Incidence of hospital-admitted severe traumatic brain injury and in-hospital fatality rates in a Pacific Island country: A 5-year retrospective study

Background: Epidemiology of severe traumatic brain injury (TBI) is poorly defined in the Pacific region, including in New Caledonia. The aim of this study was to assess the incidence, causes and outcome of hospital-admitted severe TBI in the whole population of New Caledonia. Methods: A retrospective study on patients with severe TBI admitted to the only trauma centre during the 5-year period (2008-2012) was performed. The electronic patient register was searched for diagnoses of intracranial injuries to identify patients. Severe TBI was defined as a Glasgow Coma Scale Score <= 8 during the first 24 hours after injury. Results: The annual incidence ranged from 10/100 000 in 2010 to 15/100 000 in 2011. Road traffic accidents (n=109; 71%), falls (n=26; 17%) and assaults (n=19; 12%) were causes of severe TBI. Young Melanesian adults (median age 26 [19-36]) were the most affected. In ICU, the overall case-fatality rate was 25%. The mortality rate was the highest among victims of assaults (47%). Conclusions: The high incidence of hospital-admitted patients with severe TBI in this study combined with high in-ICU mortality rates supports the need for targeted public health action to prevent assaults and traffic road accidents in this vulnerable population.