Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

Abstract

Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

Clinico-Epidemiological Study in Admitted Patients with Traumatic Brain Injury (TBI) in two selected Tertiary Care Centers in Dhaka City

“…Nath et al 23 also found that males contributed to a major part of the fraction amongst the injured (98.0%), and most patients (36.0%) were in 3 rd decade of their life. Das et al 22 also found, male-to female ratio was found to be 2.57(72%):1 (28%). Another study 19 shows male-to-female ratio of 4.6:1, which does not correlate with our observation probably due to presence of more female workers like garment workers and day laborers in the community.…”

“…Some authors have reported that the most frequent lesions in mild TBI were subgaleal and palpebral hematomas, fractures and cerebral contusions, others described craniofacial fractures as the most frequent lesions, and one study demonstrated the prevalence of cerebral contusions (26.8%), extradural hematomas (6.8%), subarachnoid hemorrhage (5.7%) and subdural hematomas (4.4%) in patients with mild traumatic brain injury 26 . Das et al 22 found on the basis of CT-scan of head, diagnoses of traumatic brain injury were AEDH in 42.3% (1,974) cases, depressed skull fracture in 28.9% cases, ASDH in 12.3% cases, brain contusion in 10.20% (476) cases, and SAH or combination in 6.34% (296) cases of the total study population. It was found that 58.0% patients were normal cognition, 22.0% cases were mild cognitive impairment, 17.62% cases were moderate cognitive impairment and only 2.0% were severe cognitive impairment during discharge.…”

“…Also, the higher incidence of traumatic brain injuryin male individuals is related to locations with higher urban violence rates 21 . Das et al 22 found, males in their third and fourth decades of life were the predominant victims of TBI, specially RTA, as they are out for their daily activities and account ~60% of total victims. Similar observations were reported by the study of Patil et al, which showed that the people in their most active and productive age group are involved in RTAs, adding a serious economic loss to the community 21 .…”

“…However, being a world's largest youthful country, this study indicated that road traffic injuries are the leading cause of mild and moderate traumatic brain injury followed by assault and falls. Almost similar distribution was reported in various parts of the country as well as in other parts of the world.Das et al 22 found that RTA is the commonest (58.3%) cause of traumatic brain injury. Fall from height scored 25.0% following assaults was in 15.3% cases.…”

“…There are 49.5% in mild group, 28.5% in moderate group 8 . Das et al 22 found on admission, all traumatic brain injurypatients are categorized on the basis of GCS scores Among them, mild traumatic brain injurywith GCS score 13 to 15 was in 60.0%, moderate traumatic brain injurywith GCS score 9 to 12 was in 25.0%. The incidence of mild traumatic brain injurywas 82.4% (84/102), while moderate traumatic brain injurywas observed in 2.0% (2/102), and severe TCI in 15.6% of the patients (16/102), in agreement with the study developed by Bruns and Hauser 25 , where mild traumatic brain injuryincidence represented 80.0% of all their cases, while moderate and severe traumatic brain injury represented 10.0% cases each.…”