Immediate management, outcomes and factors associated with mortality in traumatic brain injury patients in Kampala : A prospective study
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Background: Traumatic Brain Injury (TBI) is a leading cause of mortality and morbidity the world over, affecting mostly young males and with a disproportionately higher mortality in Sub-Saharan Africa and in urban centres. Uganda has limited skilled health care human resource and specialized medical facilities to care for the vast numbers of patients with TBI. With more than 50% of TBI related mortality occurring in the first seven days after injury, we set out to study the immediate management offered to patients with TBI in Mulago National Referral Hospital (MNRH), located in Uganda’s capital city, Kampala, their outcomes and factors associated with mortality in the first seven days of admission to hospital. Materials and methods: Following approval from the institutional ethics boards, we recruited patients, 15 years or older, with a diagnosis of TBI, admitted to Mulago National Referral Hospital. Consenting and assenting patients, 15 years or older and/ or their next of kin were interviewed to obtain information of events surrounding the injury. A waiver of consent was sought for patients who were unconscious and had no next of kin to consent on their behalf. Patients were followed up until death, discharge or up to seven days after admission, whichever occurred first, to determine the type of neuro-care received, outcomes (life or death) and factors associated with mortality. Data was collected using pre-tested questionnaires, entered into Epi-info version 3.5.1 and analysed with STATA version 14.0. Results: 397 patients with TBI analysed; 86.9% were young males, with mean age 31.52SD ± 11.19 years who had been involved in motorcycle crashes (44.5%) or assaulted (32.5%). 39.8% were brought to hospital in a Police pick-up truck and 24.4% by ambulances. 64.1% had mild TBI, only 7.6% were managed surgically. 1.01% were admitted to the Intensive care unit. The overall mortality in the first seven days of admission was 15.4%. Moderate (p<0.001) and severe TBI (p=0.001) were found to increase the risk of death in the first seven days while having one lesion (AHR 0.19, p=0.007) on neuro-imaging tests, primary (AHR0.37, p=0.018) and secondary (AHR 0.31, P=0.018) level of education and having surgery (AHR 0.12, p=0.041) were protective. Conclusions and recommendations: TBI has a high burden among young men despite our limited neurosurgical and ICU capacity. More efforts to train the required human resource, campaigns to increase road safety and safe transportation of the injured, as well as early neurosurgical intervention are still needed to reduce the burden of mortality from road traffic trauma.