IJE Advance Access originally published online on September 9, 2008
International Journal of Epidemiology 2009 38(2):452-458; doi:10.1093/ije/dyn189
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Patient outcome after traumatic brain injury in high-, middle- and low-income countries: analysis of data on 8927 patients in 46 countries
1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK.
2 Centre for Brain and Cognitive Development, School of Psychology, Birkbeck, University of London, Malet Street, WC1E 7HX, London, UK.
* Corresponding author. Dr Mary J De Silva, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK. E-mail: mary.desilva{at}lshtm.ac.uk
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Abstract |
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Background Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. The burden of TBI is greatest in low- and middle-income countries (LAMIC), yet little is known about patient outcomes in these settings.
Methods Complete data on 8927 patients from 46 countries from the corticosteroid randomization after significant head injury (CRASH) trial were analysed to explore whether outcomes 6 months after TBI differed between high-income countries and LAMIC.
Results Just under half of patients experienced a good recovery, one-third moderate or severe disability and one-quarter died within 6 months of their injury. Univariate analyses showed that patients in LAMIC were more likely to die following severe TBI, but were less likely to be disabled following mild and moderate TBI. These results were confirmed in multivariate analyses. Compared to patients in high-income countries, patients in LAMIC have over twice the odds of dying following severe TBI (OR 2.23, 95% CI 1.51–3.30) but half the odds of disability following mild (OR 0.41, 95% CI 0.23–0.72) and moderate TBI (OR 0.53, 95% CI 0.35–0.81). There were no differences between settings in the odds of death following either mild or moderate TBI.
Conclusions Reduced death rates following severe TBI in patients from high-income countries may be due to differences in medical care which may result in a higher proportion of patients surviving with a disability. Socio-cultural factors may explain the lower levels of disability after mild and moderate TBI in LAMIC.
Keywords Traumatic brain injury, Glasgow Outcome Score, high-income countries, middle-income countries, low-income countries
Accepted 13 August 2008