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Maleki MS, Mazaheri SA, Hosseini SH, Majdabadi HA, Poursadeqiyan M, Faghihi A, Naderi Z, Bardsiri TI, Khedri B, Amanat N, Khajehnasiri F, Ivanbagha R. Epidemiology of Traumatic Brain Injury in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:1818-1831. [PMID: 38033848 PMCID: PMC10682591 DOI: 10.18502/ijph.v52i9.13565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/15/2023] [Indexed: 12/02/2023]
Abstract
Background Traumatic brain injury (TBI) is one of leading cause of death and disability in Iran that has serious consequences on people's health. Understanding of epidemiology of TBI can be helpful for policy making in health care management. Therefore, this study aimed to examine the epidemiology of TBI in Iran. Methods PubMed, Web of Science, Scopus, Google scholar, and internal databases including, SID, Magiran, and IranMedex were searched to identify the relevant published studies up to Feb 2022. Moreover, the references list of key studies was scanned to find more records. The Joanna Briggs Institute (JBI) tool was used to assess the quality of included studies. The Excel and Comprehensive Meta-Analysis software were to analyze the data. Results Overall, 23,446 patients from 15 studies were included in the study. The overall mean age of the patients was 31.36 ± 0.13 yr (95%CI: 31.10 to 31.61). The majority of the patients were male (74.37%), with a male to female ratio of 3:1. The incidence rate of TBI was 15.3 to 144 per 100,000 population. The mortality rate of TBI was estimated to be 10.4% (95%CI: 5% to 19%). The most common causes of injury were road traffic accidents (RTAs) (60%; 95%CI: 49% to 70%), and falling (20%; 95%CI: 16% to 26%), respectively. The most frequent type of head injury was subdural hematoma. Conclusion Our findings highlight that appropriate control and prevention strategies should be focused on male, road traffic accidents, and the group under 40 yr.
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Affiliation(s)
- Mohsen Saheban Maleki
- Department of Anesthesia, Clinical Research Developmental Unit Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Seyed Hossein Hosseini
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mohsen Poursadeqiyan
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aboalfazl Faghihi
- Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zeinab Naderi
- Department of Nursing, Sirjan School of Medical Sciences, Sirjan, Iran
| | | | - Behzad Khedri
- Department of Social Work, Social Studies Faculty, Hanze University of Applied Science, Groningen, Netherlands
| | - Nasir Amanat
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farahnaz Khajehnasiri
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Ivanbagha
- Department of Midwifery, School of Nursing, Tabriz University of Medical Sciences, Tabriz, Iran
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Kim KH, Kim H, Song KJ, Shin SD, Kim HC, Lim HJ, Kim Y, Kang HJ, Hong KJ. Prediction of Increased Intracranial Pressure in Traumatic Brain Injury Using Quantitative Electroencephalogram in a Porcine Experimental Model. Diagnostics (Basel) 2023; 13:diagnostics13030386. [PMID: 36766491 PMCID: PMC9914917 DOI: 10.3390/diagnostics13030386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
Continuous and non-invasive measurement of intracranial pressure (ICP) in traumatic brain injury (TBI) is important to recognize increased ICP (IICP), which can reduce treatment delays. The purpose of this study was to develop an electroencephalogram (EEG)-based prediction model for IICP in a porcine TBI model. Thirty swine were anaesthetized and underwent IICP by inflating a Foley catheter in the intracranial space. Single-channel EEG data were collected every 6 min in 10 mmHg increments in the ICP from baseline to 50 mmHg. We developed EEG-based models to predict the IICP (equal or over 25 mmHg) using four algorithms: logistic regression (LR), naive Bayes (NB), support vector machine (SVM), and random forest (RF). We assessed the performance of each model based on the accuracy, sensitivity, specificity, and AUC values. The accuracy of each prediction model for IICP was 0.773 for SVM, 0.749 for NB, 0.746 for RF, and 0.706 for LR. The AUC of each model was 0.860 for SVM, 0.824 for NB, 0.802 for RF, and 0.748 for LR. We developed a machine learning prediction model for IICP using single-channel EEG signals in a swine TBI experimental model. The SVM model showed good predictive power with the highest AUC value.
