Head injury is one of the commonest and probably the most preventable medical conditions. Road traffic accident is the commonest cause of head injury globally, besides accident at home, workplace and during sports event. This neglected global epidemic has been the concern of the World Health Organization and was highlighted in 1961 World Health Day with a theme of “Accident and Their Prevention”. Accident was among the leading cause of death at that time and a new “epidemic” of public health importance. It is sad to know that after a lapse of 55 years, accident is still the most unsolved epidemic.
According to World Health Organization Road Safety 2015 Report, the global rate of road traffic deaths was 17.4 per 100,000 populations, while the Malaysian estimate rate was 24 per 100,000 populations. This rate is considerably high for our country despite having well equipped with efficient emergency access and care for road traffic victims. These include single universal access telephone number, efficient ambulance services, and availability of trained doctors and paramedics in emergency medicine.
In Malaysia Health Information Management System (HIMS) 2014 Report, trauma contributed to 11.65% from a total of attendances to emergency department at Ministry of Health (MoH) hospitals. Injury was the second highest principle cause of new attendances at specialist clinic visits and third highest principle reason for emergency department visits at MoH hospitals.
Head injury is the commonest admission diagnosis to neurosurgical ward in all MoH hospitals. In 2014, 80.3% of emergency neurosurgeries involved head injuries and 8.7% deaths from a total of admissions to neurosurgical wards were due to head injuries.
Mortality and morbidity due to head injury can be reduced by minimising the degree of secondary brain injury. Effective pre-hospital care and transportation of patient are two important factors in determining the best outcomes in patients with head injury upon arrivals at the emergency department. Improvements in the emergency health care services are also essential. The knowledge and training in the management of acute trauma cases among all healthcare providers are vital.
The introduction of evidence-based guidelines in the early management of head injury in adults is timely. Systematic referral system which includes utilisation of teleconsultation and protocols for safe transfer of patients outlined in the guidelines are important to optimise the limited number of hospitals with neurosurgical subspecialty services. This will help to establish the missing links in our efforts to provide a safe and effective early management of head injury. The utilisation of the CPG by all healthcare providers may also help to reduce current clinical practice variations and to provide optimum care for all patients with head injury.
The MOH aims to provide neurosurgery subspecialty managing complicated head injury in Hospital Kuala Lumpur and all 13 states hospitals. This was outlined in the specialty and subspecialty framework in 10th Malaysia Plan (2010 – 2015) Report.
The CPG on Early Management of Head Injury in Adults covers various aspects of early management of head injury such as initial assessment, triaging, imaging, general management, use of certain medications such as anticoagulant or antiplatelet, discharge advice and follow-up. There are many algorithms and appendices to provide better understanding of the management of head injury.
The MOH is always supportive of any effort aimed at improving delivery of healthcare services. This includes the various implementation strategies of the CPG which helps to equip healthcare providers with relevant knowledge and skills when managing patients with head injury. In relation to that, training of core trainers nationwide based on the CPG training module will be conducted soon after this launching.
DATUK DR. NOOR HISHAM ABDULLAH
Director-General of Health Malaysia
18th July 2016