1
|
Kelley JK, Jaje KE, Smitterberg CW, Reed CR, Pounders SJ, Krech LA, Groseclose RS, Fisk CS, Chapman AJ, Yang AY. Direct to Operating Room for Decompressive Craniotomy/Craniectomy in Patients With Traumatic Brain Injury. J Trauma Nurs 2023; 30:282-289. [PMID: 37702731 DOI: 10.1097/jtn.0000000000000742] [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: 09/14/2023]
Abstract
BACKGROUND Emergent decompressive craniotomy/craniectomy can be a lifesaving surgical intervention for select patients with traumatic brain injury. Prompt management is critical as early decompression can impact traumatic brain injury outcomes. OBJECTIVE This study aims to describe the feasibility and clinical impact of a new pathway for transporting patients with severe traumatic brain injury directly to the operating room from the trauma bay for decompressive craniotomy/craniectomy. METHODS This is a retrospective cohort preintervention and postintervention study of severe traumatic brain injury patients undergoing decompressive craniectomy/craniotomy at a Midwestern U.S. Level I trauma center between 2016 and 2022. In the new pathway, the in-house trauma surgeon takes the patient directly to the operating room with the neurosurgery advanced practice provider to drape and prepare the patient for surgery while the neurosurgeon is en route to the hospital. RESULTS A total of 44 patients were studied, five (5/44, 11.4%) of which were in the preintervention group and 39 (39/44, 88.6%) in the postintervention group. The median arrival-to-operating room time was shorter in the postintervention cohort (1.4 hr) than in the preintervention cohort (1.5 hr). In examining night shifts only, the preintervention cohort had shorter arrival-to-operating room times (1.2 hr) than the postintervention cohort (1.5 hr). CONCLUSION The study demonstrated that the new pathway is feasible and expedites patient transport to the operating room while awaiting the arrival of the on-call neurosurgeon.
Collapse
Affiliation(s)
- Jesse K Kelley
- Department of General Surgery, Corewell Health, Grand Rapids, Michigan (Drs Kelley, Chapman, and Yang); Michigan State University College of Human Medicine, Grand Rapids (Ms Jaje and Messrs Smitterberg and Reed); and Trauma Research Institute, Corewell Health, Grand Rapids, Michigan (Messrs Pounders and Groseclose, Mss Krech and Fisk, and Drs Chapman and Yang)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Kamabu K, La O Soria J, Tumwesigye D, Okedi XF, Kyomukama L, Muhumuza J, Musinguzi B, Kavuma D, Vivalya BMN, Loduk M, Abdullah WS. 24 h mortality and its predictors among road traffic accident victims in a resource limited setting; a multicenter cohort study. BMC Surg 2023; 23:97. [PMID: 37101207 PMCID: PMC10131391 DOI: 10.1186/s12893-023-02011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION The incidence of road traffic accidents (RTAs) is on the rise contributing to the global burden of mortality as a major global health threat. It has been estimated that 93% of RTAs and more than 90% of the resulting deaths occur in low and middle income countries. Though death due to RTAs has been occurring at an alarming rate, there is paucity of data relating to incidence and predictors of early mortality. This study was aimed at determining the 24 h mortality and its predictors among RTA patients attending selected hospitals in western Uganda. METHODS This was a prospective cohort that consecutively enrolled 211 RTA victims admitted and managed in emergency units of 6 hospitals in western Uganda. All patients who presented with a history of trauma were managed according to the advanced trauma life support protocol (ATLS). The outcome regarding death was documented at 24 h from injury. Data was analyzed using SPSS version 22 for windows. RESULTS Majority of the participants were male (85.8%) aged 15-45 years (76.3%). The most common road user category was motorcyclists (48.8%). The 24 h mortality was 14.69%. At multivariate analysis, it was observed that a motorcyclist was 5.917 times more likely to die compared to a pedestrian (P = 0.016). It was also observed that a patient with severe injury was 15.625 times more likely to die compared to one with a moderate injury (P < 0.001). CONCLUSION The incidence of 24 h mortality among road traffic accident victims was high. Being motorcycle rider and severity of injury according to Kampala trauma score II predicted mortality. Motorcyclists should be reminded to be more careful while using the road. Trauma patients should be assessed for severity, and the findings used to guide management since severity predicted mortality.
