Developing an Adjunct to an Electronic Medical Records System in a Developing Country: Establishing the First Electronic Traumatic Brain Injury Database in Yangon, Myanmar

Abstract

Abstract INTRODUCTION Traumatic brain injury (TBI) is a frequent cause of admission and fatality in Myanmar, secondary to a high number of road traffic accidents. In a country of over 50 million, trauma centers serve less than 4% of the population. North Okkalappa General Hospital (NOGH) is 1 of 3 trauma centers in Yangon providing significant care for patients with TBI. In this pilot study, we collected prospective data encompassing patient demographics, nature of injury, intervention, and outcome at a tertiary trauma center (NOGH). METHODS Neurosurgery residents utilized an iPad-driven database management online software (Redcap) to document TBI admissions, treatment, and outcomes prospectively between November 2018 and April 2019. The data was monitored and analyzed weekly by the supervising physicians at the Henry Ford Hospital in Detroit, Michigan. RESULTS There were 242 TBI admissions (mean Glasgow Coma Scale (GCS) 12.97) during the study's timeline. Etiologies consisted of motorcycle accidents (n = 130), falls (n = 45), assaults (n = 39), pedestrian–motor vehicle accidents (n = 21), industrial accidents (n = 7), and other (n = 7). A total of 50 patients presenting with GCS < 8 were admitted directly or transferred to NOGH leading to a mortality rate of 68% during hospitalization. Neurosurgery was performed in 33 patients (14%) with a 24% postoperative mortality rate. CONCLUSION Poor outcomes after severe TBI in Myanmar are multifactorial including a lack of access-to-care, suboptimal patient management (eg, pre-hospital, in-hospital and postoperative) and limited resources (eg, ventilators, arterial lines, etc.). Additionally, critical care expertise is limited. Overall, in this study we were able to establish a robust database in a research and electronic medical records-naïve location, serving to study and characterize TBI patients. Improved TBI care at local and national levels requires public education, efficient transport systems, geographically strategic trauma centers and improved in-hospital patient care. Government funding and international neurosurgery support is essential.