Tran TM, Fuller AT, Kiryabwire J, Mukasa J, Muhumuza M, Ssenyojo H, Haglund MM. World Neurosurg. 2014; 83(3): 269-277.
Affiliation
Duke University Global Health Institute, Durham, NC, USA; Division of Neurosurgery, Department of Surgery, Duke University, Durham, NC, USA. Electronic address: Michael.haglund@dm.duke.edu.
OBJECTIVE: Road traffic accidents is a leading cause of injury in low- and middle-income countries where mortality rates are much higher in general. Severe traumatic brain injury (TBI) patients tend to have very poor outcomes. In order to reduce burden from severe TBI, we describe distribution of TBI at Mulago Hospital (Kampala, Uganda) and identify association between outcomes and patient characteristics, offering insights into prevention and future research efforts to improve clinical care.
METHODS: This is a single institution retrospective chart review including patients of all ages with a Glasgow Coma Scale (GCS) score of 8 or less (measured upon admission). A database was compiled maximizing all available clinical variables. Descriptive statistics and univariable and multivariable regression models were fitted to identify significant associations with outcome (died or discharged).
RESULTS: One hundred twenty patients were identified between 1 July 2008 and 30 June 2009. The cumulative incidence of admissions is 89 per 100,000. Thirty one patients died in hospital yielding a 25.8% mortality rate. Motorcycle road traffic accident was the leading mechanism of injury and males ages 15-29 were the predominant demographic (42.5% of patients). Initial GCS, change in GCS score during hospital stay, and presence of hematoma were strongest predictors of outcome.
CONCLUSIONS: Severe TBI was a common condition for injury-related hospital admissions at Mulago Hospital.. Neurosurgery capacity may have explained the relatively lower mortality rate than previously reported from Sub-Saharan Africa. Further investigations are needed. Targeted prevention programs focused on motorcycle users and helmet law enforcement should decrease the incidence of severe TBI.