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Affiliation(s)
- Ki-Hong Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
| | - Heejin Kim
- Clinical Trials Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyoung-Jun Song
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sang-Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hee-Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Hyouk-Jae Lim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
| | - Yoonjic Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
| | - Hyun-Jeong Kang
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
| | - Ki-Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul 03080, Republic of Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Correspondence: ; Tel.: +82-2-2072-0294
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Yousefi O, Azami P, Borazjani R, Niakan A, Yadollahi M, Khalili H. Civilian penetrating traumatic brain injury: A 5-year single-center experience. Surg Neurol Int 2023; 14:28. [PMID: 36895251 PMCID: PMC9990774 DOI: 10.25259/sni_1160_2022] [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: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Background The aim of this study was to report the demographics and clinical features of patients with penetrating traumatic brain injury (PTBI) during the past 5 years in Rajaee Hospital, a tertiary referral trauma center in Shiraz, southern Iran. Methods We conducted a 5-year retrospective evaluation of all patients diagnosed with PTBI who were referred to Rajaee Hospital. We retrieved the following items from the hospital's database and PACS system: patients' demographics, on-admission Glasgow Coma Scale (GCS), presence of trauma to other organs, duration of the hospital and ICU stay, the neurosurgical interventions, any necessity of tracheostomy, duration of ventilator dependency, the entrance point of the trauma in the skull, type of assault, length of trajectory in the brain parenchyma, the number of remaining objects in the brain, the occurrence of any hemorrhagic phenomenon, the cross of the bullet from the midline or coronal suture, and the presence of the pneumocephalus. Results A total of 59 patients with a mean age of 28.75 ± 9.40 had PTBI over the 5 years. The mortality rate was 8.5%. Stab wounds, shotguns, gunshots, and airguns were the cause of injury in 33 (56%), 14 (23.7%), 10 (17%), and 2 (3.4%) patients, respectively. The median initial GCS of patients was 15 (3-15). Intracranial hemorrhage was observed in 33 cases, subdural hematoma in 18 cases, intraventricular hemorrhage in eight cases, and subarachnoid hemorrhage in four cases. The mean duration of hospitalization was 10.05 ± 10.75 (ranging from 1 to 62 days). Furthermore, 43 patients experienced ICU admission with mean days of 6.5 ± 5.62 (1-23). The temporal and frontal regions were the most common entrance points, in 23 and 19 patients, respectively. Conclusion The incidence of PTBI is relatively low in our center, possibly due to the prohibition of possession or using warm weapons in Iran. Further, multicenter studies with larger sample sizes are needed to determine prognostic factors associated with worse clinical outcomes after PTBI.
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Affiliation(s)
- Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pouria Azami
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roham Borazjani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Niakan
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Yadollahi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hosseinali Khalili
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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David S, Roy N, Lundborg CS, Wärnberg MG, Solomon H. 'Coming home does not mean that the injury has gone'-exploring the lived experience of socioeconomic and quality of life outcomes in post-discharge trauma patients in urban India. Glob Public Health 2022; 17:3022-3042. [PMID: 35129081 DOI: 10.1080/17441692.2022.2036217] [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: 12/15/2022]
Abstract
Trauma results in long-term socioeconomic outcomes that affect quality of life (QOL) after discharge. However, there is limited research on the lived experience of these outcomes and QOL from low - and middle-income countries. The aim of this study was to explore the different socioeconomic and QOL outcomes that trauma patients have experienced during their recovery. We conducted semi-structured qualitative interviews of 21 adult trauma patients between three to eight months after discharge from two tertiary-care public hospitals in Mumbai, India. We performed thematic analysis to identify emerging themes within the range of different experiences of the participants across gender, age, and mechanism of injury. Three themes emerged in the analysis. Recovery is incomplete-even up to eight months post discharge, participants had needs unmet by the healthcare system. Recovery is expensive-participants struggled with a range of direct and indirect costs and had to adopt coping strategies. Recovery is intersocial-post-discharge socioeconomic and QOL outcomes of the participants were shaped by the nature of social support available and their sociodemographic characteristics. Provisioning affordable and accessible rehabilitation services, and linkages with support groups may improve these outcomes. Future research should look at the effect of age and gender on these outcomes.
