Humans; India/epidemiology; Male; Female; Middle Aged; Adult; Europe/epidemiology; Aged; Prospective Studies; Young Adult; Adolescent; Healthcare Disparities; Registries; Hospital Mortality; Israel/epidemiology; Brain Injuries, Traumatic/mortality; Brain Injuries, Traumatic/therapy; Patient Discharge/statistics & numerical data; Brain Injuries, Traumatic; Europe; India; Israel; Patient Discharge; Health Policy; Public Health, Environmental and Occupational Health
Abstract :
[en] [en] BACKGROUND: Traumatic brain injury (TBI) is a major global health problem that disproportionally affects low- and middle-income countries. The needs for patients with TBI therefore may differ between levels of national development. We aimed to describe differences in epidemiology and acute care provision of TBI between India and Europe.
METHODS: We used data from two prospective observational registry studies - the Collaborative Indian NeuroTrauma Effectiveness Research in TBI (CINTER-TBI) and the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI), which included TBI patients with an indication for brain CT-scan presenting to 65 centres across Europe and Israel and two trauma centres in India. We performed descriptive analyses of demographic, injury, and treatment characteristics and used random-effects logistic regression with covariate adjustment to examine the likelihood of acute neurosurgical interventions and in-hospital mortality.
RESULTS: We included 22 849 patients from CENTER-TBI and 3904 from CINTER-TBI. The median age in Europe was 55 years (IQR = 32-76) compared to 27 years (IQR = 18-40) in India. The most common cause of TBI in Europe were falls (n = 12150 (53%), while traffic incidents predominated in India (n = 2130 (55%)). The proportion of patients with severe TBI was higher in India (n = 867 (22%)) than in Europe (n = 1661 (7%). Professional pre-hospital care involving ambulance service was utilised by three-fourths (n = 17203 (75%)) of European and less than a one-tenth (n = 224 (6%)) of Indian patients in our sample. Patients with severe TBI were more likely to undergo surgical contusion/haematoma evacuation in India compared to Europe (OR = 2.0; 95% CI = 1.7-2.5) and Indian patients had higher odds of undergoing intracranial pressure monitor placement (OR = 2.3; 95% CI = 2.0-2.7). A primary decompressive craniectomy was likewise more often performed in the Indian cohort (OR = 5.1; 95% CI = 3.5-7.5). Discharge destinations in Europe included rehabilitation centres (n = 1261 (6%)) or nursing homes (n = 1208 (5%)), which was rarely the case in India (n = 13 (0%) and n = 9 (0%), respectively).
CONCLUSIONS: Substantial disparities between India and Europe exist along the neurotrauma care chain, with both systems being likely to face unique features and challenges in the future.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Gupta, Deepak; JPN apex Trauma Centre, All India Institute of Medical Sciences, Department of Neurosurgery, New Delhi, India
Singh, Ranjit D; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands
Vreeburg, Rick Jg; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands
van Dijck, Jeroen Tjm; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands
den Boogert, Hugo F; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands
Sharma, Kaveri; JPN apex Trauma Centre, All India Institute of Medical Sciences, Department of Neurosurgery, New Delhi, India
Praneeth, Kokkula; JPN apex Trauma Centre, All India Institute of Medical Sciences, Department of Neurosurgery, New Delhi, India
Clarke, David B; Department of Surgery, Division of Neurosurgery, QEll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
Lecky, Fiona E; Centre for Urgent and Emergency Care Research (CURE), Sheffield Centre for Health and Related Research, School of Population Health, Faculty of Medicine and Health, University of Sheffield, Sheffield, UK ; Emergency Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, UK
Maas, Andrew Ir; Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium ; Department of Translational Neuroscience, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
Sinha, Virendra Deo; Department of Neurosurgery, Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur, Rajasthan, India ; Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
de Ruiter, Godard Cw; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands
Peul, Wilco C; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands
van Essen, Thomas A; University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Department of Neurosurgery, Leiden and The Hague, The Netherlands ; Department of Surgery, Division of Neurosurgery, QEll Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
CENTER-TBI
CINTER-TBI
Ledoux, Didier ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs généraux
The research presented in the manuscript received no external funding. The funders of the CENTER-TBI and CINTER-TBI study had no role in study design, data collection, data analysis or writing of the manuscript.
