PDF herunterladen
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 627-633
DOI: 10.4103/ajns.AJNS_4_20
Original Article

Traumatic brain injury in Mumbai: A survey of providers along the care continuum

Saksham Gupta
Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA
,
Monty Khajanchi
1   Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra
,
Harris Solomon
2   Department of Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina
,
Nakul Raykar
3   Department of Surgery, Beth Israel Deaconess Medical Center
4   Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA
,
Blake Alkire
4   Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA
5   Department of Otolaryngology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA
,
Nobhojit Roy
6   National Health System Resource Center, New Delhi
,
Kee Park
4   Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA
,
Vineet Kumar
7   Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Introduction: Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment. Methods: Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai. Results: A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others. Conclusions: Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.

Key-words:

Barriers to care - low- and middle-income countries - mortality - traumatic brain injury - urbanization

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 05. Januar 2020

Angenommen: 31. März 2020

Artikel online veröffentlicht:
16. August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg 2018;1-18.
  • 2 Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008;7:728-41.
  • 3 Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol 2013;9:231-6.
  • 4 Agrawal A, Munivenkatappa A, Shukla DP, Menon GR, Alogolu R, Galwankar S, et al. Traumatic brain injury related research in India: An overview of published literature. Int J Crit Illn Inj Sci 2016;6:65-9.
  • 5 Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 2002;24:24-8.
  • 6 Maas AI. Traumatic brain injury in India: A big problem in need of data. Neurol India 2017;65:257-8.
  • 7 Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, et al. Global cancer surgery: Delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2015;16:1193-224.
  • 8 Joffe HY. Content and thematic analysis. In: Research Methods for Clinical and Health Psychology. London: Sage; 2004. p. 56-68.
  • 9 Chowdhury T, Kowalski S, Arabi Y, Dash HH. Pre-hospital and initial management of head injury patients: An update. Saudi J Anaesth 2014;8:114-20.
  • 10 Corral L, Javierre CF, Ventura JL, Marcos P, Herrero JI, Mañez R. Impact of non-neurological complications in severe traumatic brain injury outcome. Crit Care 2012;16:R44.
  • 11 Godbolt AK, Stenberg M, Jakobsson J, Sorjonen K, Krakau K, Stålnacke BM, et al. Subacute complications during recovery from severe traumatic brain injury: Frequency and associations with outcome. BMJ Open 2015;5:e007208.
  • 12 Mohamadpour M, Whitney K, Bergold PJ. The Importance of Therapeutic Time Window in the Treatment of Traumatic Brain Injury. Front Neurosci 2019;13:07.
  • 13 Synnot A, Karlsson A, Brichko L, Chee M, Fitzgerald M, Misra MC, et al. Prehospital notification for major trauma patients requiring emergency hospital transport: A systematic review. J Evid Based Med 2017;10:212-21.
  • 14 Liu JX, Goryakin Y, Maeda A, Bruckner T, Scheffler R. Erratum to: Global Health Workforce Labor Market Projections for 2030. Hum Resour Health 2017;15:18.
  • 15 Rao KD, Shahrawat R, Bhatnagar A. Composition and distribution of the health workforce in India: Estimates based on data from the National Sample Survey. WHO South East Asia J Public Health 2016;5:133-40.
  • 16 Tiwari R, Negandhi H, Zodpey SP. Health Management Workforce for India in 2030. Front Public Health 2018;6:227.
  • 17 Rønning P, Helseth E, Skaga NO, Stavem K, Langmoen IA. The effect of ICP monitoring in severe traumatic brain injury: A propensity score-weighted and adjusted regression approach. J Neurosurg 2018;131:1896-904.
  • 18 Garg S. Universal health coverage in India: Newer innovations and the role of public health. Indian J Public Health 2018;62:167-70.
  • 19 Raykar NP, Yorlets RR, Liu C, Greenberg SL, Kotagal M, Goldman R, et al. A qualitative study exploring contextual challenges to surgical care provision in 21 LMICs. Lancet 2015;385 Suppl 2:S15.
  • 20 Gerdin M, Roy N, Khajanchi M, Kumar V, Felländer-Tsai L, Petzold M, et al. Validation of a novel prediction model for early mortality in adult trauma patients in three public university hospitals in urban India. BMC Emerg Med 2016;16:15.
  • 21 Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Surgery 2015;158:3-6.
  • 22 Raykar N, Mukhopadhyay S, Saluja S, Amte S, David S, Gnanaraj J, et al. Implementation of The Lancet Commission on Global Surgery in India. Healthc (Amst) 2019;7:4-6.