Epidemiology and Pattern of Traumatic Brain Injuries at Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal

Background

Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence.

Methods

We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September 2019.

Results

One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15–25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%).

Conclusions

TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI.

Introduction

Traumatic brain injury (TBI) is an acquired form of brain injury and is defined as “an alteration of brain function or other evidence of pathology, caused by an external force.”¹ TBI constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally.² When compared with the general population, TBIs are associated with increased mortality and decreased life expectancy.^3,4

It is estimated that more than 69 million people each year have a TBI, and approximately half the world’s population are likely to have 1 or more TBIs over the course of their lifetime.⁵ The World Health Organization estimates that 90% of the deaths due to TBI occur in low-to middle-income countries (LMIC), which is where 85% of the population live.⁶ Globally, the incidence of TBI in LMICs is increasing sharply.⁷ Despite this, there remains a lack of research into its epidemiology. This is particularly true for Nepal, where studies on TBI are scarce.

In Nepal, TBI represents one of the leading causes of death and disability, where it is estimated the incidence is 382 per 100,000, compared with a global average of 369 per 100,000.⁸ However, its incidence is likely an underestimate due to lack of motorable roads, difficult geographic location, and unavailability of nearby trained personnel, meaning many patients fail to present to a hospital.

The majority of our knowledge on the epidemiology of TBI in Nepal comes from descriptive case series or cross-sectional single-center studies. Among these injuries, RTAs and falls represent the leading cause of TBI. In recent years there has been a gradual increase in RTA-related TBI due to the surge in motorization and urbanization in the country.⁹ According to a hospital-based study, among the 1056 patients admitted over a 1-year period with a history of TBI in eastern Nepal, 76% were due to RTA.¹⁰

In recent years, the government has addressed road safety in an attempt to reduce the burden of RTAs. They have focused on improving the road infrastructure, implementing stricter traffic rules and regulations, and introducing laws enforcing the use of helmets and prohibiting drunk driving. Although these measures have reduced the number and impact of RTAs, there are at present, a lack of policies and appropriate interventions to specifically curtail and prevent TBI.

Given the lack of data in the literature and the growing incidence of TBI, this study aims to analyze the epidemiology of TBI by examining a prospectively populated database of all patients presenting to 1 of the main neurosurgical hospitals in Kathmandu, Annapurna Neurological Institute & Allied Sciences (ANIAS). The results from this study will also help in guiding the implementation of appropriate interventions and in developing policy to reduce the incidence of TBI in Nepal.