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Prevalence of a definitive airway in patients with severe traumatic brain injury received at four urban public university hospitals in India: a cohort study
  1. Monty Uttam Khajanchi1,
  2. Vineet Kumar2,
  3. Ludvig Wärnberg Gerdin3,
  4. Kapil Dev Soni4,
  5. Makhan Lal Saha5,
  6. Nobhojit Roy6,7,
  7. Martin Gerdin Wärnberg3
  1. 1 Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
  2. 2 Department of General Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
  3. 3 Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
  4. 4 Department of Critical and Intensive Care, JPN Apex Trauma Center, AIIMS (ND), New Delhi, India
  5. 5 Department of General Surgery, Institute of Postgraduate Medical Education and Research, Pondicherry, India
  6. 6 WHO Collaborating Centre for research on Surgical care delivery in LMICs, Surgical Unit, BARC Hospital (Govt. of India)  , Mumbai, India
  7. 7 School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
  1. Correspondence to Dr Monty Uttam Khajanchi, Department of General Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra 400012, India; monta32{at}


Aim To estimate the proportion of patients arriving with a Glasgow Coma Scale (GCS) less than 9 who had a definitive airway placed prior to arrival.

Methods We conducted a retrospective analysis of the data from a multicentre, prospective observational research project entitled Towards Improved Trauma Care Outcomes in India. Adults aged ≥18 years with an isolated traumatic brain injury (TBI) who were transferred from another hospital to the emergency department of the participating hospital with a GCS less than 9 were included. Our outcome was a definitive airway, defined as either intubation or surgical airway, placed prior to arrival at a participating centre.

Results The total number of patients eligible for this study was 1499. The median age was 40 years and 84% were male. Road traffic injuries and falls comprised 88% of the causes of isolated TBI. The number of patients with GCS<9 who had a definitive airway placed before reaching the participating centres was 229. Thus, the proportion was 0.15 (95% CI 0.13 to 0.17). The proportions of patients with a definitive airway who arrived after 24 hours (19%) were approximately double the proportion of patients who arrived within 6 hours (10%) after injury to the definitive care centre.

Conclusion The rates of definitive airway placement are poor in adults with an isolated TBI who have been transferred from another health facility to tertiary care centres in India.

  • traumatic brain injury
  • trauma systems
  • low-middle income country

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  • Contributors Authors MUK and MGW have conceptualised and designed this study, and have done the analysis and interpretation of data. VK has contributed to the design and analysis of the manuscript. LWG contributed to the analysis and interpretation of data. MLS and NR contributed to the concept and interpretation of data. All authors contributed to drafting the article and revising it, and approved the final version. All authors agree to be responsible for all aspects of the work.

  • Funding The data collection was funded by the Swedish National Board of Health and Welfare and the Laerdal Foundation. There is no funding to report on this submission.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The TITCO project was granted waivers of informed consent from all study centres. The study received approval from the institutional ethics committee of the four centres involved in the study. The ethics approval registration numbers were EC/NP-279/2013 RP-O1/2013 from the All India Institute of Medical Sciences Ethics Committee, IEC/11/13 from the Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal General Hospital Institutional Ethics Committee, IEC/279 from the Institute of Post Graduate Medical Education and Research (IPGME&R) Research Oversight Committee (Institutional Ethics Committee), and IEC(I)OUT/222/14 from the Seth GS Medical College and King Edward Memorial Hospital Institutional Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are available to whoever wants by emailing the corresponding author or the last author (MGW). They can write their aim or objective, and then the authors can decide if that study can be done without duplication of work.