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Affiliation(s)
- Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Doctors For You, Mumbai, India
| | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | | | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, Durham, NC, USA
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Ashraf M, Kamboh UA, Hussain SS, Raza MA, Mehboob M, Zubair M, Ahmad M, Ashraf N. Traumatic Brain Injury in Underage Motorcycle Drivers: Clinical Outcomes and Sociocultural Attitudes from a Lower-Middle-Income Country. World Neurosurg 2022; 167:e413-e422. [PMID: 35964900 DOI: 10.1016/j.wneu.2022.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Poor societal attitudes and inadequate law enforcement have greatly contributed to the increase in underage motorcycle driving in Pakistan. This study reports the burden of traumatic brain injury (TBI), clinical characteristics/outcomes, and reason for driving in underage motorcyclists. MATERIALS AND METHODS A prospective study was conducted throughout 2021. Demographics, mechanism of injury, helmet use, number of passengers, clinical outcomes, reason for driving and parental awareness/consent status, referral pathway, and transport duration were documented. RESULTS Of a total of 1052 motorcyclists with TBI, 112 were underage drivers. The mean age was 14.7 years (range, 10-17 years); 98.2% were male and 17% wore protective helmets. The most common reason for driving was recreational, followed by for domestic chores. In 66 patients, there was parental awareness and 30 of these patients had active parental consent. These patients reported domestic chores as the reason for their journey, whereas recreational purposes were a more prevalent reason in patients without parental awareness/consent (P < 0.001). Most patients were brought by provincial ambulance service (response time 12.8 minutes). Some patients came from peripheral hospitals (26.8%) and private hospitals (14.3%) that lacked neurosurgical cover, and these were associated with severer baseline injuries (P < 0.001). The average stay was 6.5 days, and 75.9% of patients were discharged with a good Glasgow Outcome Scale score. CONCLUSIONS Most underage patients with TBI resulting from motorcycle driving are adolescent boys who do not use helmets. Trauma prevention systems and involvement of multiple stakeholders are needed to reduce underage driving. Efficient referral systems must transport patients to appropriate neurosurgical cover, which is lacking outside major cities.
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Affiliation(s)
- Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom; Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan.
| | - Usman Ahmad Kamboh
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Syed Shahzad Hussain
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan; Department of Neurosurgery, Gujranwala Medical College, Gujranwala, Pakistan
| | - Muhammad Asif Raza
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mehreen Mehboob
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Mohammad Zubair
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Manzoor Ahmad
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
| | - Naveed Ashraf
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore, Pakistan
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Jeon YK, Jeong J, Shin SD, Song KJ, Kim YJ, Hong KJ, Ro YS, Park JH. The effect of age on in-hospital mortality among elderly people who sustained fall-related traumatic brain injuries at home: A retrospective study of a multicenter emergency department-based injury surveillance database. Injury 2022; 53:3276-3281. [PMID: 35907679 DOI: 10.1016/j.injury.2022.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND People older than 65 years tend to have traumatic brain injuries (TBIs) more frequently and have a higher mortality rate after TBI than younger individuals. The aim of this study was to determine the effects of age on in-hospital mortality among patients who had fall-related TBIs at home, emphasizing the effect of specific locations in the house on the outcome. METHODS This cross-sectional study was conducted using the Emergency Department-based Injury In-Depth Surveillance (EDIIS) database in South Korea. Patients aged 65 years or older with a slip or fall injury, accidental injury at home, and no major diagnosis other than TBI were included. The primary outcome was in-hospital mortality. Subgroup analysis was conducted to determine the effect of locations on the relationship between age and in-hospital mortality. RESULTS Of the 2,571,442 patients in the EDIIS database, 9,747 were included in this study. The most common injury location was room or bedroom (29.1%), followed by living room or kitchen (23.0%), bathroom (20.2%), stairs (15.8%), and outdoor spaces of the house (11.9%). There was a significant association between increased in-hospital mortality and oldest old age. The stairs or outdoor spaces of the house was significantly associated with in-hospital mortality compared to rooms inside the house. The oldest age group showed a higher association with in-hospital mortality than the young-old group, especially in the bathroom, stairs, and outdoor spaces of the house. CONCLUSIONS Elderly individuals over the age of 85 are the most vulnerable to fall-related TBI mortality at home. A fall prevention strategy for the oldest-old is needed, especially for the bathroom, stairs, and the ancillary space outside the house.
