Cost of treating head trauma doubles in SUS – 03/31/2023 – Health

At the age of 27, physician Alexandre Fagundes dreams of regaining autonomy. In June 2020, after a serious car accident in Rio Grande do Sul, due to poor road signs, he suffered a severe traumatic brain injury (TBI) and is in his second hospitalization at the Lucy Montoro Rehabilitation Network, in São Paulo.

He uses a wheel chair, has speech and memory difficulties, but sees progress in the rehabilitation process. “I already have more trunk control.” A dream? “Go back to walking, playing tennis and specializing in psychiatry.”

After six years and two months of the serious car accident he suffered in Canoinhas (SC) and a long rehabilitation process, which involved physiotherapy, speech therapy, physical and cognitive activities, electrical engineer Kaio Fuck, 31, says he has had a normal life.

Work, drive, hang out with friends. Of the sequelae left by cranioencephalic trauma, occasional seizures persist, which are controlled with medication. “I was born again on January 28, 2017,” she says. It’s not an exaggeration. In the 15-minute journey to the nearest public hospital, Fuck suffered eight cardiac arrests.

Stabilized, he was transferred to Albert Einstein Hospital (SP), underwent neurosurgery and spent three weeks in the ICU. When he left, he wasn’t walking, he was in diapers and he spoke very few words… in English.

Severe traumatic brain injury (TBI) represents today the main reason for premature death and physical, psychological and social disability of adults in Brazil and has grown among young men.

In the five units of the Lucy Montoro network, linked to the São Paulo government, cases rose by 52% between 2020 and 2022 (from 27 to 41). Men represent 87% of patients, with a higher incidence in the age group between 21 and 30 years (30%).

Although there is much underreporting of these injuries in the country, statistics indicate that there are approximately 131,000 hospitalizations due to TBIs, with young people between 20 and 29 years old accounting, on average, for the largest share of this volume (21%).

An article published in the Revista Brasileira de Terapia Intensiva, based on data from DataSUS, shows that public expenditure on treatments increased from US$ 23.5 million (R$ 123.7 million) in 2008 to US$ 52.8 million ( R$ 278 million) in 2019. The projection for 2020 was an expense of US$ 54.5 million (R$ 287 million).

Of these values, more than 80% are related to hospital costs. The data does not include outpatient, rehabilitation, medication, home treatment, caregivers, transportation and days not worked by the patient or family expenses.

Due to the impacts of these injuries on costs and on people’s lives, experts in the field have argued that it is time for the country to review its public health policies in the prevention, treatment and rehabilitation of these traumas.

According to emergency physician Andrea Pereira Regner, professor at the Federal University of Health Sciences in Porto Alegre (RS), Brazil has experienced a setback in recent years in relation to the prevention of traumatic brain injuries caused by traffic accidents and firearms.

In 2019, President Jair Bolsonaro (PL) tried to eliminate radars on federal highways, but ran into Justice. Even so, inspections by the Federal Highway Police were relaxed and, as a result, the number of fatal accidents on the roads rose again after falling for seven years.

“We know that it has an impact on the increase of traumas when speed control is relaxed, releases ‘sparrow’ [radares]. The second cause of death in trauma is interpersonal violence, and we see an escalation”, she says.

In January 2019, President Jair Bolsonaro (PL) relaxed, through decrees, the rules for access to weapons and ammunition in the country. Civilians are now allowed to buy in quantities and calibers previously not allowed, and Brazil has been breaking records in registrations and importation.

Regner coordinated a recent study in which he followed 437 patients with severe TBI, and one data impressed the team. While in the international literature the proportion is two to three male victims of trauma for each female, in Brazil it was eight males for each female.

“Think of the impact of this in 15 years. We will have difficulty with the male body, which is losing work capacity. Severe TBI is what most leads to the loss of years of life”, he says.

Accidents with motor vehicles lead the statistics of serious TBIs in Brazil and in the rest of the world. Around here, motorcycles are ahead of cars. Data from the National Traffic Secretariat showed that, in 2021 alone, the number of accidents was 632,764, equivalent to 72 records per hour.

The doctor recalls that more than 90% of severe TBI patients will have some degree of disabling sequelae. “In addition to the direct cost of SUS care, we have the cost of the loss of productivity of these people, the need for social support [INSS].”

According to neurosurgeon Feres Chaddad, professor and head of neurosurgery at Unifesp (Federal University of São Paulo) and BP (Beneficência Portuguesa de São Paulo), today there are bottlenecks in the entire line of care for traumatic brain injury, starting with primary care.

“These patients need to go immediately to a hospital that has the resources to treat multiple trauma patients. Samu is a great advance, but many patients are still taken to health centers that do not have the structure to care for them and end up dying.”

He says there are SUS hospitals with neurological ICUs and specialized teams, but many suffer from a lack of materials, such as a catheter to measure intracranial pressure, and the structure for these services.

Overcrowding in these units is frequent, which makes surgeries take a long time to happen, worsening the prognosis. “They are long-stay patients, they end up congesting the emergency room, the wards and the ICUs.”

In the study conducted by physician Andrea Regner, 91% of patients were taken to the hospital by Samu and had access to ICU beds. This integrated care is reflected in the reduction of mortality. While the mortality rate in ICUs due to TBIs in the country reaches 70%, in the evaluated group it was 30%.

Access to rehabilitation is another difficulty. Linamara Rizzo Battistella, professor of physiatry at USP and creator of the Lucy Montoro network, recalls that the sooner the patient is in an adequate rehabilitation program, the better the response and the outcome. “Rehabilitation does not begin when the individual is discharged from the hospital, but when he arrives at the hospital.”

According to her, the ideal would be that, after discharge from a rehabilitation center, this patient would continue to be monitored in primary health care to maintain functional gains. “The maintenance of care in primary care makes the person able to resume a situation of adequate autonomy.”