Traumatic brain injury triage in India: A simple, low-cost intervention for emergency head injury care

Background: The Revised Trauma Score (RTS), a composite of the Glasgow Coma Scale (GCS), systolic blood pressure and respiratory rate, is a validated triage tool that does not require sophisticated equipment or extensive training of emergency response personnel for its administration. Although traumatic brain injuries (TBIs) comprise a massive burden particularly in the developing world, they have received inadequate attention in the context of global health. Low-cost measures such as the widespread deployment of RTS-based triage have the potential to significantly impact TBI care in resource-limited settings marked by a scarcity of Computed Tomography (CT) scan machines. Methods: Patients presenting to the Emergency Room (ER) of a government-run tertiary hospital in Hubli, India during June 2010 were surveyed. GCS, SBP and RR were prospectively collected to compute the RTS. Primary outcome measures were CT scan severity of TBI (assigned retrospectively by an experienced neurosurgeon using the Marshall classification) and death in the ER. All variables were treated as categorical and analyzed by the Chi-square test. Results: 54 patients (mean age 36 +/- 16 years; 43 male; 70% road traffic accident, 24% falls) included. RTS severity was positively correlated with CT severity (p=0.009) and death in the ER (p<0.0001). Patients requiring “immediate triage” on the RTS were more likely to have used alcohol (12/24 vs 8/30, p=0.07). Conclusions: The RTS represents a convenient and inexpensive intervention that can potentially be adopted by emergency medical programs in India to enhance head injury care.