outcomes of delirium among hospitalized patients in Zambia. METHODS We conducted a prospective cohort study at the University Teaching Hospital in Lusaka, Zambia, from October 2017 to April 2018. The primary exposure was delirium duration over the initial 3 days of hospitalization, assessed daily using the Brief Confusion Assessment Method. The primary outcome was 6-month mortality. Secondary outcomes included 6-month disability, evaluated using the World Health Organization Disability Assessment Schedule 2.0. FINDINGS 711 adults were included (median age, 39 years; 461 men; 459 medical, 252 surgical; 323 with HIV). Delirium prevalence was 48.5% (95% CI, 44.8%-52.3%). 6-month mortality was higher for delirious participants (44.6% [39.3%-50.1%]) versus non-delirious participants (20.0% [15.4%-25.2%]; P < .001). After adjusting for covariates, delirium duration independently predicted 6-month mortality and disability with a significant dose-response association between number of days with delirium and odds of worse clinical outcome. Compared to no delirium, presence of 1, 2 or 3 days of delirium resulted in odds ratios for 6-month mortality of 1.43 (95% CI, 0.73-2.80), 2.20 (1.07-4.51), and 3.92 (2.24-6.87), respectively (P < .001). Odds of 6-month disability were 1.20 (0.70-2.05), 1.73 (0.95-3.17), and 2.80 (1.78-4.43), respectively (P < .001). CONCLUSION Among hospitalized medical and surgical patients in Zambia, delirium prevalence was high and delirium duration independently predicted mortality and disability at 6 months. This work lays the foundation for prevention, detection, and management of delirium in low-income countries. Long-term follow up of outcomes of critical illness in resource-limited settings appears feasible using the WHO Disability Assessment Schedule.
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Affiliation(s)
- Justin K. Banerdt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Kondwelani Mateyo
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Lusaka, Zambia
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Elisabeth D. Riviello
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Deanna Saylor
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Lusaka, Zambia
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Douglas C. Heimburger
- University of Zambia School of Medicine, Lusaka, Zambia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
| | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, United States of America
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17
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Griswold DP, Khan AA, Chao TE, Clark DJ, Budohoski K, Devi BI, Azad TD, Grant GA, Trivedi RA, Rubiano AM, Johnson WD, Park KB, Broekman M, Servadei F, Hutchinson PJ, Kolias AG. Neurosurgical Randomized Trials in Low- and Middle-Income Countries. Neurosurgery 2020; 87:476-483. [PMID: 32171011 PMCID: PMC7426187 DOI: 10.1093/neuros/nyaa049] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 12/28/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The setting of a randomized trial can determine whether its findings are generalizable and can therefore apply to different settings. The contribution of low- and middle-income countries (LMICs) to neurosurgical randomized trials has not been systematically described before. OBJECTIVE To perform a systematic analysis of design characteristics and methodology, funding source, and interventions studied between trials led by and/or conducted in high-income countries (HICs) vs LMICs. METHODS From January 2003 to July 2016, English-language trials with >5 patients assessing any one neurosurgical procedure against another procedure, nonsurgical treatment, or no treatment were retrieved from MEDLINE, Scopus, and Cochrane Library. Income classification for each country was assessed using the World Bank Atlas method. RESULTS A total of 73.3% of the 397 studies that met inclusion criteria were led by HICs, whereas 26.7% were led by LMICs. Of the 106 LMIC-led studies, 71 were led by China. If China is excluded, only 8.8% were led by LMICs. HIC-led trials enrolled a median of 92 patients vs a median of 65 patients in LMIC-led trials. HIC-led trials enrolled from 7.6 sites vs 1.8 sites in LMIC-led studies. Over half of LMIC-led trials were institutionally funded (54.7%). The majority of both HIC- and LMIC-led trials evaluated spinal neurosurgery, 68% and 71.7%, respectively. CONCLUSION We have established that there is a substantial disparity between HICs and LMICs in the number of published neurosurgical trials. A concerted effort to invest in research capacity building in LMICs is an essential step towards ensuring context- and resource-specific high-quality evidence is generated.
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Affiliation(s)
- Dylan P Griswold
- Stanford University School of Medicine, Stanford, California
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ahsan A Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia
| | - Tiffany E Chao
- Stanford University School of Medicine, Stanford, California
- Department of Surgery, Santa Clara Valley Medical Center, San Jose, California
| | - David J Clark
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Karol Budohoski
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - B Indira Devi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Tej D Azad
- Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Gerald A Grant
- Stanford University School of Medicine, Stanford, California
| | - Rikin A Trivedi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Andres M Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia
| | - Walter D Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marike Broekman
- Department of Neurosurgery, Leiden University Medical Center, Leiden and Haaglanden Medical Center, the Hague, the Netherlands
| | - Franco Servadei
- Department of Neurosurgery, Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Angelos G Kolias
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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Abstract
PURPOSE OF REVIEW The burden of critical illness in low-income and middle-income countries (LMICs) is substantial. A better understanding of critical care outcomes is essential for improving critical care delivery in resource-limited settings. In this review, we provide an overview of recent literature reporting on critical care outcomes in LMICs. We discuss several barriers and potential solutions for a better understanding of critical care outcomes in LMICs. RECENT FINDINGS Epidemiologic studies show higher in-hospital mortality rates for critically ill patients in LMICs as compared with patients in high-income countries (HICs). Recent findings suggest that critical care interventions that are effective in HICs may not be effective and may even be harmful in LMICs. Little data on long-term and morbidity outcomes exist. Better outcomes measurement is beginning to emerge in LMICs through decision support tools that report process outcome measures, studies employing mobile health technologies with community health workers and the development of context-specific severity of illness scores. SUMMARY Outcomes from HICs cannot be reliably extrapolated to LMICs, so it is important to study outcomes for critically ill patients in LMICs. Specific challenges to achieving meaningful outcomes studies in LMICs include defining the critically ill population when few ICU beds exist, the resource-intensiveness of long-term follow-up, and the need for reliable severity of illness scores to interpret outcomes. Although much work remains to be done, examples of studies overcoming these challenges are beginning to emerge.
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Affiliation(s)
- Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka, and University College London, London, United Kingdom; University of Amsterdam, Amsterdam, The Netherlands, and Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka; Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand, and University of Oxford, Oxford, United Kingdom
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