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Affiliation(s)
- Yoo Kyung Jeon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Yu Jin Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
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Edalatfar M, Sadeghi-Naini M, Khayat Kashani HR, Movahed M, Sharif-Alhoseini M. A minimum data set for traumatic brain injuries in Iran. Chin J Traumatol 2022; 25:283-292. [PMID: 34690039 PMCID: PMC9459006 DOI: 10.1016/j.cjtee.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/20/2021] [Accepted: 09/14/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Traumatic brain injury (TBI) is one of the major public health concerns worldwide. Developing a TBI registry could facilitate characterizing TBI, monitoring the quality of care, and quantifying the burden of TBI by collecting comparable and standardized epidemiological and clinical data. However, a national standard tool for data collection of the TBI registry has not been developed in Iran yet. This study aimed to develop a national minimum data set (MDS) for a hospital-based registry of patients suffering from TBI in Iran. METHODS The MDS was designed in 2 phases, including a literature review and a Delphi study with content validation by an expert panel. After the literature review, a comprehensive list of administrative and clinical items was obtained. Through a two-round e-Delphi approach conducted by invited experts with clinical and research experience in the field of TBI, the final data elements were selected. RESULTS A MDS of TBI was assigned to 2 parts: administrative part with 5 categories including 52 data elements, and clinical part with 9 categories including 130 data elements. CONCLUSION For the first time in Iran, we developed a MDS specified for TBI consisting of 182 data elements. The MDS would facilitate implementing a TBI's national level registry and providing essential, comparable and standardized information.
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Affiliation(s)
- Maryam Edalatfar
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Khayat Kashani
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Movahed
- Department of Psychology, HELP University, Kuala Lumpur, Malaysia
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author.
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Petitfour L, Bonnet E, Mathevet I, Nikiema A, Ridde V. Out-of-pocket payments and catastrophic expenditures due to traffic injuries in Ouagadougou, Burkina Faso. HEALTH ECONOMICS REVIEW 2021; 11:46. [PMID: 34928432 PMCID: PMC8691006 DOI: 10.1186/s13561-021-00344-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the out-of-pocket expenditures linked to Road Traffic Injuries in Ouagadougou, Burkina Faso, as well as the prevalence of catastrophic expenditures among those out-of-pocket payments, and to identify the socio-economic determinants of catastrophic expenditures due to Road Traffic Injuries. METHODS We surveyed every admission at the only trauma unit of Ouagadougou between January and July 2015 at the time of their admission, 7 days and 30 days later. We estimate a total amount of out-of-pocket expenditures paid by each patient. We considered an expense as catastrophic when it represented 10% at least of the annual global consumption of the patient's household. We used linear models to determine if socio-economic characteristics were associated to a greater or smaller ratio between out-of-pocket payment and global annual consumption. FINDINGS We surveyed 1323 Road injury victims three times (admission, Days 7 and 30). They paid in average 46,547 FCFA (83.64 US dollars) for their care, which represent a catastrophic expenditure for 19% of them. Less than 5% of the sample was covered by a health insurance scheme. Household economic status is found to be the first determinant of catastrophic health expenditure occurrence, exhibiting a significant and negative on the ratio between road injury expenditures and global consumption. CONCLUSION Our findings highlight the importance of developing health insurance schemes to protect poor households from the economic burden of road traffic injuries and improve equity in front of health shocks.
