• Samitha Samanamalee, Ponsuge Chathurani Sigera, De SilvaAmbepitiyawaduge PubuduAPNetwork for Improving Critical Care Systems and Training, 2nd Floor, YMBA Building, Colombo, 08, Sri Lanka.National Intensive Care Surveillance, Quality Secretariat Building, Castle Street Hospital for Women, Colombo, 08, , Kaushila Thilakasiri, Aasiyah Rashan, Saman Wadanambi, Kosala Saroj Amarasiri Jayasinghe, Arjen M Dondorp, and Rashan Haniffa.
• Health Education Bureaue, No.2, Kynsey Road, Colombo, 08, Sri Lanka.
• BMC Anesthesiol. 2018 Jan 8; 18 (1): 44.

BackgroundThis study evaluates post-ICU outcomes of patients admitted with moderate and severe Traumatic Brain Injury (TBI) in a tertiary neurocritical care unit in an low middle income country and the performance of trauma scores: A Severity Characterization of Trauma, Trauma and Injury Severity Score, Injury Severity Score and Revised Trauma Score in this setting.MethodsAdult patients directly admitted to the neurosurgical intensive care units of the National Hospital of Sri Lanka between 21st July 2014 and 1st October 2014 with moderate or severe TBI were recruited. A telephone administered questionnaire based on the Glasgow Outcome Scale Extended (GOSE) was used to assess functional outcome of patients at 3 and 6 months after injury. The economic impact of the injury was assessed before injury, and at 3 and 6 months after injury.ResultsOne hundred and one patients were included in the study. Survival at ICU discharge, 3 and 6 months after injury was 68.3%, 49.5% and 45.5% respectively. Of the survivors at 3 months after injury, 43 (86%) were living at home. Only 19 (38%) patients had a good recovery (as defined by GOSE 7 and 8). Three months and six months after injury, respectively 25 (50%) and 14 (30.4%) patients had become "economically dependent". Selected trauma scores had poor discriminatory ability in predicting mortality.ConclusionsThis observational study of patients sustaining moderate or severe TBI in Sri Lanka (a LMIC) reveals only 46% of patients were alive at 6 months after ICU discharge and only 20% overall attained a good (GOSE 7 or 8) recovery. The social and economic consequences of TBI were long lasting in this setting. Injury Severity Score, Revised Trauma Score, A Severity Characterization of Trauma and Trauma and Injury Severity Score, all performed poorly in predicting mortality in this setting and illustrate the need for setting adapted tools.

35 keywords...

hide…