Collapse
Affiliation(s)
- Kinyamaniyi Kamabu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Jorge La O Soria
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Deus Tumwesigye
- Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Xaviour Francis Okedi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Lauben Kyomukama
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Joshua Muhumuza
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda.
| | - Brian Musinguzi
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Daniel Kavuma
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Bives Mutume Nzanzu Vivalya
- Department of Psychiatry, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Michael Loduk
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| | - Wani Shabani Abdullah
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Western Campus, PO. Box 70, Ishaka-Bushenyi, Uganda
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Owolabi EO, Nyamathe S, Joseph C, Khuabi LAJN, English RG, Vlok A, Erasmus E, Geduld HI, Lategan HJ, Chu KM. Mapping access to care and identification of barriers for traumatic brain injury in a South African township. J Eval Clin Pract 2023; 29:380-391. [PMID: 36415056 DOI: 10.1111/jep.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022]
Abstract
RATIONALE South Africa has a high traumatic injury burden resulting in a significant number of persons suffering from traumatic brain injury (TBI). TBI is a time-sensitive condition requiring a responsive and organized health system to minimize morbidity and mortality. This study outlined the barriers to accessing TBI care in a South African township. METHODS This was a multimethod study. A facility survey was carried out on health facilities offering trauma care in Khayelitsha township, Cape Town, South Africa. Perceived barriers to accessing TBI care were explored using qualitative interviews and focus group discussions. The four-delay framework that describes delays in four phases was used: seeking, reaching, receiving, and remaining in care. We purposively recruited individuals with a history of TBI (n = 6) and 15 healthcare professionals working with persons with TBI (seven individuals representing each of the five facilities, the heads of neurosurgery and emergency medical services and eight additional healthcare providers who participated in the focus group discussions). Quantitative data were analysed descriptively while qualitative data were analysed thematically, following inductive and deductive approaches. FINDINGS Five healthcare facilities (three community health centres, one district hospital and one tertiary hospital) were surveyed. We conducted 13 individual interviews (six with persons with TBI history, seven with healthcare providers from each of the five facilities, neurosurgery department and emergency medical service heads and two focus group discussions involving eight additional healthcare providers. Participants mentioned that alcohol abuse and high neighbourhood crime could lead to delays in seeking and reaching care. The most significant barriers reported were related to receiving definitive care, mostly due to a lack of diagnostic imaging at community health centres and the district hospital, delays in interfacility transfers due to ambulance delays and human and infrastructural limitations. A barrier to remaining in care was the lack of clear communication between persons with TBI and health facilities regarding follow-up care. CONCLUSION Our study revealed that various individual-level, community and health system factors impacted TBI care. Efforts to improve TBI care and reduce injury-related morbidity and mortality must put in place more community-level security measures, institute alcohol regulatory policies, improve access to diagnostics and invest in hospital infrastructures.
Collapse
Affiliation(s)
- Eyitayo O Owolabi
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa.,Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Samukelisiwe Nyamathe
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Occupational therapy, Stellenbosch University, Cape Town, South Africa
| | - Lee-Ann Jacobs-Nzuzi Khuabi
- Department of Health and Rehabilitation Sciences, Division of Occupational therapy, Stellenbosch University, Cape Town, South Africa
| | - Rene G English
- Department of Global Health, Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
| | - Adriaan Vlok
- Division of Neurosurgery, Stellenbosch University, Cape Town, South Africa
| | - Elaine Erasmus
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Heike I Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Hendrick J Lategan
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Kathryn M Chu
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa.,Department of Surgery, University of Botswana, Gaborone, Botswana
| |
Collapse
|
5
|
Ganefianty A, Songwathana P, Nilmanat K. Transitional care programs to improve outcomes in patients with traumatic brain injury and their caregivers: A systematic review and meta-analysis. BELITUNG NURSING JOURNAL 2021; 7:445-456. [PMID: 37497284 PMCID: PMC10367996 DOI: 10.33546/bnj.1592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 09/12/2021] [Indexed: 07/28/2023] Open
Abstract
Background Effective nursing interventions for caring for patients with moderate to severe traumatic brain injury are still challenging during a transition from hospital to home. Since traumatic brain injury has deep-rooted sequelae, patients and their caregivers require better arrangement and information on the condition to achieve improved outcomes after discharge. Objective This study aimed to assess transitional care programs to improve outcomes of patients with traumatic brain injury and their caregivers. Methods A systematic review and meta-analysis were performed on studies retrieved from ProQuest, PubMed, Science Direct, CINAHL, and Google Scholar from January 2010 to July 2021. RevMan 5.4.1 software was used for meta-analysis. Results Nine studies were systematically selected from 1,137 studies. The standard approaches of interventions used in patients with traumatic brain injury and their caregivers were education, mentored problem-solving, home-and community-based rehabilitation, counseling, skill-building, and psychological support. We observed that there was significant evidence indicating beneficial effects of intervention in increasing the physical functioning of patients with traumatic brain injury (SMD = -0.44, 95% CI -0.60 to -0.28, p <0.001), reducing the psychological symptoms among caregivers (SMD = -0.42, 95% CI -0.59 to -0.24, p <0.001), and increasing the satisfaction (SMD = -0.35, 95% CI -0.60 to -0.11, p = 0.005). Conclusion Education, skill-building, and psychological support should be the main components in transitional care nursing programs for patients with traumatic brain injury and their caregivers.
