Citation

Smart LR, Mangat HS, Issarow B, McClelland P, Mayaya G, Kanumba E, Gerber LM, Wu X, Peck RN, Ngayomela I, Fakhar M, Stieg PE, Hartl R. World Neurosurg. 2017; 105: 238-248.

Affiliation

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.wneu.2017.05.101

PMID

28559070

Abstract

BACKGROUND: Severe traumatic brain injury (TBI) is a major cause of death and disability worldwide. However, prospective TBI data from sub-Saharan Africa are sparse. This study examines the epidemiology, and explores management of severe TBI patients and adherence to the Brain Trauma Foundation (BTF) Guidelines at a tertiary care referral hospital in Tanzania.

METHODS: Patients with severe TBI hospitalized at Bugando Medical Centre, Mwanza, Tanzania, were recorded in a prospective registry. Epidemiological, clinical, treatment and outcome data were recorded.

RESULTS: Between September 2013 and October 2015, 371 patients with TBI were admitted. 33% (115/371) had severe TBI. Mean age was 32.0±20.1 years, and the majority were male (80.0%). Vehicular injuries were the most common cause of injury (65.2%). Half of the patients (47.8%) were hospitalized on the same day as their injury. Only 49.6% underwent computed tomography (CT) of the brain, and 58.3% were admitted to the intensive care unit (ICU). Continuous arterial blood pressure (cABP) monitoring and intracranial pressure (ICP) monitoring were not performed on any patient. 38.3% of patients with severe TBI received hyperosmolar therapy and 35.7% underwent craniotomy. Two-week mortality was 34.8%.

CONCLUSION: Mortality of patients with severe TBI at Bugando Medical Center, Tanzania, is approximately twice that in high-income countries. ICU care, CT imaging, cABP and ICP monitoring are underutilized or unavailable in the tertiary referral hospital setting. Improving outcomes after severe TBI will require concerted investment in pre-hospital care as well as improvement in availability of ICU resources, CT imaging and expertise in multidisciplinary care.

Copyright © 2017. Published by Elsevier Inc.

Language: en

Keywords

Sub-Saharan Africa; Tanzania; adherence; guidelines; mortality; traumatic brain injury