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Longitudinal Observational Analysis of Traumatic Brain Injury Epidemiology and Pre-Hospital Intervals During the COVID-19 Pandemic in a West Java Tertiary Center Ni Wayan Lisa Suasti; Akhmad Imron; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1517

Background: The COVID-19 pandemic necessitated large-scale social restrictions (PSBB) in Indonesia, drastically altering population mobility and, consequently, the landscape of neurotrauma. While the reduction in road traffic Incidents (RTIs) during lockdowns is well-documented, the collateral impact on the golden hour—the critical pre-hospital interval for traumatic brain injury (TBI) resuscitation—remains under-researched in lower-middle income countries (LMICs). This study analyzes the longitudinal shifts in TBI epidemiology, injury mechanisms, and hospital admission intervals across pre-pandemic, pandemic, and relaxation phases. Methods: This retrospective observational study analyzed 1,519 TBI patients admitted to the Emergency Department of Dr. Hasan Sadikin General Hospital (RSHS), a tertiary referral center in West Java, from January 2019 to December 2021. The cohort was stratified into three phases: Pre-Pandemic (2019), Pandemic/PSBB (2020), and Relaxation (2021). Variables included demographics, injury mechanisms, Glasgow Coma Scale (GCS), loss of consciousness (LOC), and Hospital Admission Interval (MRS). Results: Total TBI admissions exhibited a sharp V-shaped trend, decreasing by 75% in 2020 compared to 2019, driven by a collapse in RTI volume (490 to 107 cases). Admissions rebounded in 2021 (n=705). Males (78.4%) and young adults (15-24 years) constituted the majority, with RTI accounting for 74.78% of all mechanisms. While pediatric (0-4 years) and geriatric (≥65 years) groups were prone to falls, the most critical finding concerned pre-hospital delays. Despite reduced traffic density, only 3.23% of patients arrived within the golden hour (<1 hour). The majority (40.42%) arrived between 5-12 hours, and a significant cohort (17.44%) experienced delays exceeding 12 hours, indicating persistent systemic barriers to rapid care regardless of road conditions. Conclusion: The pandemic successfully suppressed TBI volume through mobility restrictions but failed to improve pre-hospital admission times. The persistence of significant delays (>5 hours) for the vast majority of patients highlights that the barriers to the golden hour in Indonesia are structural rather than traffic-dependent. Future trauma systems must address these pre-hospital inefficiencies to improve outcomes.

Metabolic and Inflammatory Signatures of Neurotrauma: Correlating Early Glycemic and Leukocytic Shifts with Glasgow Coma Scale Scores Ni Wayan Lisa Suasti; Roland Sidabutar; Agung Budi Sutiono; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1519

Background: Traumatic brain injury (TBI) precipitates a profound systemic physiological stress response, often termed the sympathetic storm, characterized by neuroendocrine dysregulation and widespread inflammation. While admission biomarkers such as White Blood Cell (WBC) count and Blood Glucose levels are routinely measured, their comparative utility in stratifying injury severity—particularly in distinguishing between moderate and severe phenotypes—remains under-characterized. This study aimed to evaluate the discriminatory power of these markers, hypothesizing that metabolic and immune responses exhibit distinct saturation kinetics relative to the Glasgow Coma Scale (GCS). Methods: We conducted a retrospective analytical observational study at Dr. Hasan Sadikin General Hospital (RSHS), a level I trauma center in Bandung, Indonesia. From an annual pool of admitted neurotrauma patients (January–December 2021), a stratified sample of 238 patients aged 18-60 years was analyzed. Strict exclusion criteria were applied to minimize confounders, including a history of metabolic disease and alcohol intoxication. TBI severity was stratified into mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8). Statistical analysis utilized the Kruskal-Wallis and Mann-Whitney tests to assess non-parametric relationships. Results: The cohort was predominantly male (82.8%) and young (18-40 years, 68.9%). Both biomarkers correlated with overall severity; however, their trajectories diverged significantly. WBC counts exhibited a threshold effect, rising significantly from Mild (17.50 ± 6.56 x10³/µL) to Moderate (18.81 ± 5.27 x10³/µL) severity, but plateauing between moderate and severe groups (p>0.05), suggesting a saturation of the demargination response. Conversely, blood glucose displayed a graded linear escalation: Mild (133.11 ± 34.53 mg/dL), moderate (158.35 ± 49.59 mg/dL), and severe (226.14 ± 105.61 mg/dL) (p<0.001), with significant discrimination across all severity pairings. Conclusion: Admission hyperglycemia serves as a superior, graded biomarker for stratifying TBI severity compared to leukocytosis, which functions primarily as a binary threshold marker. The observed immune plateau contrasts with the linear metabolic scaling, highlighting stress-induced hyperglycemia as a critical indicator of severe neuro-metabolic derangement.