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Affiliation(s)
| | - Emmanuel Bonnet
- Institut de Recherche sur le Développement, Bondy, 93140 France
- Résiliences, Research Institute for Development, Bondy, 93140 France
| | | | - Aude Nikiema
- Institut des Sciences des Sociétés, Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Institut de Recherche sur le Développement, Bondy, 93140 France
- CEPED, Research Institute for Development, Paris, 75007 France
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Zakeri R, Nosratnejad S, Sadeghi-Bazargani H, Dalal K, Yousefi M. The economic burden of road traffic injuries until one-year after hospitalization: A survey study. ACCIDENT; ANALYSIS AND PREVENTION 2021; 163:106459. [PMID: 34710782 DOI: 10.1016/j.aap.2021.106459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/15/2021] [Accepted: 10/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Road Traffic Injuries (RTIs) are one of the most crucial and challenging public health problems in low and middle income countries. Despite continuous efforts to estimate both personal and societal costs of RTIs however, their long-term effects have remained marginal. The current study aimed to explore the economic burden of RTIs until one year after the victim's hospitalization. METHODS The study included a total of 1150 RTI victims, who were admitted to two trauma-referral hospitals during 2016. Data on direct medical costs, direct non-medical costs and indirect costs were gathered for each study sample via hospital records and phone surveys. Direct and indirect costs from a social perspective were estimated based on Micro Costing Approach followed by the Human Capital Approach. Also, the explanatory variables affecting the costs of RTIs were identified using the liner regression model. RESULTS The average amounts of direct (medical, non-medical), indirect, and total costs of RTI were estimated as 2,908 US$ (1,591 US$, 1,316 US$), 5,790 US$, and 8,701 US$ respectively. Also, several variables were significantly affecting the costs of RTIs including age, marital status, employment status, severity of injury, receiving physiotherapy care, victim's vehicle type in crash, crash time and location. CONCLUSIONS Findings suggest that RTIs are considered as an enormous burden on Iranian GDP per capita and health expenditure per capita occupying 167% and 347% respectively. This enormous economic burden caused by RTIs requires more policy regulations and prevention programs to decrease RTIs.
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Affiliation(s)
- Raana Zakeri
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shirin Nosratnejad
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | - Koustuv Dalal
- Department of Public Health Science, School of Health Sciences, Mid Sweden University, Sweden
| | - Mahmood Yousefi
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Application of machine learning to predict the outcome of pediatric traumatic brain injury. Chin J Traumatol 2021; 24:350-355. [PMID: 34284922 PMCID: PMC8606603 DOI: 10.1016/j.cjtee.2021.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/23/2021] [Accepted: 06/02/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Traumatic brain injury (TBI) generally causes mortality and disability, particularly in children. Machine learning (ML) is a computer algorithm, applied as a clinical prediction tool. The present study aims to assess the predictability of ML for the functional outcomes of pediatric TBI. METHODS A retrospective cohort study was performed targeting children with TBI who were admitted to the trauma center of southern Thailand between January 2009 and July 2020. The patient was excluded if he/she (1) did not undergo a CT scan of the brain, (2) died within the first 24 h, (3) had unavailable complete medical records during admission, or (4) was unable to provide updated outcomes. Clinical and radiologic characteristics were collected such as vital signs, Glasgow coma scale score, and characteristics of intracranial injuries. The functional outcome was assessed using the King's Outcome Scale for Childhood Head Injury, which was thus dichotomized into favourable outcomes and unfavourable outcomes: good recovery and moderate disability were categorized as the former, whereas death, vegetative state, and severe disability were categorized as the latter. The prognostic factors were estimated using traditional binary logistic regression. By data splitting, 70% of data were used for training the ML models and the remaining 30% were used for testing the ML models. The supervised algorithms including support vector machines, neural networks, random forest, logistic regression, naive Bayes and k-nearest neighbor were performed for training of the ML models. Therefore, the ML models were tested for the predictive performances by the testing datasets. RESULTS There were 828 patients in the cohort. The median age was 72 months (interquartile range 104.7 months, range 2-179 months). Road traffic accident was the most common mechanism of injury, accounting for 68.7%. At hospital discharge, favourable outcomes were achieved in 97.0% of patients, while the mortality rate was 2.2%. Glasgow coma scale score, hypotension, pupillary light reflex, and subarachnoid haemorrhage were associated with TBI outcomes following traditional binary logistic regression; hence, the 4 prognostic factors were used for building ML models and testing performance. The support vector machine model had the best performance for predicting pediatric TBI outcomes: sensitivity 0.95, specificity 0.60, positive predicted value 0.99, negative predictive value 1.0; accuracy 0.94, and area under the receiver operating characteristic curve 0.78. CONCLUSION The ML algorithms of the present study have a high sensitivity; therefore they have the potential to be screening tools for predicting functional outcomes and counselling prognosis in general practice of pediatric TBIs.
