Emerging Challenges in the Management of Initial Traumatic Brain Injury: A Prospective Study from a Developing Country


  • Usman Haqqani
  • Bilal Khan
  • Ali Shahjehan
  • Sajjad Ullah
  • Shafaat Hussain




Traumatic Brain Injury, Head injury, Ventilator Support


Objective:  To identify and highlight the challenges faced in initial traumatic brain injury management in a developing country

Materials and Methods:  The study includes 294 TBI-related admissions. We included all admitted Patients with Traumatic brain injury via. A and E (accident & emergency) departments and all patients of either age or gender. We included information related to the area of the initial trauma, whether the patient was referred from another setup after initial management, whether CT brain was performed at an initial health care facility, time since trauma to our hospital/ER presentation, duration of stay in our hospital, whether ICU was provided or not, and whether the patient was managed conservatively or required surgery at our hospital.

Results:  Out of the total patients received male to female ratio was 9 to 1 and the age group most involved was 15 to 45 years old.72% of patients were referred from local healthcare setups. 24% of patients underwent surgery. 64% were received from other districts. CT was performed by 41% before presenting. 61% of patients reached the hospital within 3 hours of injury. 51% stayed in the hospital for 1 – 3 days. 17% were shifted to ICU, Ventilator support was only given to 9.5% of patients. In 25% of patients, Steroids were given, and 5 redo surgeries were performed in the same hospital setting.

Conclusion:  This Short report provides a snapshot of the difficulties and weaknesses of the health system in the region.


Hayes RL, Jenkins LW, Lyeth BG. Neurotransmitter-mediated mechanisms of traumatic brain injury: acetylcholine and excitatory amino acids. Journal of neurotrauma, 1992; 9 Suppl. 1: S173-87.

Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury. Journal of neurology, 2019; 266 (11): 2878-89.

Araki T, Yokota H, Morita A. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurologia medico-chirurgica, 2017; 57 (2): 82-93.

Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. The Medical clinics of North America, 2020; 104 (2): 213-38.

Oberholzer M, Müri RM. Neurorehabilitation of Traumatic Brain Injury (TBI): A Clinical Review. Medical sciences (Basel, Switzerland), 2019; 7 (3).

Tagliaferri F, Compagnone C, Korsic M, Servadei F, Kraus J. A systematic review of brain injury epidemiology in Europe. Acta neurochirurgica, 2006; 148 (3): 255-68; Discussion 68.

Coronado VG, Xu L, Basavaraju SV, McGuire LC, Wald MM, Faul MD, et al. Surveillance for traumatic brain injury-related deaths--United States, 1997-2007. Morbidity and mortality weekly report Surveillance summaries (Washington, DC: 2002). 2011; 60 (5): 1-32.

Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. The Lancet Neurology, 2017; 16 (12): 987-1048.

Vella MA, Crandall ML, Patel MB. Acute Management of Traumatic Brain Injury. Surg Clin North Am. 2017; 97 (5): 1015-30.

Bryson CN, Cramer RJ, Schmidt AT. Traumatic brain injury and lifetime suicidality: Applying the interpersonal-psychological theory perspective. Death studies, 2017; 41 (7): 399-405.

Vella MA, Crandall ML, Patel MB. Acute

Management of Traumatic Brain Injury. Surg Clin North Am. 2017; 97 (5): 1015-30.

Smart LR, Mangat HS, Issarow B, McClelland P, Mayaya G, Kanumba E, et al. Severe Traumatic Brain Injury at a Tertiary Referral Center in Tanzania: Epidemiology and Adherence to Brain Trauma Foundation Guidelines. World Neurosurgery, 2017; 105: 238-48.

Dias C, Rocha J, Pereira E, Cerejo A. Traumatic brain injury in Portugal: trends in hospital admissions from 2000 to 2010. Acta medica portuguesa. 2014; 27 (3): 349-56.

Huijben JA, Volovici V, Cnossen MC, Haitsma IK, Stocchetti N, Maas AIR, et al. Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Critical care (London, England),s 2018; 22 (1): 90.