Collapse
Affiliation(s)
- Amelia Ganefianty
- Doctor of Philosophy Program in Nursing Science, Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
| | | | | |
Collapse
|
6
|
Rubiano AM, Griswold DP, Jibaja M, Rabinstein AA, Godoy DA. Management of severe traumatic brain injury in regions with limited resources. Brain Inj 2021; 35:1317-1325. [PMID: 34493135 DOI: 10.1080/02699052.2021.1972149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
IMPORTANCE Severe traumatic brain injury (sTBI) is a critical health problem in regions of limited resources (RLRs). Younger populations are among the most impacted. The objective of this review is to analyze recent consensus-based algorithms, protocols and guidelines proposed for the care of patients with TBI in RLRs. OBSERVATIONS The principal mechanisms for sTBI in RLRs are road traffic injuries (RTIs) and violence. Limitations of care include suboptimal or non-existent pre-hospital care, overburdened emergency services, lack of trained human resources, and surgical and intensive care. Low-cost neuromonitoring systems are currently in testing, and formal neurotrauma registries are forming to evaluate both long-term outcomes and best practices at every level of care from hospital transport to the emergency department (ED), to the operating room and intensive care unit (ICU). CONCLUSIONS AND RELEVANCE The burden of sTBI is highest in RLRs. As working-age adults are the predominantly affected age-group, an increase in disability-adjusted life years (DALYs) generates a loss of economic growth in regions where economic growth is needed most. Four multi-institutional collaborations between high-income countries (HICs) and LMICs have developed evidence and consensus-based documents focused on capacity building for sTBI care as a means of addressing this substantial burden of disease.
Collapse
Affiliation(s)
- Andres M Rubiano
- Professor of Neurosciences and Neurosurgery, Universidad El Bosque - Bogota, Colombia/Medical and Research Director, Meditech Foundation, Cali, Colombia.,Global Health Research Group in Neurotrauma, Neuroscience Department, University of Cambridge, Cambridge, UK
| | - Dylan P Griswold
- , Candidate, Stanford Medical School, Stanford, CA, USA.,, Cambridge, UK
| | - Manuel Jibaja
- , School of Medicine International University. Intensive Care Unit - Hospital Eugenio Espejo, Quito, Ecuador
| | - Alejandro A Rabinstein
- Critical Care, Professor of Neurology, Medical Director of the Neuroscience ICU -, Mayo Clinic, USA
| | - Daniel Agustin Godoy
- Medical Director Neurointensive Care Unit, Sanatorio Pasteur; Assistant Professor of Intensive Care-Hospital San Juan Bautista-, Catamarca, Argentina
| |
Collapse
|
7
|
Everitt A, Root B, Calnan D, Manwaring P, Bauer D, Halter R. A bioimpedance-based monitor for real-time detection and identification of secondary brain injury. Sci Rep 2021; 11:15454. [PMID: 34326387 PMCID: PMC8322167 DOI: 10.1038/s41598-021-94600-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/13/2021] [Indexed: 01/01/2023] Open
Abstract
Secondary brain injury impacts patient prognosis and can lead to long-term morbidity and mortality in cases of trauma. Continuous monitoring of secondary injury in acute clinical settings is primarily limited to intracranial pressure (ICP); however, ICP is unable to identify essential underlying etiologies of injury needed to guide treatment (e.g. immediate surgical intervention vs medical management). Here we show that a novel intracranial bioimpedance monitor (BIM) can detect onset of secondary injury, differentiate focal (e.g. hemorrhage) from global (e.g. edema) events, identify underlying etiology and provide localization of an intracranial mass effect. We found in an in vivo porcine model that the BIM detected changes in intracranial volume down to 0.38 mL, differentiated high impedance (e.g. ischemic) from low impedance (e.g. hemorrhagic) injuries (p < 0.001), separated focal from global events (p < 0.001) and provided coarse 'imaging' through localization of the mass effect. This work presents for the first time the full design, development, characterization and successful implementation of an intracranial bioimpedance monitor. This BIM technology could be further translated to clinical pathologies including but not limited to traumatic brain injury, intracerebral hemorrhage, stroke, hydrocephalus and post-surgical monitoring.