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Tunthanathip T, Oearsakul T, Tanvejsilp P, Sae-Heng S, Kaewborisutsakul A, Madteng S, Inkate S. Predicting the Health-related Quality of Life in Patients Following Traumatic Brain Injury. Surg J (N Y) 2021; 7:e100-e110. [PMID: 34159258 PMCID: PMC8211484 DOI: 10.1055/s-0041-1726426] [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: 09/06/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023] Open
Abstract
Background Traumatic brain injury (TBI) commonly causes death and disability that can result in productivity loss and economic burden. The health-related quality of life (HRQoL) has been measured in patients suffering from TBI, both in clinical and socioeconomic perspectives. The study aimed to assess the HRQoL in patients following TBI using the European quality of life measure-5 domain-5 level (EQ-5D-5L) questionnaire and develop models for predicting the EQ-5D-5L index score in patients with TBI. Method A cross-sectional study was performed with 193 TBI patients who had completed the EQ-5D-5L questionnaire. The clinical characteristics, Glasgow coma scale (GCS) score, treatment, and Glasgow outcome scale (GOS) were collected. The total data was divided into training data (80%) and testing data (20%); hence, the factors affecting the EQ-5D-5L index scores were used to develop the predictive model with linear and nonlinear regression. The performances of the predictive models were estimated with the adjusted coefficient of determination (R 2 ) and the root mean square error (RMSE). Results A good recovery was found at 96.4%, while 2.1% displayed an unfavorable outcome. Moreover, the mean EQ-5D-5L index scores were 0.91558 (standard deviation [SD] 1.09639). GCS score, pupillary light reflex, surgery, and GOS score significantly correlated with the HRQoL scores. The multiple linear regression model had a high adjusted R 2 of 0.6971 and a low RMSE of 0.06701, while the polynomial regression developed a nonlinear model that had the highest adjusted R 2 of 0.6843 and the lowest RMSE of 0.06748. Conclusions A strong positive correlation between the physician-based outcome as GOS and HRQoL was observed. Furthermore, both the linear and nonlinear regression models were acceptable approaches to predict the HRQoL of patients after TBI. There would be limitations for estimating the HRQoL in unconscious or intubated patients. The HRQoL obtained from the predictive models would be an alternative method to resolve this problem.
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Affiliation(s)
- Thara Tunthanathip
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Thakul Oearsakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Pimwara Tanvejsilp
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Sakchai Sae-Heng
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Anukoon Kaewborisutsakul
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Suphavadee Madteng
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Srirat Inkate
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
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HASHEMPOUR R, TAHMASEBI A, VEYSI M, AMINI M, TAVAKOLI N. Cost Analysis of Accidents according to Demographic Factors in Iran. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1346-1353. [PMID: 31497557 PMCID: PMC6708525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The first cause of death and disability constituting to the burden of disease in Iran has been accident and injury incidents. Young people are more at risk, these accidents have a negative effect on the national gross domestic product (GDP), on the one hand, and they increase the costs of the health system on the other hand. Therefore, this study aimed to analyze the costs and epidemiological pattern of accidents. METHODS The study variables in the first 8 months of 2016 included from Tehran Province, Iran; age, sex, how to transfer to the hospital, consequences of an accident, the injured area, and costs. Overall, 400 cases were investigated by referring to the patients' files and deriving the intended data. SPSS software used to analyze the data and statistical tests of t-test and ANOVA were applied. RESULTS Most accidents have happened in summer months of Jun, Jul and Aug. Most of the files (48%) were related to the age group of 16-30. The mean cost was 9024.82 dollar. In total, 39% of the road accidents had occurred by motorcycle and 90.8% of the patients discharged from the hospital. CONCLUSION Since about half of the traffic accidents were related to the age of 16 to 30 who were the active population of a community, therefore, any disability or death in these groups could cause an economic burden on the community and increase DALY. Thus, it appears essential to develop proper programs such as education for appropriate driving and strict rules for giving driving license to these ages.
