An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam).

BACKGROUND: Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status. METHODS: Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method. RESULTS: Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets. CONCLUSIONS: RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden

Outcome in TBI Patients with Early Physiotherapy and Post-discharge Rehabilitation: Indian Experience

AbstractTraumatic brain injury (TBI) is a major cause of death and disability worldwide and early initiation of physiotherapy with continuing rehabilitation may improve outcomes. Materials/Methods All adult TBI patients with GCS 5–12 admitted from May 2018 to December 2019 were included. Early physiotherapy was initiated before the fifth day of admission and continued post discharge. Patients and families were educated in a rehabilitation program with printed handouts and video clips. All patients are followed up via telephone/video calls after discharge. We assessed the Glasgow Outcome Score (GOS) and disability at 15, 30, and 90 days post discharge, and 180 days follow-up was also suggested but only a few (38) patients reported. Data were compared with matched patients treated in previous years. Results A total of 1,233 patients were studied. At 3-month follow-up by telephonic and video calls, GOS 5 was noted (63.7%; 174/ 273) in 2019 compared with (41.3%; 41/ 98) in 2018. The number of discharges increased after initiation of physiotherapy and rehabilitation programs (38%; 288/759 in 2019 versus 24%; 115/474 in 2018). Post-discharge deaths were also less (5.9%; 17/288) in 2019 compared with (14.8%; 17/115) in 2018. Conclusion Early rehabilitation and post-discharge therapy are associated with improved outcomes of TBI patients. Refinements in data collection and communication improve patient follow-up and functional outcomes.</jats:p

Practical Challenges in the Management and Outcome of Unknown Patients with Head Injury

Abstract Background: Majority of road accidents are treated at nearby private hospitals. Head injury patients whose identity is not established are invariably being treated at government hospitals. The factors influencing the management and outcome of such unknown patients are possible only in government hospitals. Limited studies are available related to these unknown patients. Objective: This study attempted to analyze the management issues in such patients and tried to find solutions that will improve the outcome. Methods: It was an observational study over 2 years. All patients whose identity could not be established at admission were studied. Standard traumatic brain injury protocols were followed. Issues and challenges in managing these patients were noted. Many challenges popped up once patient was shifted out of intensive care unit and were studied. Results: Eighty-five patients were studied with male preponderance. Common age group was 41 to 60 years. The main cause of head injury was road traffic accident. Seventy-six patients were severely injured. Acute subdural hematomas was the most common computed tomography finding (36 patients). Sixty-nine patients were managed conservatively and 16 needed surgery. Forty-nine patients died in hospital, and other patients recovered well. Twenty-two patients were discharged home and 11 took discharge against medical advice after being identified by relatives. None were accommodated into destitute homes even after recovery. Conclusion: Unknown patients usually have poor outcome with more deaths in spite of standard care. Their management is fraught with challenges. They need special care for which staff should be motivated; hospital must have good network to establish identity.</jats:p

An Exploratory Qualitative Study of the Prevention of Road Traffic Collisions and Neurotrauma in India: Perspectives From Key Informants in an Indian Industrial City (Visakhapatnam)

Abstract Background: Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status.Methods: Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method.Results: Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the victim, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets.Conclusions: RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden.</jats:p

An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam)

Abstract Background Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status. Methods Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method. Results Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets. Conclusions RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden. </jats:sec