This study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting.
Adult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited.
A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury.
One hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become “economically dependent”. Selected trauma scores had poor discriminatory ability in predicting mortality.
This observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.
Deb S, Lyons I, Koutzoukis C. Neuropsychiatric sequelae one year after a minor head injury. Journal of Neurol Neurosurg Psychiatry. 1998;65(6):899–902. CrossRef
Levin HS, Grossman RG. Behavioral sequelae of closed head injury. Archives Neurology. 1978;35:720–7. CrossRef
Zhu P, Jiang J. Employment of trauma and injury severity score and a severity characterization of trauma in the outcome evaluation of trauma care and their research advances. Chinese Medical Journal. 1998;111(2):169–73. PubMed
Rabbani A, Moini M. Application of “trauma and injury severity score” and “a severity characterization of trauma” score to trauma patients in a setting different from “major trauma outcome study.”. Archives of Iranian medicine. 2007;10(3):383–6. PubMed
Fuller A, Tran T, Muhumuza M, Haglund MM. Building neurosurgical capacity in low and middle income countries. eNeurologicalSci. 2016;3:1–6. CrossRef
Veerasingam E. An analysis of outcome of head injury patients admitted to the accident service neuro surgical intensive care unit at the National Hospital of Sri Lanka. Sri Lanka Journal of Anaesthesiology. 2005;13:30–5.
Whitnall L, McMillan TM, Murray GD, Teasdale GM. Disability in young people and adults after head injury: 5-7 year follow up of a prospective cohort study. Journal of Neurol Neurosurg Psychiatry. 2006;77(5):640–5. CrossRef
Bouamra O, Jacques R, Edwards A, Yates DW, Lawrence T, Jenks T, Woodford M, et al. Prediction modelling for trauma using comorbidity and “true” 30-day outcome. Emergency Medical Journal. 2015;32(12):933–8. CrossRef
StataCorp. Stata Data analysis and statistical software, 2017. http://www.stata.com/company/(accessed 01/01/2010).
Deepika, A., Devi, B. I., & Shukla, D. (2017). Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury, Neurol India 2017 Jan-Feb;65(1):83–86.
Gupta D, Sharma D, Kannan N, Prapruettham S, Mock C, Wang J, et al. Guideline adherence and outcomes in severe adult traumatic brain injury for the CHIRAG (collaborative head injury and guidelines) study. World Neurosurgery. 2016;89:169–79. https://doi.org/10.1016/j.wneu.2015.12.097 CrossRefPubMedPubMedCentral
Haniffa R, et al. Applicability of APACHE II model to a low middle income country setting. Under review Journal of Critical Care.
Williams TA, Leslie GD. Challenges and possible solutions for long-term follow-up of patients surviving critical illness. Australian Critical Care 2011;24(3):175–185.
Vassar MJ, Lewis FR, Chambers JA, Mullins RJ, O’Brien PE, Weigelt JA, Hoang MT, et al. Prediction of outcome in intensive care unit trauma patients: a multicenter study of acute physiology and chronic health evaluation (APACHE), trauma and injury severity score (TRISS), and a 24-hour intensive care unit (ICU) point system. Journal of Trauma-Injury Infection & Critical Care. 1999;47:324–9. CrossRef
Haniffa et al. Applicability of APACHE II in a Lower Middle Income Country. J Crit Care. 2017;:under review.
Hosmer DW, Lemeshow S. Applied logistic regression second edition. Applied Logistic Regression. 2004;392
Gunaratne A, Wadanambi S. An audit on admission of patients with head injury to teaching hospital Karapitiya, Galle. Sri Lankan Journal of Anaesthesiology. 2009;17(2):51–4. CrossRef
Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj GKO. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation. 2007;22(5):341–53. PubMed
Balestreri M, Czosnyka M, Chatfield DA, Steiner LA, Schmidt EA, Smielewski P, et al. Predictive value of Glasgow coma scale after brain trauma: change in trend over the past ten years. J NeurolNeurosurg Psychiatry. 2004;75:161–2. http://jnnp.bmj.com/content/75/1/161.long
Majdan M, Brazinova A, Rusnak M, Leitgeb J. Outcome prediction after traumatic brain injury: comparison of the performance of routinely used severity scores and multivariable prognostic models. Journal of Neurosciences in Rural Practice. 2017;8(1):20–9. https://doi.org/10.4103/0976-3147.193543. CrossRefPubMedPubMedCentral
- Traumatic brain injury (TBI) outcomes in an LMIC tertiary care centre and performance of trauma scores
Ponsuge Chathurani Sigera
Ambepitiyawaduge Pubudu De Silva
Kosala Saroj Amarasiri Jayasinghe
Arjen M. Dondorp
- BioMed Central
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