Early management of traumatic brain injury in a Tertiary hospital in Central Kenya: A clinical audit

Abstract

Background:Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is mostly attributed to road traffic accidents in resource-poor areas. However, access to neurosurgical care is poor in these settings and patients in need of neurosurgical procedures are often managed by general practitioners or surgeons.Materials and Methods:A retrospective clinical audit of the initial management of patients with TBI in Thika Level 5 Hospital (TL5H), a Tertiary Hospital in Central Kenya. Seventeen audit criteria divided into five clinical domains were identified and patient case notes reviewed for compliance with each criterion. Data were analyzed separately for those below 13 years owing to differences in response to brain trauma in those below this age.Results:Overall, there was poor compliance with audit criteria in both groups. Among those below 13 years of age, only 3 out of 17 criteria achieved compliance and 4 out of 17 criteria achieved compliance for those above 13 years of age. Assessment for the need for a cervical radiograph (7.1% and 8.8% compliance) and administration of oxygen (21.4% and 20.6% compliance) had the worst performance in both groups.Conclusion:Poor compliance to audit criteria indicates the low quality of care for patients with TBI in TL5H. Quality improvement strategies with follow-up audits are needed to improve care. There is a need to develop and enforce evidence-based protocols and guidelines for use in the management of patients with TBI in sub-Saharan Africa.

A prospective neurosurgical registry evaluating the clinical care of traumatic brain injury patients presenting to Mulago National Referral Hospital in Uganda

“…With respect to diagnostic capacity, patients at MNRH are faced with challenges in access and cost similar to patients in other LMIC settings. [ 23 ] To obtain a head CT scan—necessary for surgical decision making—caregivers typically arrange their own transportation to nearby private Nakasero Hospital, the only facility within close proximity to MNRH with a functional CT scanner, and pay for the scan and films out of pocket. The financial burden of a CT scan, which can range from $70 to $132[ 24 ], can be almost equal to the average monthly income in Uganda.…”

Epidemiology, Management, and Functional Outcomes of Traumatic Brain Injury in Sub-Saharan Africa

“…24 Studies have shown that the use of management protocols for patients with severe TBI are associated with reductions in death up to 6 months after hospital discharge, and overall improved neurologic outcome. 25 Although management protocols would have to be contextualized to the setting, 26 their implementation may make it possible to ensure that all patients receive the highest level of care possible.…”

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review

“…Even when hypoxemia was identified, oxygen was not always provided or used appropriately with only 27%-29% of patients with hypoxemia receiving oxygen in two different studies [ 21 , 40 ]. Similarly, compliance with oxygen therapy in traumatic brain injury patients was found to be “dismal” [ 41 ]. An assessment of first year doctors in Ghana found that 28% prescribed oxygen for mild to moderate asthma and 74% for severe asthma, with many unaware that there was some degree of hypoxemia even with mild asthma [ 39 ].…”