Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Department of Anesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India.
Acta Neurochir (Wien). 2021 Oct;163(10):2919-2930. doi: 10.1007/s00701-021-04908-x. Epub 2021 Jun 22.
Although head injury (HI) from low- and middle-income countries (LMIC) heavily contributes to the global disease burden, studies are disproportionately less from this part of the world. Knowing the different epidemiological characteristics from high-income nations can target appropriate prevention strategies. This study aims to provide a comprehensive overview of the clinico-epidemiological data of HI patients, focusing on the existing challenges with possible solutions from a developing nation's perspective.
This is a prospective, registry-based, observational study of HI in an Indian tertiary trauma-care center over 4 years. Various clinico-epidemiological parameters, risk factors, and imaging spectrum were analyzed in a multivariate model to identify the challenges faced by LMIC and discuss pragmatic solutions.
The study included a large-volume cohort of 14,888 patients. Notably, half of these patients belonged to mild HI, despite most were referred (90.3%) cases. Only one-third (30.8%) had severe HI. Less than a third reached us within 6 h of injury. Road traffic accidents (RTA) accounted for most injuries (61.1%), especially in the young (70.9%). Higher age, males, RTA, helmet non-usage, drunken driving, systemic injuries, and specific imaging features had an independent association with injury severity.
The study represents the much-needed, large-volume, epidemiological profile of HI from an LMIC, highlighting the suboptimal utilization of peripheral healthcare systems. Strengthening and integrating these facilities with the tertiary centers in a hub and enhanced spoke model, task sharing design, and efficient back-referrals promise effective neurotrauma care while avoiding overburden in the tertiary centers. Better implementation of road safety laws also has the potential to reduce the burden of HI.
尽管来自中低收入国家（LMIC）的头部损伤（HI）对全球疾病负担的影响巨大，但来自这些地区的研究却不成比例地较少。了解高收入国家的不同流行病学特征可以针对适当的预防策略。本研究旨在提供 HI 患者临床流行病学数据的综合概述，重点介绍发展中国家面临的现有挑战及可能的解决方案。
这是一项在印度一家三级创伤治疗中心进行的为期 4 年的前瞻性、基于登记的观察性 HI 研究。在多变量模型中分析了各种临床流行病学参数、危险因素和影像学谱，以确定来自 LMIC 的挑战，并讨论切实可行的解决方案。
该研究纳入了一个大规模的 14888 例患者队列。值得注意的是，尽管大多数患者是转诊而来（90.3%），但其中一半患者属于轻度 HI。只有三分之一（30.8%）患者有严重 HI。不到三分之一的患者在受伤后 6 小时内到达我们这里。道路交通伤害（RTA）占大多数损伤（61.1%），尤其是年轻人（70.9%）。较高的年龄、男性、RTA、不使用头盔、酒后驾车、全身损伤和特定的影像学特征与损伤严重程度具有独立相关性。
本研究代表了来自 LMIC 的急需的、大规模的 HI 流行病学概况，突出了周边医疗保健系统的利用不足。加强和整合这些设施与三级中心的枢纽和增强型辐射模式、任务分担设计和高效的反馈转诊，有望在避免三级中心负担过重的同时提供有效的神经创伤护理。更好地实施道路安全法也有可能减轻 HI 的负担。
