Management and outcome of traumatic brain injury patients at Muhimbili Orthopaedic Institute Dar es Salaam, Tanzania

Boniface, Respicious; Lugazia, Edwin Rwebugisa; Ntungi, Abel Mussa; Kiloloma, Othman

doi:10.11604/pamj.2017.26.140.10345

Cited by 31 publications

(41 citation statements)

References 19 publications

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“…In comparable studies originating from high-income countries the use of CT scan amounts to 87% of all trauma cases [ 37 ]. A previous study in Tanzania showed high user fee-cost and the low knowledge of traumatic-brain-injury protocols among the providers limited a wider utilization of CT scan, which may contribute to the low usage rates [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

Mwandri

Hardcastle

Sawe

et al. 2020

African Journal of Emergency Medicine

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Background Appropriate referrals of injured patients could improve clinical outcomes and management of healthcare resources. To gain insights for system development, we interrogated the current situation by assessing burden, patient demography, causes of injury, trauma mortality and the care-process. Methods We used an observational, cross-sectional study design and convenience sampling to review patient charts from 3 major hospitals and the death registry in Tanzania. Results Injury constitutes 9–13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however, the trauma death registry figures exceeded the ‘inpatient deaths’ and recorded up to 16%. Most patients arrive through a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the trauma admissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%) were the leading causes of injury. The care process revealed a normal primary-survey rate of 73–90%. Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and disability (80%). Most patients had non-operative management (42–57%) or surgery for wound care or skeletal injuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were each performed in 10%. Conclusion The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded in the death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process, funding and recording. We found a functional hospital referral-network, transport system, and death registry.

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Section: Discussionmentioning

confidence: 99%

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

Mwandri

Hardcastle

Sawe

et al. 2020

African Journal of Emergency Medicine

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“…In Kigali, TBIs were most commonly caused by RTIs, which is similar to prior studies from neighboring countries. 6,20 Other Sub-Saharan African countries, however, have reported lower rates of head injuries associated with RTIs. 5 A possible cause for the high incidence reported in the study is the rapid urbanization of Kigali, which is bringing more vehicles onto the road.…”

Section: Discussionmentioning

confidence: 99%

“…5 Road traffic crashes were the leading cause of TBI in Tanzania (59%). 6 In Kigali, the capital city of Rwanda, TBIs are responsible for approximately 16% of injuries presenting to the University Teaching Hospital of Kigali (CHUK), with severe TBI patients having a mortality rate as high as 58%. 7,8 This made head injury the most common diagnosis in injury-related deaths in 2012.…”

Section: Introductionmentioning

confidence: 99%

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Rosenberg

Mukeshimana

Uwamahoro

et al. 2020

Prehosp. Disaster med.

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Introduction: Traumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d’Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda. Hypothesis/Problem: What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda? Methods: A retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data. Results: Patients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU. Conclusion: Currently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.

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“…One study at a large tertiary hospital in Malawi found 18% of admitted trauma patients had a TBI with a 30% mortality rate for all TBI [ 9 ]. A retrospective analysis at a tertiary hospital in Tanzania reported 56% of TBIs were due to road traffic incidents with 17.8% of TBI patients classified as severe and a 30.7% mortality rate [ 10 ]. A retrospective review of over ten-thousand injured patients presenting to tertiary hospitals in Western Cape, South Africa identified TBI in 24% of injured patients; 27% of these TBIs were moderate to severe and required admission [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Surgery was indicated for 15% of patients who had a CT scan and medical treatment was changed in an additional 18% [ 12 ]. The majority of TBI patients are young males (average age range 28.8-38.8 years), with the majority of TBI originating from road traffic incidents, interpersonal violence, and falls [ 1 , 4 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Emergency department management of traumatic brain injuries: A resource tiered review

Dixon

Comstock

Whitfield

et al. 2020

African Journal of Emergency Medicine

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Introduction Traumatic brain injury is a leading cause of death and disability globally with an estimated African incidence of approximately 8 million cases annually. A person suffering from a TBI is often aged 20–30, contributing to sustained disability and large negative economic impacts of TBI. Effective emergency care has the potential to decrease morbidity from this multisystem trauma. Objectives Identify and summarize key recommendations for emergency care of patients with traumatic brain injuries using a resource tiered framework. Methods A literature review was conducted on clinical care of brain-injured patients in resource-limited settings, with a focus on the first 48 h of injury. Using the AfJEM resource tiered review and PRISMA guidelines, articles were identified and used to describe best practice care and management of the brain-injured patient in resource-limited settings. Key recommendations Optimal management of the brain-injured patient begins with early and appropriate triage. A complete history and physical can identify high-risk patients who present with mild or moderate TBI. Clinical decision rules can aid in the identification of low-risk patients who require no neuroimaging or only a brief period of observation. The management of the severely brain-injured patient requires a systematic approach focused on the avoidance of secondary injury, including hypotension, hypoxia, and hypoglycaemia. Most interventions to prevent secondary injury can be implemented at all facility levels. Urgent neuroimaging is recommended for patients with severe TBI followed by consultation with a neurosurgeon and transfer to an intensive care unit. The high incidence and poor outcomes of traumatic brain injury in Africa make this subject an important focus for future research and intervention to further guide optimal clinical care.

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Management and outcome of traumatic brain injury patients at Muhimbili Orthopaedic Institute Dar es Salaam, Tanzania

Cited by 31 publications

References 19 publications

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Emergency department management of traumatic brain injuries: A resource tiered review

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