1 Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16:987–1048. Medline:29122524 doi:10.1016/S1474-4422(17)30371-X
2 Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;130:1080–97. Medline:29701556 doi:10.3171/2017.10.JNS17352
3 Singh M, Pal R, Yarasani P, Bhandarkar P, Munivenkatappa A, Agrawal A. International Classification of Diseases-Based Audit of the Injury Database to Understand the Injury Distribution in Patients Who have Sustained a Head Injury (International Classification of Diseases Codes: S00-S09). J Emerg Trauma Shock. 2018;11:253–64. Medline:30568367 doi:10.4103/JETS.JETS_90_17
4 Burton A. A key traumatic brain injury initiative in India. Lancet Neurol. 2016;15:1011–2. Medline:27339662 doi:10.1016/S1474-4422(16)30131-4
5 Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21:1004–60. Medline:36183712 doi:10.1016/S1474-4422(22)00309-X
6 Government of India, Ministry of Health and Family Welfare. Capacity building for developing trauma care facilities on national highways. Operational guidelines. New Delhi, India: Government of India, Ministry of Health and Family Welfare; 2015. Available: https://dghs.gov.in/WriteReadData/userfiles/file/Operational_Guidelines_Trauma.pdf. Accessed; 21 October 2024.
7 Maas AI, Menon DK, Steyerberg EW, Citerio G, Lecky F, Manley GT, et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery. 2015;76:67–80. Medline:25525693 doi:10.1227/NEU.0000000000000575
8 Lecky FE, Otesile O, Marincowitz C, Majdan M, Nieboer D, Lingsma HF, et al. The burden of traumatic brain injury from low-energy falls among patients from 18 countries in the CENTER-TBI Registry: A comparative cohort study. PLoS Med. 2021;18:e1003761. Medline:34520460 doi:10.1371/journal.pmed.1003761
9 Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology. 2007;18:805–35. Medline: 18049195 doi:10.1097/EDE.0b013e3181577511
10 Singh RD, van Dijck JTJM, van Essen TA, Lingsma HF, Polinder SS, Kompanje EJO, et al. Randomized Evaluation of Surgery in Elderly with Traumatic Acute SubDural Haematoma (RESET-ASDH trial): study protocol for a pragmatic randomized controlled trial with multicenter parallel group design. Trials. 2022;23:242. Medline:35351178 doi:10.1186/s13063-022-06184-1
11 Benedetto N, Gambacciani C, Montemurro N, Morganti R, Perrini P. Surgical management of acute subdural haematomas in elderly: report of a single center experience. Br J Neurosurg. 2017;31:244–8. Medline:27760467 doi:10.1080/02688697.2016.1244249
12 Malik C, Khanna S, Jain Y, Jain R. Geriatric population in India: Demography, vulnerabilities, and healthcare challenges. J Family Med Prim Care. 2021;10:72–6. Medline:34017706 doi:10.4103/jfmpc.jfmpc_1794_20
13 Madaan P, Agrawal D, Gupta D, Kumar A, Jauhari P, Chakrabarty B, et al. Clinicoepidemiologic Profile of Pediatric Traumatic Brain Injury: Experience of a Tertiary Care Hospital From Northern India. J Child Neurol. 2020;35:970–4. Medline: 32748676 doi:10.1177/0883073820944040
14 Express News Service. ‘Safe balcony, safe child’: AIIMS launches new campaign. 2022. Available: https://indianexpress.com/article/cities/delhi/safe-balcony-safe-child-aiims-launches-new-campaign-8278274/. Accessed; 16 February 2024.
