Injury patterns in patients with severe traumatic brain injuries from motor crashes admitted to Mulago Hospital Accidents & Emergency Unit

Abstract

Introduction: The global burden of Road Traffic Crashes (RTC) has been seen to be on the increase. Uganda has one of the highest rates of RTCs in the Sub-Saharan region. Victims of RTCs sustain varying degrees of injuries depending on factors including the velocity at the time of impact, presence of protective gear like helmets and jackets, and if it was a motorcycle–motorcycle or motorcycle–vehicle crash. High speed collisions have been shown to result in severe forms of injuries and, in many cases, polytrauma. Research has been done on isolated injuries particularly head injuries, chest injuries and limb injuries by specialists in the various areas of neurosurgery, cardiothoracic surgery, general surgery, and orthopaedics. Some injuries are undetected in the context of obvious other injuries. Limited studies have been done to document the patterns of other injuries associated with patients who sustain severe head injuries. This study aimed to describe the patterns of multiple injuries and the correlation of these other injuries with severe head injuries resulting from RTCs in Uganda. Methods: This was cross sectional study design that described the injury patterns and assessed the relationship of polytrauma in patients with severe head injury to the mechanism of injury (RTCs involving motorcycles and vehicles).The study population was all adult patients (≥18 years) with severe head injury sustained from motor road traffic crashes admitted at Mulago Hospital Accidents & Emergency unit during the study period. Data were extracted from patient charts using a validated data abstraction tool and complete head to toe physical examination was carried out and injuries recorded. Data were analysed to determine the relationship of polytrauma in patients with severe head injury to the mechanism of injury. Results: The participants were predominantly males, and the overall study population median age was 32 (25-39). The commonest modes of transportation of patients to the hospital were Police Pickup trucks (40%) and ambulance (36.1%). Among motorcycle RTCs, (19.2%) wore helmets; 21.2% had protective gear; with injury identified mainly in; the limbs (84.8%), neck (76.8%), chest (39.4%), and abdomen (26.3%). Patients from vehicle RTCs were 19% more likely to have polytrauma when compared to patients from motorcycle RTCs Conclusion: This study showed that patients who sustain severe traumatic brain injuries from vehicle crashes have an increased likelihood of having multiple injuries, compared to patients from motorcycle RTCs. For motorcycle users, injuries most commonly affect the limbs. At particular risk are motorcyclists who do not wear helmets and protective coveralls.