The case for hospital preparedness for traumatic brain injury in India: A timely call for systemic reform

Traumatic brain injury (TBI) is one of the most serious yet non-priority public health issues in India.^[1,2] Road traffic accidents contribute to nearly 60% of TBIs, and an estimate says more than 1.6 million hospitalizations every year, which would mean that the healthcare system of India needs to be prepared to respond seriously and with persistence. The research by Adusumilli et al., published in the Journal of Neurosciences in Rural Practice, is a timely and worthy effort in this direction.^[3]

This cross-sectional evaluation of the Karnataka secondary and tertiary centers in the Kolar district recommends a new criterion-based scoring system along the lines of national guidelines published by the Neurotrauma Society of India. The results are both interesting and disturbing: A staggering 81% of the hospitals under analysis were deemed to have only Level 4 readiness, which is adequate only to manage minor head injuries. Not one hospital achieved Level 1, the best readiness level to manage extreme TBI cases. Such results point toward a glaring deficit of emergency neurotrauma treatment, especially in the rural and semiurban areas.

Most importantly, this research does more than merely identify gaps; it offers a reproducible, context-specific measuring instrument for national hospital surveys. This allows for scalable benchmarking of facility preparedness and can guide strategic investment in infrastructure, human resources, training, and policy change.

Three conclusions of far-reaching significance follow from this research:

• Harmonization is imperative: The lack of harmonized systems for managing TBI perpetuates inequality and inefficiency. The scoring system proposed in this work needs to be perfected and instituted at the state and national levels to enable systematic tracking and accountability.

• Infrastructure needs to be decentralized: Dependence on a few urban areas with appropriate equipment results in delay of treatment, especially fatal in neurotrauma. The creation of district-level intensive care units (ICUs), emergency rooms (ERs), and imaging units is non-negotiable.

• Capacity-building is the answer: Human capital, such as neurosurgeons, emergency medicine doctors, and ICU nurses, needs to be upgraded, particularly in peripheral and private hospitals, which constitute the majority of India’s healthcare chain.

The Adusumilli et al. paper offers a crucial planning evidence base.^[3] It is an appeal to recall that optimization of trauma care is not technology’s or tertiary care’s but equitable readiness in every district. As universal health coverage arrives in India, making every hospital TBI-capable is not a distinction – it is a public health obligation.