Effects of a Rural Trauma System on Traumatic Brain Injuries

Tiesman, Hope M.; Young, Tara; Torner, James C.; McMahon, Mark; Peek‐Asa, Corinne; Fiedler, John L.

doi:10.1089/neu.2006.0196

Cited by 41 publications

(35 citation statements)

References 21 publications

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“…This is why calls continue to be made for the establishment, at least, of regional trauma centers in many of these LMIC for the optimal care of the critically head injured [1,11,31] .…”

Section: Outcome Of Hi In Nigeriamentioning

confidence: 99%

Clinicoepidemiological Profiles and Outcomes during First Hospital Admission of Head Injury Patients in Ikeja, Nigeria

2008

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Background: Although head injury (HI) is a major public health problem in Nigeria and other low and middle income countries of the world, there is a paucity of data from these societies. This is largely due to under-reporting. We carried out a prospective study of the clinicoepidemiological profiles and outcomes following the first hospitalization of a cohort of head-injured patients in Ikeja, Nigeria, a metropolitan African city. Methods: In an 8-month period from May until December 2005, data from all HI cases seen in our neurosurgical unit were prospectively recorded for subsequent analysis. These include demographics, mechanism of injury, pre-neurosurgical care received, severity of injury using the Glasgow Coma Scale, presence of hemodynamic instability, pupillary anomalies and associated systemic injuries, cranial computed tomography (CT) findings and the number of surgical interventions, as well as outcomes after the first hospital admission using the Glasgow Outcome Scale. Determinants of outcome were explored using the χ² test and the level of significance was put at p = 0.05. Results: There were 143 cases of HI, which is about one fifth of our total workload, including 122 males and 21 females aged 0.5–85 years (mean age 29.15). The majority (88%) were either school children or low income earners. Road accidents accounted for 75% of the cases; three quarter of the cases had some initial care in other health facilities before the arrival in our unit, at an average of 33 h. Mild, moderate and severe HI accounted for 60, 18 and 22%, respectively. About a quarter of the patients sustained other systemic injuries. Cranial CT scanning was obtainable in 40 patients (28%); 9 of these revealed surgical mass lesions, of whom 5 had life-saving operations. Many well-known determinants of a poor outcome of HI were prevalent in this study group and found to have a significantly adverse effect on patient outcome. Conclusions: HI is a major public health problem in Nigeria, taking up at least one fifth of the neurosurgical workload. The prehospital emergency medical service is poorly organized. Determinants of a poor outcome of HI are highly prevalent, including poor accessibility to cranial CT scanning, absence or inadequacy of logistics for neurocritical care and an inadequate number of neurosurgeons.

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“…This is why calls continue to be made for the establishment, at least, of regional trauma centers in many of these LMIC for the optimal care of the critically head injured [1,11,31] .…”

Section: Outcome Of Hi In Nigeriamentioning

confidence: 99%

Clinicoepidemiological Profiles and Outcomes during First Hospital Admission of Head Injury Patients in Ikeja, Nigeria

2008

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“…[1][2][3][4][5] Most trauma centers are in urban regions. In a rural state, referral to a major center presents greater obstacles and increased difficulty for injured patients who must travel long distances for treatment.…”

Section: Introductionmentioning

confidence: 99%

Payer Status and Increased Distance Traveled for Fracture Care in a Rural State

Lack

Carlo²,

Marsh³

2013

Journal of Orthopaedic Trauma

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Increasing volume of orthopaedic trauma at a rural level 1 trauma center was associated with increasing travel distance for patients. Specifically, there was a dramatic increase in the volume of patients presenting for the care of simple orthopaedic injuries, these patients traveled greater distances with time and were more likely to beon Medicaid. Patients presenting with emergent injuries were also more likely to be on Medicaid. The appropriate triage of orthopaedic injuries requires a well-designed trauma system, including local on-call orthopaedists who can appropriately direct the care of patients with a variety of injuries. The effect of payer status on travel distance may be addressed through changes in reimbursement. Long-distance referral of orthopaedic trauma deserves further study as it affects patient outcomes, cost, and convenience of care.

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“…The fact that TBI results in the greatest public health burden in terms of YPLL due to in-hospital death while other neurologic disorders have shown improvements in mortality and YPLL over time suggests that TBI represents a continued target for clinical and resource allocation [32,33]. Increasing TBI in-hospital mortality may also be a result of improved pre-hospital care, but it has been suggested that in-hospital care has trailed the advances made in the triage and transport of TBI patients prior to hospitalization [28,[34][35][36].…”

Section: Discussionmentioning

confidence: 99%