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Affiliation(s)
- Reza HASHEMPOUR
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali TAHMASEBI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad VEYSI
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad AMINI
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nader TAVAKOLI
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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Moradi Moghadam O, Nematollahi N, Shiri Malek Abad E, Hasani V, Tabibkhooei A, Sheikhvatan M, Niakan Lahiji M. Effect of Modafinil Administration on the Level of Consciousness in Patients with Brain Injuries of Moderate Severity. Trauma Mon 2018; 24. [DOI: 10.5812/traumamon.61505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/24/2017] [Accepted: 01/09/2018] [Indexed: 07/04/2024] Open
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Sapkota D, Bista B, Adhikari SR. Economic Costs Associated with Motorbike Accidents in Kathmandu, Nepal. Front Public Health 2016; 4:273. [PMID: 28018898 PMCID: PMC5156657 DOI: 10.3389/fpubh.2016.00273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Abstract
Background Road traffic accidents, considered as global tragedies, are in increasing trend; however, the safety situation is very severe in developing countries incurring substantial amount of human, economic, and social costs. Motorcycle crashes, the commonest form, occur mostly in economically active population. However, there is limited number of studies on economic burden of motorcycle crashes. This study aims to estimate the total cost and disability-adjusted life years (DALYs) lost due to motorbike accidents among victims of Kathmandu Valley. Materials and methods Retrospective cross-sectional study was conducted among the patients with a history of motorbike accidents within the past 3 to 12 months from the date of data collection. Interview was conducted using pro forma among 100 victims of accidents and their caregiver in case of death from November 15, 2014 to May 15, 2015. Cost estimation of motorbike accident was done based on human capital approach. Data collection tool was pretested, and collected data were analyzed using SPSS and Microsoft Excel. Results Males (79%) belonging to the economically productive age group shared the highest proportion among total accidents victims. Most common reason for accidents was reported to be poor road condition (41%). Indirect cost was found to be significantly higher than direct costs, highlighting its negative impact on economy of family and nation due to productivity loss. Total DALYs lost per person was found to be 490 years, and national estimation showed large burden of motorbike accidents due to huge DALY loss. Conclusion For low-resource countries such as Nepal, high economic costs of motorbike accidents can pose additional burden to the fragile health system. These accidents can be prevented, and their consequences can be alleviated. There is an urgent need for reinforcement of appropriate interventions and legislation to decrease its magnitude and its associated grave economic consequences so as to nib this emerging epidemic in the bud.
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Affiliation(s)
- Diksha Sapkota
- Kathmandu University School of Medical Sciences , Dhulikhel , Nepal
| | - Bihungum Bista
- Nepal Health Research Council, Ministry of Health and Population , Kathmandu , Nepal
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Epidemiology of Road Traffic Injuries in Iran: Based on the Data from Disaster Management Information System (DMIS) Of the Iranian Red Crescent. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.38743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Khalili H, Sadraei N, Niakan A, Ghaffarpasand F, Sadraei A. Role of Intracranial Pressure Monitoring in Management of Patients with Severe Traumatic Brain Injury: Results of a Large Level I Trauma Center in Southern Iran. World Neurosurg 2016; 94:120-125. [DOI: 10.1016/j.wneu.2016.06.122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 02/01/2023]
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