Healthcare pathway after sever traumatic brain injury: About a Tunisian population.

OBJECTIVE: The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population.

MATERIAL/PATIENTS AND METHODS: Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospital, assessments of the injury types, duration of coma, length of hospitalization in the Intensive Care Unit (ICU) and finally the discharge mode after the ICU stay (transfer to neurosurgery ward, to rehabilitation unit, or home discharged).

RESULTS: This study highlights the following results: - the predominance of young patients (76.9% under 35 years old); - the male dominance was clear (80%); - road traffic accidents are the main etiology of STBI with a frequency of 61.5% and the transport to the hospital was provided by emergency medical service in only 8 cases; - the predominance of STBI in the months of May and September; - the traumatic brain injury types are dominated by cerebral contusions (42.3%) and intracerebral hemorrhage (46.2%); - two patients remained in a vegetative state and 3 in pauci-relational condition. After an average ICU hospitalization of 10.5±12days [1-45], no patient was admitted into a rehabilitation unit, only 7 patients were addressed to physical medicine and rehabilitation consultation and 18 patients were transferred to neurosurgery.

DISCUSSION-CONCLUSION: The management of patients with STBI is complex to organize and must be performed by multidisciplinary teams. We should note the acute shortage in physical medicine and functional rehabilitation and waking units in the hospital structures of our healthcare system. So in order to create a better management strategy, the first aspect to be taken into consideration, is to develop the bonds between the medical structures and professionals dealing with head injuries in our hospitals and possibly the creation of mobile consultation units made of volunteers in PMR, reanimation, neurosurgery, psychiatry, psychology, physical therapy, nursing and social assistance.