Large study on traumatic brain injury highlights global inequality in
causes and treatment

Date:
March 17, 2022
Source:
University of Cambridge
Summary:
A large study examining the surgical management of traumatic brain
injuries highlights regional inequalities in both major causes
and treatment of such injuries.



FULL STORY ========================================================================== Neurosurgery experts from Cambridge have led the largest ever
study examining the surgical management of traumatic brain injuries, highlighting regional inequalities in both major causes and treatment
of such injuries.


==========================================================================
The Global Neurotrauma Outcomes Study, funded by the NIHR, is published
in The Lancet Neurology and provides data to assist in decision making
and improving outcome for patients with traumatic brain injury globally.

The paper focuses on types of cases, the way they are managed, and death
rates, and was compiled using data submitted by 159 hospitals in 57
countries to a central database, which the researchers then analysed. The researchers stratified countries into four tiers (very high, high,
medium, low) according to their Human Development Index (HDI), which
takes account of factors like life expectancy, education, and income.

The prospective study determined that patients in the low HDI tier were
often young and tended to suffer skull fractures due to assault but were classified as 'mild' traumatic brain injury (TBI).

In the medium and high HDI tiers, patients were also young, but most had moderate to severe TBI caused by a road traffic collision and extradural haematoma -- a bleed on the outside of the dura mater, the membrane
covering of the brain.

In the very high tier, patients tended to be older and presented with
a moderate or severe TBI associated with a fall and acute subdural
haematoma -- a bleed on the inner surface of the dura mater.



========================================================================== Quality of care was generally less favourable in lower HDI settings,
including delays to surgery and a lack of postoperative monitoring
equipment and intensive care. The very high HDI tier had the highest
proportion of operations in which the most senior surgeon present in the operating theatre was a fully qualified neurosurgeon, while the medium
HDI tier had the lowest proportion.

The study also found significant variations between hospitals in the
outcome of patients.

Angelos Kolias, Consultant Neurosurgeon at Cambridge University Hospitals
NHS Foundation Trust (CUH) and NIHR Global Neurotrauma Research Group
associate director, said: "The results show that overall mortality
is low, reflecting the life-saving nature of surgery for traumatic
brain injuries. Many of these patients would have died without an
operation. However, we also need to address deficits in pre-hospital
management and long-term rehabilitation." David Clark, a trainee
neurosurgeon and University of Cambridge research fellow, said:
"A particularly important finding is that outcome is influenced more
by hospital characteristics than country of origin, which raises the possibility that changing the systems and processes of care in individual hospitals might be able to improve mortality. The paper sows the seeds
for discussion and change." The research was funded by the NIHR using
UK government aid to support global health research.

Alexis Joannides, Consultant Neurosurgeon at CUH and NIHR Global
Neurotrauma Research Group informatics lead, added: "The contribution
of several clinicians and researchers from several hospitals across the
world has been possible due to the infrastructure and collaborations
supported by the NIHR.

"The database and data management process used in the study have now laid
the foundation for a global registry of traumatic brain injuries that
we have established to support ongoing quality improvement and research
in the field of traumatic brain injury." Peter Hutchinson, Professor
of Neurosurgery at the University of Cambridge and Director of the NIHR
Global Neurotrauma Research Group, said: "This is the largest study in
the world looking at the surgical management of head injuries and will
be of practical value to clinicians and others planning strategies for
the future.

"The collaboration across such a vast number of hospitals and countries, together with the support of the World Federation of Neurosurgical
Societies and continental neurosurgical societies, has been phenomenal."

========================================================================== Story Source: Materials provided by University_of_Cambridge. The original
text of this story is licensed under a Creative_Commons_License. Note:
Content may be edited for style and length.


========================================================================== Related Multimedia:
* Map_showing_most_common_causes_of_traumatic_brain_injury ========================================================================== Journal Reference:
1. David Clark et al. Casemix, management, and mortality of patients
receiving emergency neurosurgery for traumatic brain injury
in the Global Neurotrauma Outcomes Study: a prospective
observational cohort study. The Lancet Neurology, 2022; DOI:
10.1016/S1474-4422(22)00037-0 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220317111915.htm

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