Background Despite the high burden, little is known about Road-Traffic Injury (RTI)-related Traumatic Brain Injury (TBI) in Low-and-middle-income countries. This study determined the epidemiology, clinical characteristics, health outcome and pre-hospital care factors of RTI-related TBI in Bangladesh.
Methodology A cross-sectional study was conducted at Dhaka Medical College and Hospital, from May-June 2017. Data were collected during admission and at the time of discharge. A pre-tested semi-structured questionnaire along with Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS) and EuroQol-5D-3L was used. Chi-square test and multivariate regression analysis was done and Odds Ratio (OR) were calculated to identify vulnerability of RTI-related TBI and its predictive factors for mortality.
Results Total TBI cases were 659 within the study period. The mean age of the patients was 32.3 years and majority (80.1%) of the patients were male. RTI was the leading (62%) cause of TBI followed by physical assault (17%) and fall (16%). Patients with RTI-related TBI had 1.95 (95% CI 1.21–3.14) times higher chance of falling into severe category of GCS score (<8) and 3 (95% CI 1.59–5.78) times higher chance of mortality than patients who sustained TBI due to other causes. The GCS score (<8) (OR 8.1, p< 0.01, 95% CI 4.1–16.2), duration of loss of consciousness >1-hour (OR 4.4, p< 0.01, 95% CI 1.4–8.1) and time gap in initiation of treatment >8-hours (OR 2.8, p< 0.01, 95% CI 1.4–5.5) were identified as the predictive factors of mortality through multivariate regression analysis. Nearly none of the patients received any first aid treatment and emergency transport service following TBI. Two-third patients were referred from primary and secondary healthcare facilities and among them, one-third patients didn’t receive any treatment prior to referral.
Conclusion RTI is the most vulnerable mechanism of TBI and young male of economically productive age group are the most vulnerable group. The GCS score, duration of loss of consciousness, and time gap in initiation of treatment are the predictive factors for mortality due to RTI-related TBI. Evidence from this study can aid in policy making, prevention, and establishment of pre-hospital care at national level in Bangladesh and other developing countries.
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