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Epidemiology of Traumatic Brain Injury in Neurosurgery Department of Tertiary Referral Hospital at North Sumatera, Indonesia

Citation : Tandean S, Japardi J, Kollins F, Loe ML. Epidemiology of Traumatic Brain Injury in Neurosurgery Department of Tertiary Referral Hospital at North Sumatera, Indonesia. Medicinus. 2019 February; 7(5):146–149


Introduction
Traumatic brain injury (TBI) is the most common problem that caused morbidity and mortality in the world. Morbidity caused by TBI is one of socioeconomic burden for family and country. TBI is prevalent in low, middle, and high-income country and can affects to all ages. TBI can be caused by many factors but the most common is falls, being struck by or against n object, traffic injury, and assaults. 1,2 Incidence of TBI in worlwide was estimated 69 million lives with the highest in Western Pacific and Southeast Asia countries. The prevalence of TBI in Indonesia according to Riskesdas 2007 is 7,5% from all diseases and increase to 8,2% in 2013. Three provinces with the highest prevalence of TBI are Papua (1%), North Sumatera (0,9%), and Bangka Belitung (0,8%). According to National Center for Injury Prevention and Control, the highest rate of TBI was found in older adults (more than 75 years old) and dominated by male than female. 2,3 Epidemiology information of TBI is very important in understanding thc causes and risk factors so that effective programs can be designed to prevent and bring down injury. Various report claimed that TBI Epidemiological pattern has been changing lately. This study purposed to provide overview of TBI pattern in tertiary referral hospital at North Sumatera with focus on epidemiological data of TBI pattern.

Materials and methods
This was a retrospective study of all patients with head injury at neurosurgery department of H. Adam Malik general hospital from June to December 2018. The hospital is tertiary referral hosptial located in Medan, North Sumatera, Indonesia with bed capacity of 720. North Sumatera has 14.42 million populations. This study was approved by the Health Research Ethical Committee Medical Faculty of Universitas Sumatera Utara / H. Adam Malik General Hospital.
All medical records of TBI patients from neurosurgery department were assessed for several variables as age, gender, etiology, severity, length of stay and outcome. The severity category was based on Glasgow coma scale (GCS) measurement in emergency department i.e mild TBI (GCS 13-15), Moderate TBI (GCS 9-12), and Severe TBI (GCS 8). Exclusion criteria for this study as death on arrival and brain injury due to cerebrovascular disease, seizure, or psychiatric problems. All data will be presented descriptively as frequency and percentage in tables.

Results
During the period of study, 118 patients with traumatic brain injury were admitted in neurosurgery ward. From all patients with TBI, 89 (75.4%) were males and 29 (24.6%) were female so the ratio is 3.1:1. Patients' age were ranged every 10 years with highest frequency of 43 (36.4%) was found in the age range of 18-35 years and followed by 27 (22.9%) in the age of >56 years. Based on etiology of TBI, the most common cause was road traffic accident (n= 95, 80.5%) then followed by falls (n= 15, 12.7%) and violence (n= 8, 6.8%).

Table 1. Characteristics of patients
The patients whose GCS category were stated mild TBI, which constituted 78 (66.1%) were the highest frequency, followed by moderate TBI constituted 29 (24.6%). Based on brain lesion, the highest frequency was epidural hematoma for 40 (3.9%) then followed by intraparenchymal hemorrhage for 33 (28%). The highest outcome of patients of study was discharged (n= 84, 71.2%) then followed by mortality (n= 20, 17%). Length of stay in this study were ranged every 5 days with highest frequency of 45 (38.1%) was found in the length stay of 1-5 days and followed by 37 (31.4%) in the length stay of 6-10 days.

Discussion
Total of traumatic brain injury cases from neurosurgery department of H. Adam Malik general hospital in 2010 showed 1627 cases which 1021 cases are mild TBI, 444 cases are moderate TBI, and 162 cases are severe TBI. Compare to our data, there were significant reduction TBI cases from 1627 cases in 12 months to 118 cases in 6 months. North Sumatera only has 9 neurosurgeons in 2010 but in 2019 this amount have increased two times into 21 neurosurgeons.
Enhancement of neurosurgery service in secondary healthcare at North sumatera decreaseing referral need to tertiary referral hospital. 4 Several studies showed that TBI in both developing and developed countries dominate by male than female. This study also showed that males were more affected than females. While most of TBI found in productive age between 21-40 years. In this study, the highest frequency of TBI was also found in productive age, between 18-35 years. This might be caused by the fact that males with productive age are more active in daily activities that prone to head injury such as vehicle operation and working on heights. 5,6 Road traffic accident has the highest frequency for the cause of TBI in this study. Traffic accident was also the most common causedof TBI in developing country. Meanwhile, fall and assault were the most prevalent cause of TBI in developed country. This can be caused by better road network and good implementation of traffic rules. 6,7 Mild Head injury has the highest frequency of TBI from this study and other studies also reported the same result. 7,8 The mortality rate for TBI was declined significantly over decade from 39% in 1984 to 27% in 1996. Mortality rate in this study was 16,9% which mean better treatment over years but still two times higher than US National Health Statistics Reports. 9,10 Length of stay in this study commonly under 10 days is 69,5% and under 15 days is 90.7%. Study from US and Canada reported different length of stay which average length of stay in US is 7.3 days and in Canada is 11.7%. Several important factors that can prolonged length of stay are age, gender, GCS, injury severity, and ventilator usage. 10,11 Being a retrospective study could have loss of important information that might be relevant. This is limitations of present study.
Retrospective study has disadvantage of poor recording due to relied on accuracy of written records. This can happen because our record still paper based so poor keeping is common.

Conclusion
TBI patients were dominate by male with range from 18-35 years. Traffic injury was the most common cause of TBI. Most of TBI patients were mild with length of stay less than 10 years. Mortality rate in our study is 16.8%.

Conflicts of interest
There are ni conflicts of interest