Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry

Abstract

BackgroundTraumatic brain injury (TBI) is an important cause of morbidity and mortality in low/middle-income countries. The objective was to assess causes and outcomes of unintentional and intentional TBI among patients presenting to a tertiary care hospital in Uganda.MethodsThis study was conducted at Mulago National Referral Hospital, Kampala, Uganda, for 15 months in 2016–2017. Patients of all ages, males and females, presenting to the emergency department with suspected or documented TBI were enrolled. Patient demographics, TBI causes and outcomes were recorded. The outcome of interest was unintentional and intentional TBI.ResultsIntent was known for 3749 patients, of these 69.7% were unintentional TBI and 30.3% were intentional TBI. The average age of patients in both groups was similar (28±14 years) with over 70% of patients between 19 and 45 years age group. About 80% were males in both groups. The main causes of unintentional TBI were road traffic injuries (RTI) (88.9%) and falls (11.1%). Pedestrians (42.1%) and motorcycle drivers (28.1%) were the most common road users. Among patients with unintentional TBI, about 43.6% were admitted, 34.0% were sent home. There were 73 deaths: 63 were patients with RTI and 10 had a fall. Although assault (97.1%) was the main cause of intentional TBI, those patients with self-harm were likely to be in severe Glasgow Coma Scale range (39.4%) compared with victims of assault (14.2%). Among patients with intentional TBI, 42.6% were admitted and 37.1% were sent home. There were 30 deaths: 29 were assault victims and 1 of self-harm.DiscussionUnintentional TBI caused by RTI and intentional TBI caused by assault are common among young males attending Mulago Hospital in Kampala.Level of evidenceProspective observational study, level III.

Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

“…Another study by Tran et al (2015) found that males aged 15–29 years comprised the predominant demographic with a male:female ratio of 4.5:1. Similarly, Zia et al (2019) studied 3,749 TBI patients, with over 70% of patients between 19–45 years age group and 80% were males. This could be linked to males being more active within occupational sectors characterized by high risk.…”

“…Over 90% of TBI related deaths disproportionately occur in low- and middle-income countries such as those in the African region ( Johnson & Griswold, 2017 ). In Uganda, such deaths from TBI mainly result from fatal road traffic crashes ( Zia et al, 2019 ) and delayed presentation to health facilities ( Vaca et al, 2019 ). Described as a silent epidemic, the World Health Organization (WHO) projected that by 2020, road traffic injuries (RTI) will be a major cause of TBI and will rank 3rd as a leading cause of disability adjusted life years lost ( World Health Organization, 2015 ).…”

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

“…In high-income countries (HICs), these strategies have been implemented in various forms which range from adapting the environment, legislation, safety education and skills training, to strengthening post-trauma response systems and improving access to acute and postacute care [14,[18][19][20][21]. However, LMICs often lag far behind in this area despite the higher toll of neurotrauma in these societies [4,6,22]. It is also clear that not all HIC approaches may be applicable to the LMIC context due to differences in environment, resources, population, culture and infrastructure [23,24].…”

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: A scoping review

“…In high income countries (HICs), these strategies have been implemented in various forms which range from adapting the environment, legislation, safety education and skills training, to strengthening post-trauma response systems and improving access to acute and post-acute care [14,[18][19][20][21]. However, LMICs often lag far behind in this area despite the higher toll of neurotrauma in these societies [4,6,22]. It is also clear that not all HIC approaches may be applicable to the LMIC context due to differences in environment, resources, population, culture and infrastructure [23,24].…”