Collapse
Affiliation(s)
- Alicia Everitt
- Thayer School of Engineering, Dartmouth College, HB 8000, 14 Engineering Dr., Hanover, NH, 03755, USA.
| | - Brandon Root
- Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - Daniel Calnan
- Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | | | - David Bauer
- Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - Ryan Halter
- Thayer School of Engineering, Dartmouth College, HB 8000, 14 Engineering Dr., Hanover, NH, 03755, USA.,Neurological Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| |
Collapse
|
8
|
Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study. World J Emerg Surg 2020; 15:58. [PMID: 33059728 PMCID: PMC7560107 DOI: 10.1186/s13017-020-00338-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) contribute to 90% of injuries occurring in the world. The liver is one of the commonest organs injured in abdominal trauma. This study aims to highlight the demographic and management profile of liver injury patients, presenting to four urban Indian university hospitals in India. METHODS This is a retrospective registry-based study. Data of patients with liver injury either isolated or concomitant with other injuries was used using the ICD-10 code S36.1 for liver injury. The severity of injury was graded based on the World Society of Emergency Surgery (WSES) grading for liver injuries. RESULTS A total of 368 liver injury patients were analysed. Eighty-nine percent were males, with road traffic injuries being the commonest mechanism. As per WSES liver injury grade, there were 127 (34.5%) grade I, 96 (26.1%) grade II, 70 (19.0%) grade III and 66 (17.9%) grade IV injuries. The overall mortality was 16.6%. Two hundred sixty-two patients (71.2%) were managed non-operatively (NOM), and 106 (38.8%) were operated. 90.1% of those managed non-operatively survived. CONCLUSION In this multicentre cohort of liver injury patients from urban university hospitals in India, the commonest profile of patient was a young male, with a blunt injury to the abdomen due to a road traffic accident. Success rate of non-operative management of liver injury is comparable to other countries.
Collapse
|
9
|
Balogun JA, Akwada O, Awana E, Balogun FM. Access to the Intensive Care Unit by Severe Head Injury Patients. J Neurosci Rural Pract 2019; 10:666-671. [PMID: 31831988 PMCID: PMC6906106 DOI: 10.1055/s-0039-3399476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background
The management of severe traumatic brain injury is directed at avoidance of secondary brain injuries. The intensive care unit (ICU) provides the ideal environment to achieving improved survival and functional outcome. The study sets out to identify the factors that determine the access of patients with severe head injury presenting at our hospital, to the ICU and their impact on outcome.
Materials and Methods
his was a longitudinal study at the University College Hospital, Ibadan. Data of all consecutive severe head injury patients over a 9-month period, presenting to the accident and emergency department, was collected and analyzed using descriptive statistics and chi-squared test. The level of significance was
p
< 0.05.
Result
There were 36 males (80.0%) in our study, with road crashes (25; 79.5%) as the most common mechanism of injury. Most patients (33; 73.3%) were transferred to our center after initial care in another hospital. Though 31(68.9%) patients had access to the ICU, they were all delayed, with the most common reason for the delay being lack of ICU space. More patients who got admitted into ICU (14; 45.2%) were alive at 28 days into admission (
p
= 0.04). The females (6; 13.3%) significantly survived till 28 days on admission compared with males (
p
= 0.03), but there was no difference in the survival rates between children and adults.
