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Table of Contents    
NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
Year : 2017  |  Volume : 65  |  Issue : 2  |  Page : 259-260

The role of systematic collection of epidemiological data from India in reducing the burden of traumatic brain injury


Department of Neurosurgery, School of Medical Sciences, University of Adelaide, South Australia, Past President of the International Neurotrauma Society, Chairman, Neurotrauma Committee, Asian Australasian Society of Neurological Surgeons

Date of Web Publication10-Mar-2017

Correspondence Address:
Peter Reilly
Clinical Professor of Neurosurgery, School of Medical Sciences, University of Adelaide, South Australia

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.201851

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How to cite this article:
Reilly P. The role of systematic collection of epidemiological data from India in reducing the burden of traumatic brain injury. Neurol India 2017;65:259-60

How to cite this URL:
Reilly P. The role of systematic collection of epidemiological data from India in reducing the burden of traumatic brain injury. Neurol India [serial online] 2017 [cited 2017 Mar 26];65:259-60. Available from: http://www.neurologyindia.com/text.asp?2017/65/2/259/201851


Indian neurosurgeons and other emergency personnel face an enormous task of grappling with an ever-increasing burden of neurotrauma. The challenge is met with great courage and expertise but often with inadequate equipment and personnel.[1] Accurate epidemiological data is an essential weapon that helps in seeking better funding for training, equipment, establishment of trauma system protocols and research.

A systematic review of quantitative research on traumatic brain injury (TBI) in India by Massenburg et al., published in this journal, concludes that the qualitative studies currently available in India are sparse and limited in scope and quality. In an extensive analysis of all major databases, the authors found 72 relevant publications of sufficient quality to warrant inclusion, mostly from the past 10 years. The only analysable findings were that the major causes of TBI were road traffic accidents and falls; males dominated; the mean age of the victims was 31.3 years; and, the in-hospital mortality was 24.6%.[2]

This systemic review can provide only a broad outline of the actual scenario of neurotrauma, prevalent in India. The authors point towards some of the deficiencies which they identified. The published reports come from urban hospitals so that non-academic and rural centres were underrepresented. There is insufficient information regarding the grade of injury and its severity. The only outcome measure was the in-hospital mortality. The important conclusion which the authors draw is that there is a dire need for better quality epidemiological studies on TBI in India. This article, indeed, provides a thought-provoking message, which has a much wider application and relevance, not only for low and middle income (LMIC) countries, but also, for all countries and regions, to varying degrees. Reliable epidemiological data is the foundation of health care planning at all stages, from prevention to rehabilitation. Thus, it helps in designing and applying appropriate preventive strategies through all phases of management of TBI from the accident site to rehabilitation. Relevant preventive measures depend on knowing how, where and to whom accidents occur. The effectiveness of preventable strategies can only be determined by reliable statistics.

The review records only in-hospital mortality and omits any measure of prehospital mortality and preventable morbidity. Other studies would suggest that these figures are likely to be significant. Prehospital mortality and morbidity can only be reduced by properly equipped and staffed ambulances services. In a current survey by the Asian Australasian Society of Neurological Surgeons of level 1 trauma centres in several low and middle income (LMIC) countries, the initial aid to the trauma vicitms was provided by an ambulance officer in 12% of cases. 52% of patients with TBI reached the hospital in an ambulance but only 28% were accompanied by a trained personnel. An ambulance service with properly trained personnel, well equipped with communication systems and based on well-documented and established protocols can only be justified by an accurate and current epidemiological evidence.

Trauma systems which link rural and level 1 trauma centres need to be designed to suit the local needs. These elements should be based on guidelines which assist the local doctors in their immediate management and in their linkage with the trauma centre. These guidelines need to be developed to suit all stages of treatment, the personnel and equipment available and supplement the well-established evidence based systems developed for high level intensive care. At the other end of the injury pathway, the outcome data provides the basis to design and implement appropriate rehabilitation.

A full picture of the effects of neurotrauma must include costs and outcome, two closely related factors. The victims of TBI frequently suffer from lifelong disability that affects their social and economic lives. The direct and indirect costs of their disability to the community are well documented in high income countries; these figures are certainly less well documented in LMIC countries but are likely to be very large and may have a huge impact on the establishment of proper trauma care facilities, if collected proficiently. The pattern of trauma varies from country to country and within regions of countries. The published data from western countries do not apply to LMIC countries. Furthermore, there are significant changes in these figures with time, due to changes in the transport modalities, urbanisation and aging, and the introduction of injury prevention measures. The worldwide aging of different populations is itself changing the pattern of neurotrauma, increasing the cost of health care and therefore, requiring different preventive strategies.[3] These evolving changes can only be recognised by high quality epidemiological studies.

The need for standardisation of TBI data collection has been approached by developing consensus - based common data elements which can form the basis of standardised online data collection. This approach is being applied in a major European study.[4],[5] This standardisation will allow the collection of valid regional and national data on which trauma management can be designed, and the research compared and collated.

This important review should initiate discussion on the development of high quality, standardised epidemiological data as a basis for future research in India into the means of reducing the growing personal, social and financial burden of TBI.

 
  References Top

1.
Prusty GK, Gururaj GK, Kallol K. Neurotrauma: An emerging epidemic in low- and middle-income countries. In: Traumatic and Spinal Cord Injury Ed. C Morgani-Kossmann, R Raghupathi, A Maas. Cambridge University Press, 2012 pp 17-29.  Back to cited text no. 1
    
2.
Massenburg BB, Veetil DK, Raykar NP, Agrawal A, Roy N, Gerdin M. A systematic review of quantitative research on traumatic brain injury in India. Neurol India 2017;65:305-15.  Back to cited text no. 2
  [Full text]  
3.
Reilly PL. Current evaluation of TBI epidemiology in an ageing society with improved preventative measures In: Traumatic and Spinal Cord Injury. Editors: Morgani-Kossmann C, Raghupathi R, Maas A. Cambridge, UK; Cambridge University Press, 2012 pp 1-16.  Back to cited text no. 3
    
4.
Maas AIR., Harrison-Felix CL, Menon D, Adelson PD, Balkin T, Bullock R, et al. Standardizing data collection in traumatic brain injury. J Neurotrauma 2011;28;177-87.  Back to cited text no. 4
    
5.
Maas AI, Menon DK, Steyerberg EW, Citerio G, Lecky F, Manley GT, et al. CENTER-TBI Participants and Investigators. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 2015;76:67-80.  Back to cited text no. 5
    




 

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