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Challenges in TBI management : a prospective study in a public sector hospital of a developing country
EANS Academy. Khanzada M. 09/25/19; 275503; EP05036
Muhammad Khalid Khanzada
Muhammad Khalid Khanzada

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Abstract
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Objective: to identify and highlight the challenges faced in traumatic brain injury management in a developing country
Methods: It is a prospective observational study conducted in Department of Neurosurgery, Lady Reading Hospital, Peshawar, from February 2018 to October 18.the study includes 288 TBI patients, admitted to neurosurgery ward.All expired patients were excluded. The patients were assessed through structured proforma, all data was analysed via spss version 20
Results: Only 28% TBI patients (n=84) were brought directly to hospital whereas 72 % patients (n=216) were referred.64% patients (n= 192) were received from other districts. 72 patients underwent surgery while 216 were treated conservatively.
Large number of patients referred from other districts had CT performed (n=105/216) but there was no health facility to manage and so they were refered. Mean no of CTs performed in our hospital was 1.5 per patient.
70 % patients were brought to our hospital within 3 hours of onset of injury while 22 % reached hospital from 3 to 6 hours .Out of the surgical group it was noted half patients under went surgery within 3 hours of admission.16 % (n=46) patients were discharged after 1 day hospital stay while 51% (n=147) patients stayed in hospital for 2 or 3 days.Only 17 % (n=51) patients were shifted to ICU, Ventilator support was only given to 7% (n=22) patients. Steroids were given in 39 % patients,9 redo surgeries were performed in same hospital setting
Conclusions: This observational study, provides a snap shot of the difficulties and challenges faced in the management of TBI patients in the region.neurosurgery centers in center/tertiary care hospital are overburdened with patients who can be managed conservatively in local setups at periphery .Greater turn over of patients due to large referrals inturn affects patient management by reducing hospital stay and provision of hospital facilities.
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