Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from a rural set-up of a developing country

Agrawal, Amit; Baisakhiya, Nitish; Kakani, Anand; Nagrale, Manda

doi:10.4103/2229-5151.79276

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…Hence, our findings are not generalizable to non-Western countries because lack of resources restricts the routine use of aggressive treatment strategies in these countries. 52 Related, our findings cannot be generalized to children because it is known that guideline adherence in children varies from guideline adherence in adults 36 and might also be influenced by other factors such as concern about radiation.…”

Section: Discussionmentioning

confidence: 85%

Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review

Cnossen

Scholten

Lingsma

et al. 2021

Journal of Neurotrauma

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Guidelines aim to improve the quality of medical care and reduce treatment variation. The extent to which guidelines are adhered to in the field of traumatic brain injury (TBI) is unknown. The objectives of this systematic review were to (1) quantify adherence to guidelines in adult patients with TBI, (2) examine factors influencing adherence, and (3) study associations of adherence to clinical guidelines and outcome. We searched EMBASE, MEDLINE, Cochrane Central, PubMed, Web of Science, PsycINFO, SCOPUS, CINAHL, and grey literature in October 2014. We included studies of evidence-based (inter)national guidelines that examined the acute treatment of adult patients with TBI. Methodological quality was assessed using the Research Triangle Institute item bank and Quality in Prognostic Studies Risk of Bias Assessment Instrument. Twenty-two retrospective and prospective observational cohort studies, reported in 25 publications, were included, describing adherence to 13 guideline recommendations. Guideline adherence varied considerably between studies (range 18-100%) and was higher in guideline recommendations based on strong evidence compared with those based on lower evidence, and lower in recommendations of relatively more invasive procedures such as craniotomy. A number of patient-related factors, including age, Glasgow Coma Scale, and intracranial pathology, were associated with greater guideline adherence. Guideline adherence to Brain Trauma Foundation guidelines seemed to be associated with lower mortality. Guideline adherence in TBI is suboptimal, and wide variation exists between studies. Guideline adherence may be improved through the development of strong evidence for guidelines. Further research specifying hospital and management characteristics that explain variation in guideline adherence is warranted.

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Section: Discussionmentioning

confidence: 85%

Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review

Cnossen

Scholten

Lingsma

et al. 2021

Journal of Neurotrauma

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“…In patients on mechanical ventilation, tracheostomy may facilitate weaning from the ventilator, decrease length of intensive care unit (ICU) or hospital stay, and improve pulmonary toilet 3,4 . Many studies have confirmed that tracheostomy is a safe, effective method of airway management for patients with severe head, facial and multisystem organ trauma 5 . If performed appropriately in a setting with adequate resources, it is associated with a low complication rate 6 .…”

Section: Introductionmentioning

confidence: 99%

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study

et al. 2022

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Background Tracheostomy alone, without mechanical ventilation, has been advocated to maintain a free airway in patients with traumatic brain injury in low-income settings with minimal critical care capacity. However, no reports exist on the outcomes of this strategy. We examine the results of this practice at a central hospital in Malawi. Methods This is a retrospective review of medical records and prospectively gathered trauma surveillance data of patients admitted to Kamuzu Central Hospital, with traumatic brain injury from January 2010 to December 2015. In-hospital mortality rates were examined according to registered traumatic brain injury severity and airway management. Results In our analysis, 1875 of 2051 registered traumatic brain injury patients were included; 83.3% were male, mean age 32.6 (SD 12.9) years. 14.2% (n=267) of the patients had invasive airway management (endotracheal tube or tracheostomy) with or without mechanical ventilation. Mortality in severe traumatic brain injury treated with tracheostomy without mechanical ventilation was 42% (10/24) compared to 21% (14/68) in patients treated without intubation or tracheostomy (p= 0.043). Tracheostomies had an overall complication rate of 11%. Conclusion Tracheostomy without mechanical ventilation in severe traumatic brain injury did not improve survival outcomes in our setting. Tracheostomy for severe traumatic brain injury cannot be recommended when mechanical ventilation is not available unless there are sufficient specialized human resources for follow up in the ward. Efforts to improve critical care facilities and human resource capacity to allow proper use of mechanical ventilation in severe traumatic brain injury should be a high priority in low-income countries where the burden of trauma is high.

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Multimodality Monitoring Consensus Statement: Monitoring in Emerging Economies

Figaji

Puppo

2014

Neurocrit Care

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The burden of disease and so the need for care is often greater at hospitals in emerging economies. This is compounded by frequent restrictions in the delivery of good quality clinical care due to resource limitations. However, there is substantial heterogeneity in this economically defined group, such that advanced brain monitoring is routinely practiced at certain centers that have an interest in neurocritical care. It also must be recognized that significant heterogeneity in the delivery of neurocritical care exists even within individual high-income countries (HICs), determined by costs and level of interest. Direct comparisons of data between HICs and the group of low- and middle-income countries (LAMICs) are made difficult by differences in patient demographics, selection for ICU admission, therapies administered, and outcome assessment. Evidence suggests that potential benefits of multimodality monitoring depend on an appropriate environment and clinical expertise. There is no evidence to suggest that patients in LAMICs where such resources exist should be treated any differently to patients from HICs. The potential for outcome benefits in LAMICs is arguably greater in absolute terms because of the large burden of disease; however, the relative cost/benefit ratio of such monitoring in this setting must be viewed in context of the overall priorities in delivering health care at individual institutions.

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Resource utilization in the management of traumatic brain injury patients in a critical care unit: An audit from a rural set-up of a developing country

Cited by 4 publications

References 26 publications

Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review

Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study

Multimodality Monitoring Consensus Statement: Monitoring in Emerging Economies

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