Conclusion
Our study underscores the need for ICU admission in these patients to optimize outcome and identify the nonavailability of beds, as the most important cause of delayed access, as well as the need for increased manpower capacity and organized resource utilization.
Collapse
Affiliation(s)
- James A Balogun
- Division of Neurosurgery, Department of Surgery, University of Ibadan, College of Medicine, Ibadan, Nigeria.,Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Obioma Akwada
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Emily Awana
- Department of Anaesthesia, University College Hospital, Ibadan, Nigeria
| | - Folusho M Balogun
- College of Medicine, Institute of Child Health, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
10
|
Bhalla K, Sriram V, Arora R, Ahuja R, Varghese M, Agrawal G, Tiwari G, Mohan D. The care and transport of trauma victims by layperson emergency medical systems: a qualitative study in Delhi, India. BMJ Glob Health 2019; 4:e001963. [PMID: 31803512 PMCID: PMC6882548 DOI: 10.1136/bmjgh-2019-001963] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/25/2019] [Accepted: 11/02/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Ambulance-based emergency medical systems (EMS) are expensive and remain rare in low- and middle-income countries, where trauma victims are usually transported to hospital by passing vehicles. Recent developments in transportation network technologies could potentially disrupt this status quo by allowing coordinated emergency response from layperson networks. We sought to understand the barriers to bystander assistance for trauma victims in Delhi, India, and implications for a layperson-EMS. Methods We used qualitative methods to analyse data from 50 interviews with frontline stakeholders (including taxi drivers, medical professionals, legal experts and police), one stakeholder consultation and a review of documents. Results Respondents noted that most trauma victims in Delhi are rapidly brought to hospital by bystanders, taxis and police. While ambulances are common, they are primarily used for interfacility transfers. Entrenched medico-legal practices result in substantial police presence at the hospital, which is a major source of harassment of good Samaritans and interferes with patient care. Trauma victims are often turned away by for-profit hospitals due to their inability to pay, leading to delays in treatment. Recent policy efforts to circumscribe the role of police and force for-profit hospitals to stabilise patients appear to have been unsuccessful. Conclusions Existing healthcare and medico-legal practices in India create large systemic impediments to improving trauma outcomes. Until India’s ongoing health and transport sector reforms succeed in ensuring that for-profit hospitals reliably provide care, good Samaritans and layperson-EMS providers should take victims with uncertain financial means to public facilities. To avoid difficulties with police, providers of a layperson-EMS would likely need official police sanction and carry visible symbols of their authority to provide emergency transport. Delhi already has several key components of an EMS (including dispatcher coordinated police response, large ambulance fleet) that could be integrated and expanded into a complete system of emergency care.
Collapse
Affiliation(s)
- Kavi Bhalla
- Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Veena Sriram
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Richa Ahuja
- Indian Institute of Technology Delhi, New Delhi, Delhi, India
| | | | | | - Geetam Tiwari
- Indian Institute of Technology Delhi, New Delhi, Delhi, India
| | - Dinesh Mohan
- Indian Institute of Technology Delhi, New Delhi, Delhi, India
| |
Collapse
|
11
|
Bashford T, Joannides A, Phuyal K, Bhatta S, Mytton J, Harrison R, Hutchinson P. Nuancing the need for speed: temporal health system strengthening in low-income countries. BMJ Glob Health 2019; 4:e001816. [PMID: 31543997 PMCID: PMC6730567 DOI: 10.1136/bmjgh-2019-001816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/05/2019] [Accepted: 08/10/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- Tom Bashford
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| | - Alexis Joannides
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| | - Kamal Phuyal
- NIHR Global Health Research Group on Burn Trauma, Kathmandu, Nepal
| | - Santosh Bhatta
- NIHR Global Health Research Group on Nepal Injury Research, University of the West of England Bristol, Bristol, UK
| | - Julie Mytton
- NIHR Global Health Research Group on Nepal Injury Research, University of the West of England Bristol, Bristol, UK
| | - Robert Harrison
- NIHR Global Health Research Group on African Snakebite Research, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter Hutchinson
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| |
Collapse
|
12
|
Invitation to the GNS-I Study; a Global Evaluation of Traumatic Brain Injury in Low-, Middle-, and High- income Countries. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e21. [PMID: 31410398 PMCID: PMC6683588 DOI: 10.22114/ajem.v0i0.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|