Longitudinal Observational Analysis of Traumatic Brain Injury Epidemiology and Pre-Hospital Intervals During the COVID-19 Pandemic in a West Java Tertiary Center Ni Wayan Lisa Suasti; Akhmad Imron; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1517

Background: The COVID-19 pandemic necessitated large-scale social restrictions (PSBB) in Indonesia, drastically altering population mobility and, consequently, the landscape of neurotrauma. While the reduction in road traffic Incidents (RTIs) during lockdowns is well-documented, the collateral impact on the golden hour—the critical pre-hospital interval for traumatic brain injury (TBI) resuscitation—remains under-researched in lower-middle income countries (LMICs). This study analyzes the longitudinal shifts in TBI epidemiology, injury mechanisms, and hospital admission intervals across pre-pandemic, pandemic, and relaxation phases. Methods: This retrospective observational study analyzed 1,519 TBI patients admitted to the Emergency Department of Dr. Hasan Sadikin General Hospital (RSHS), a tertiary referral center in West Java, from January 2019 to December 2021. The cohort was stratified into three phases: Pre-Pandemic (2019), Pandemic/PSBB (2020), and Relaxation (2021). Variables included demographics, injury mechanisms, Glasgow Coma Scale (GCS), loss of consciousness (LOC), and Hospital Admission Interval (MRS). Results: Total TBI admissions exhibited a sharp V-shaped trend, decreasing by 75% in 2020 compared to 2019, driven by a collapse in RTI volume (490 to 107 cases). Admissions rebounded in 2021 (n=705). Males (78.4%) and young adults (15-24 years) constituted the majority, with RTI accounting for 74.78% of all mechanisms. While pediatric (0-4 years) and geriatric (≥65 years) groups were prone to falls, the most critical finding concerned pre-hospital delays. Despite reduced traffic density, only 3.23% of patients arrived within the golden hour (<1 hour). The majority (40.42%) arrived between 5-12 hours, and a significant cohort (17.44%) experienced delays exceeding 12 hours, indicating persistent systemic barriers to rapid care regardless of road conditions. Conclusion: The pandemic successfully suppressed TBI volume through mobility restrictions but failed to improve pre-hospital admission times. The persistence of significant delays (>5 hours) for the vast majority of patients highlights that the barriers to the golden hour in Indonesia are structural rather than traffic-dependent. Future trauma systems must address these pre-hospital inefficiencies to improve outcomes.

Metabolic and Inflammatory Signatures of Neurotrauma: Correlating Early Glycemic and Leukocytic Shifts with Glasgow Coma Scale Scores Ni Wayan Lisa Suasti; Roland Sidabutar; Agung Budi Sutiono; Guata Naibaho
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1519

Background: Traumatic brain injury (TBI) precipitates a profound systemic physiological stress response, often termed the sympathetic storm, characterized by neuroendocrine dysregulation and widespread inflammation. While admission biomarkers such as White Blood Cell (WBC) count and Blood Glucose levels are routinely measured, their comparative utility in stratifying injury severity—particularly in distinguishing between moderate and severe phenotypes—remains under-characterized. This study aimed to evaluate the discriminatory power of these markers, hypothesizing that metabolic and immune responses exhibit distinct saturation kinetics relative to the Glasgow Coma Scale (GCS). Methods: We conducted a retrospective analytical observational study at Dr. Hasan Sadikin General Hospital (RSHS), a level I trauma center in Bandung, Indonesia. From an annual pool of admitted neurotrauma patients (January–December 2021), a stratified sample of 238 patients aged 18-60 years was analyzed. Strict exclusion criteria were applied to minimize confounders, including a history of metabolic disease and alcohol intoxication. TBI severity was stratified into mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS 3-8). Statistical analysis utilized the Kruskal-Wallis and Mann-Whitney tests to assess non-parametric relationships. Results: The cohort was predominantly male (82.8%) and young (18-40 years, 68.9%). Both biomarkers correlated with overall severity; however, their trajectories diverged significantly. WBC counts exhibited a threshold effect, rising significantly from Mild (17.50 ± 6.56 x10³/µL) to Moderate (18.81 ± 5.27 x10³/µL) severity, but plateauing between moderate and severe groups (p>0.05), suggesting a saturation of the demargination response. Conversely, blood glucose displayed a graded linear escalation: Mild (133.11 ± 34.53 mg/dL), moderate (158.35 ± 49.59 mg/dL), and severe (226.14 ± 105.61 mg/dL) (p<0.001), with significant discrimination across all severity pairings. Conclusion: Admission hyperglycemia serves as a superior, graded biomarker for stratifying TBI severity compared to leukocytosis, which functions primarily as a binary threshold marker. The observed immune plateau contrasts with the linear metabolic scaling, highlighting stress-induced hyperglycemia as a critical indicator of severe neuro-metabolic derangement.

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