Severe brain injury epidemiology in Western Macedonia: experience of a general hospital as the basis for planning brain injury management

Introduction

Studies on patients with severe brain injury (SBI) are few and are based on data from specialized centers. In Western Macedonia the main reason for transferring trauma patients is SBI, to a neurosurgeon with a travel time as long as 3 hours. Five general hospitals serve the health service needs of a population of 301,522 inhabitants. Bodosakeio General Hospital covers a real population of 100,000 and is the only one in the region backed by an intensive care unit and 24-hour facilities for computerised tomography scanning.

Objective

The objective of this study was to evaluate the incidence, distribution, clinical patterns and early outcome of SBI patients admitted to our non-neurosurgical hospital, as a basis for future efforts at improvements.

Methods

Cases of SBI patients admitted to Bodosakeio hospital (Glasgow Coma Scale ≤ 8) were identified retrospectively for a 23-month period (January 2002–December 2003) using data from the District Health System of West Macedonia, the accident and emergency unit, the hospital forms registering interhospital transports and the intensive care unit records. Extracted data concerned the incidence, gender distribution, age, external causes, C-T lesions, associated injuries, early transfer and mortality at the end of acute hospitalization. Additionally, data for the SBI distribution throughout the five general hospitals in the region were analyzed.

Results

During the study period 1127 traumatic brain injury cases were registered, comprising 11.22% of the Bodosakeio Hospital Surgical Emergency Department workload. A total of 63.17% of cases were from traffic-related causes, followed by falls (18.5%). Over 1.96% were dead on arrival, 47.17% were discharged home after initial assessment, leaving 50.87% to be admitted to hospital, mainly for observation. Of these, 32 (2.83%) were classified as having SBI and needed to be transferred to a neurosurgical unit. The characteristics of SBI patients for Bodosakeio Hospital and the distribution of transferred SBI patients for the five general hospital sites within West Macedonia are presented in Tables 1 and 2.

Table 1

Table 2

Conclusion

There is a need for strong preventive measures to control the high incidence of SBI in the region. The mortality rates are acceptable when compared with other reports, suggesting adequate quality of initial stabilization and transport, and competency and speed in the detection of candidates for surgical decompression. Nevertheless this system may lead to some avoidable deaths, especially in acute intracranial hemorrhage. The optimal situation would be the presence of a neurosurgeon in the medical team admitting patients with severe head trauma and the concentration of injury services since no hospital receives sufficient patients to develop and maintain expertise.