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|NI FEATURE: THE EDITORIAL DEBATE II-- PROS AND CONS
|Year : 2017 | Volume
| Issue : 2 | Page : 257-258
Traumatic brain injury in India: A big problem in need of data
Andrew I R Maas
Member of Neurotraumatology Committee of the World Federation of Neurosurgical Societies, Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
|Date of Web Publication||10-Mar-2017|
Andrew I R Maas
Department of Neurosurgery, Antwerp University Hospital/University of Antwerp, Wilrijkstraat 10, 2650 Edegem
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maas AI. Traumatic brain injury in India: A big problem in need of data. Neurol India 2017;65:257-8
In this edition of Neurology India, Massenburg et al., (2017) report a systematic review to characterize the quantitative literature on traumatic brain injury (TBI) in India. This is a very timely and important study. TBI is increasingly being recognized as a public health problem of immense proportions with the substantial burden of disability and death occurring in low and middle income countries (LMICs). In high income countries, the incidence of TBI due to road traffic incidents has decreased following the successful implementation of preventive measures (legislations, safer roadway infrastructure, car safety measures and helmets); nevertheless, the burden of TBI in these countries remains high due to an increasing number of elderly patients with TBI due to a fall. Road traffic accidents remain the main cause of TBI in LMICs. Approximately 90% of the world's road fatalities occur in the setting of LMICs, although they only have half of the worlds' vehicles.
International awareness, that action is necessary, is increasing: The United Nations Decade of Action for Road Safety (2011-2020) aims to reduce to half, the 1.3 million traffic-related deaths each year by 2020 through various measures including road safety management, safer vehicles, better informed road users and an improved post-crash response (World Health Organization 2011). In the late spring of 2017, the journal, Lancet Neurology, will be publishing a dedicated commissioned issue on 'Traumatic Brain Injury.' The Journal of Neurosurgery is expected to draw attention to the neurosurgical problems prevalent in LMICs and are particularly focusing on care of patients suffering from TBI in a special edition, expected in the first half of this year. Thus, internationally too, recognition of the relevance of management of TBI, specifically with reference to LMICs, is increasing. An increased awareness amongst politicians and the general public is essential to motivate the implementation of preventive programs and measures to improve the general care of these patients. Accurate data, procured at a national level, on the size of the problem (in order to secure potential gains in decreasing health costs following improvements in prevention and care) are a prerequisite for the development and successful implementation of measures aimed to reduce the burden. India has the second largest world population and over a quarter of the world's trauma deaths occur in India. Data from the national crime record bureau report an increase of 63% in accident related deaths over the period 2004-2013. The total volume of TBI in India is unknown, but estimates suggest that there are more than a million trauma related deaths in India per year, of which 50% are TBI related.
In their systematic review, Massenburg et al., identify a total of 72 manuscripts reporting on nearly 20,000 patients over a 27-year period. No clear changes in demographics or mortality were noted over this time period and, importantly, road traffic incidents remained the most important cause of injury. The authors note that the quality of reporting of quantitative studies on TBI in India is low and that future studies should ensure methodological excellence. I would strongly support their statement, “Without high quality studies, recommendations for policy changes will not have strong clinical, empirical evidence.”
Important as the reported results of this study are, perhaps what is even more important is what the authors could not report because of lack of data: We should recognize that the total number of 20,000 patients with TBI on whom data have been published (that has been collected over 27 years, which actually represents less than 1,000 subjects studied/year) is only a fraction of the total number of patients suffering from TBI annually in India. Even at conservative estimates of approximately 10 million moderate-to-severe TBI per year, this would only represent 0.1% of the population suffering from TBI. Further, across the studies, large differences exist in the quantity of data reported. Gender was not reported in over a quarter of the studies, and age was not considered in over half the studies. Data on in-hospital mortality were lacking in nearly two-third of the studies. The most important message from this systematic review is to highlight the lack of data and lack of evidence. The results reported should form a strong incentive for a nationwide concerted effort to improve the capture of standardized epidemiological data on TBI in order to form a sound basis for implementation of preventive measures and improvements in prehospital, acute and post-acute care.
| » References|| |
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;65:305-14. [Full text]
National Crime Records Bureau Ministry of Home Affairs Government of India, 2014. Accidental Deaths and Suicides in India 2014; pp. 3-322.
Roozenbeek B, Maas AIR, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nature Reviews Neurology 2013;9:231-6.