Introduction: Traumatic brain injury (TBI) is a major public health problem in both U.S. and India. CHIRAG project examine relationship between adherence to 2007 BTF Guidelines and outcomes in severe TBI patients
Methods: After joint Indo (Ministry of Health) and US (NINDS R21 mechanism) , data collected at HMC in Seattle JPN in New Delhi. Inclusion criteria were: age=18 years, admission (GCS) score <9 and (AIS) =3, intubated (ICU) = 48 hours and no CPR prior to admission. Data on demographic characteristics, pre-hospital and hospital clinical course (adherence to guidelines) and outcomes (discharge mortality/ discharge Glasgow Outcome Scale (GOS)) were abstracted.
Results: 196/400 patients have been enrolled at both sites: Follow up rates among eligible patients at JPN are: discharge (100%; 55/55), 3 month (93%; 51/55) and 6 month (60%; 31/51). Overall adherence rates ranged between 56-63% across both sites. There were differences in adherence frequencies for certain indicators such as avoidance of hypoxia and hypotension, administration of peri-intubation antibiotics, ICP monitoring, use of propofol used to control ICP and use of antiepileptic drugs used to decrease early seizures. Use of advanced neuromonitoring techniques in this cohort was low for both sites. Discharge mortality was comparable across both sites at approximately 30%. At discharge, most patients were alive with minor/moderate impairment group at both sites. More patients at HMC were alive with baseline functioning at 3 months (HMC 67%; 31/46 vs. JPN 27%;13/49) and 6 months (HMC 73%; 29/40
vs. JPN 55%; 16/29).
Conclusions: Joint Indo-US TBI research examining adherence to evidence based guidelines is feasible. Interim results suggest that while the overall adherence rate across both sites ranges between 50 and 60%, there is variation in adherence to select guideline indicators. Discharge mortality is comparable across both HMC and JPN whereas longer term outcomes may differ between sites.
Patient Care: Outcome of this study will define parameters influencing outcome/prognostication in head injured patients across the glob and also indicate the need of adherence to BTF guidelines for improvement in outcome of TBI patients.
Learning Objectives: To define adherence to Brain Trauma foundation guidelines in 2 countries : India and USA . To lay down recommendations based on outcome of this study in two countries.