15 Agrawal A, Munivenkatappa A, Shukla DP, Menon GR, Alogolu R, Galwankar S, et al. Traumatic brain injury related research in India: An overview of published literature. Int J Crit Illn Inj Sci. 2016;6:65–9. Medline:27308253 doi:10.4103/2229-5151.183025
16 Babhulkar S, Apte A, Barick D, Hoogervorst P, Tian Y, Wang Y. Trauma care systems in India and China: A grim past and an evolving future. OTA Int. 2023;2 Suppl 1:e017. Medline:37675255 doi:10.1097/OI9.0000000000000017
17 Passmore J, Yon Y, Mikkelsen B. Progress in reducing road-traffic injuries in the WHO European region. Lancet Public Health. 2019;4:e272–3. Medline:31078465 doi:10.1016/S2468-2667(19)30074-X
18 Veerappan VR, Nagendra B, Thalluri P, Manda VS, Rao RN, Pattisapu JV. Reducing the Neurotrauma Burden in India-A National Mobilization. World Neurosurg. 2022;165:106–13. Medline:35724880 doi:10.1016/j.wneu.2022.06.058
19 Tiwary B, Nilima N, Majumdar P, Singh M, Khan MA. Quality of services provided by public funded ambulance program: Experience from a northern state in India. Clin Epidemiol Glob Health. 2020;8:962–6. doi:10.1016/j.cegh.2020.03.005
20 Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, et al. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol. 2022;21:438–49. Medline:35305318 doi:10.1016/S1474-4422(22)00037-0
21 Pruthi N, Ashok M, Kumar VS, Jhavar K, Sampath S, Devi BI. Magnitude of pedestrian head injuries & fatalities in Bangalore, south India: a retrospective study from an apex neurotrauma center. Indian J Med Res. 2012;136:1039–43. Medline: 23391802
22 Joshipura MK, Shah HS, Patel PR, Divatia PA, Desai PM. Trauma care systems in India. Injury. 2003;34:686–92. Medline: 12951294 doi:10.1016/S0020-1383(03)00163-3
23 Chandankhede AR, Thombre SD. Advancements and Challenges in Neurosurgical Practice in India: Where Do We Stand? Cureus. 2023;15:e37738. Medline:37223140 doi:10.7759/cureus.37738
24 van Essen TA, Lingsma HF, Pisică D, Singh RD, Volovici V, den Boogert HF, et al. Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. Lancet Neurol. 2022;21:620–31. Medline:35526554 doi:10.1016/S1474-4422(22)00166-1
25 van Essen TA, van Erp IAM, Lingsma HF, Pisică D, Yue JK, Singh RD, et al. Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural haematoma (CENTER-TBI): an observational cohort study. EClinicalMedicine. 2023;63:102161. Medline:37600483 doi:10.1016/j.eclinm.2023.102161
26 van Essen TA, den Boogert HF, Cnossen MC, de Ruiter GCW, Haitsma I, Polinder S, et al. Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study. Acta Neurochir (Wien). 2019;161:435–49. Medline:30569224 doi:10.1007/s00701-018-3761-z
27 Volovici V, Pisică D, Gravesteijn BY, Dirven CMF, Steyerberg EW, Ercole A, et al. Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. Acta Neurochir (Wien). 2022;164:1693–705. Medline:35648213 doi:10.1007/s00701-022-05257-z
28 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 Neurosurg. 2016;89:169–79. Medline:26806065 doi:10.1016/j.wneu.2015.12.097
29 Kumar SG, Roy G, Kar SS. Disability and rehabilitation services in India: issues and challenges. J Family Med Prim Care. 2012;1:69–73. Medline:24479007 doi:10.4103/2249-4863.94458
30 World Health Organization. Rehabilitation 2030: a call for action: 6-7 February 2017, Executive Boardroom, WHO Headquarters, meeting report. Geneva, Switzerland: World Health Organization; 2020. Available: https://iris.who.int/handle/10665/339910. Accessed: 20 October 2024.
31 Abbing HR. Health, Healthcare and Ageing Populations in Europe, a Human Rights Challenge for European Health Systems. Eur J Health Law. 2016;23:435–52. Medline:29210245 doi:10.1163/15718093-12341427
32 World Health Organization Regional Office for Europe. Health and care workforce in Europe: time to act. Geneva, Switzerland: World Health Organization Regional Office for Europe; 2022. Available: https://www.who.int/europe/publications/i/item/9789289058339. Accessed: 20 October 2024.
