Mechanism of Pediatric Traumatic Brain Injury in Southwestern Uganda: A Prospective Cohort of 100 Patients

Punchak, Maria; Abdelgadir, Jihad; Obiga, Oscar; Itait, Martha; Najjuma, Josephine Nambi; Haglund, Michael M.; Kitya, David

doi:10.1016/j.wneu.2018.02.191

Cited by 14 publications

(16 citation statements)

References 19 publications

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“…Concerning mechanisms of injury, unintentional pedestrian RTA and falls were the most common causes followed by intentional fights/violence injuries. is is in line with most of the studies done in developing countries [2,8,18,22,30,34,[37][38][39].…”

Section: Discussionsupporting

confidence: 89%

“…Globally, TBI is projected to be the third leading cause of death and injury by the World Health Organization in 2020 [2,5,6]. Pediatric TBI is reported to be the most common cause of injury-related death, and it commonly follows road traffic accidents and falls [7,8]. TBI accounted for 8.3% of the pediatric emergency department (ED) visits with mild severity according to the Western studies [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study

Bedry

Tadele

2020

Emergency Medicine International

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Background. Traumatic brain injury (TBI) is the most common cause of death/disability in children. The Glasgow coma scale and other parameters are used for treatment/follow-up of TBI. Childhood TBI data are scarce from sub-Saharan Africa. The study aimed to determine the pattern and predictors of the TBI outcome in Southern Ethiopia. Methods. An observational cross-sectional study was conducted from September 2017 to September 2018 at Hawassa University Hospital. Structured questionnaires were used for data collection. Significant associations were declared at a P value of <0.05. Results. There were 4,258 emergency room (ER) visits during the study period, and TBI contributed to 317 (7.4%) cases. The mean age of study subjects was 7.66 ± 3.88 years. Boys, predominantly above 5 years of age, comprise 218 (68.8%) of the study subjects with a male to female ratio of 2.2 : 1. Pedestrian road traffic accidents (RTA), 120 (37.9%), and falls, 104 (32.8%), were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231 (72.9%), 61 (19.2%), and 25 (7.9%) of cases, respectively. Most of the TBI cases presented within 24 hrs of injury, 258 (81.4%). Recovery with no neurologic deficit, 267 (84.2%); focal neurologic deficit, 30 (9.5%); depressed mentation, 10 (3.2%); and death, 10 (3.2%), were documented. Signs of increased intracranial pressure (ICP) at admission [AOR: 1.415 (95% CI: 1.4058–9.557)], severe TBI [AOR: 2.553 (95% CI: 1.965–4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 1.873–7.874)], and presence of contusion, diffuse axonal injury (DAI), or intracranial bleeding on the head computed tomography (CT) scan [AOR: 2.45 (95% CI: 1.811–7.952)] predicted poor TBI outcome. Conclusion. TBI contributed to 7.4% of pediatric ER visits. Pedestrian RTA and falls, early presentation (<24 hours of injury), and mild form of TBI among boys were the most common documented patterns. ICP, hyperglycemia, severe TBI, and presence of contusion, DAI, or intracranial bleeding on head CT predicted poor outcome. Strategies to ensure road safety and to prevent falls and animal-related injuries and TBI follow-up for ICP and glycemic controls are recommended.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study

Bedry

Tadele

2020

Emergency Medicine International

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“…18,29 Our finding may be attributable to a younger average age of the general population in Uganda as well as a higher incidence of trauma, which tends to affect younger patients. 1,10,16,34 Additionally, within this Ugandan cohort, we found an overall preponderance of males, with a ratio of 2.5:1, which is slightly higher than the 1.7:1 ratio noted in a study based in the US. 29 Furthermore, among those who had trauma in our study, the ratio of males to females was 6.7:1, even higher than the male to female ratios reported for CSDH patients in Nigeria.…”

Section: Discussioncontrasting

confidence: 63%

Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital

Kitya

Punchak

Abdelgadir³

et al. 2018

Neurosurgical Focus

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OBJECTIVECauses, clinical presentation, management, and outcomes of chronic subdural hematoma (CSDH) in low- and middle-income countries are not well characterized in the literature. Knowledge regarding these factors would be beneficial in the development and implementation of effective preventive and management measures for affected patients. The authors conducted a study to gain a better understanding of these factors in a low-income setting.METHODSThis prospective study was performed at Mbarara Regional Referral Hospital (MRRH) in Uganda between January 2014 and June 2017. Patients of any age who presented and were diagnosed with CSDH during the aforementioned time period were included in the study. Variables were collected from patients’ files at discharge and follow-up clinic visits. The primary outcome of interest was death. Secondary outcomes of interest included discharge Glasgow Coma Scale (GCS) score, ICU admission, wound infection, and CSDH recurrence.RESULTSTwo hundred five patients, the majority of whom were male (147 [72.8%]), were enrolled in the study. The mean patient age was 60.2 years (SD 17.7). Most CSDHs occurred as a result of motor vehicle collisions (MVCs) and falls, 35.6% (73/205) and 24.9% (51/205), respectively. The sex ratio and mean age varied depending on the mechanism of injury. Headache was the most common presenting symptom (89.6%, 173/193), whereas seizures were uncommon (11.5%, 23/200). Presenting symptoms differed by age. A total of 202 patients underwent surgical intervention with burr holes and drainage, and 22.8% (46) were admitted to the ICU. Two patients suffered a recurrence, 5 developed a postoperative wound infection, and 18 died. Admission GCS score was a significant predictor of the discharge GCS score (p = 0.004), ICU admission (p < 0.001), and death (p < 0.001).CONCLUSIONSTrauma from an MVC is the commonest cause of CSDH among the young. For the elderly, falling is common, but the majority have CSDH with no known cause. Although the clinical presentation is broad, there are several pronounced differences based on age. Burr hole surgery plus drainage is a safe and reliable intervention. A low preoperative GCS score is a risk factor for ICU admission and death.

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“…Concerning mechanism of injury, unintentional pedestrian RTA and falls were the commonest causes followed by intentional fighting/violence injuries. This is in line with most of the studies done in developing countries [2,8,18,22,30,34,[37][38][39].…”

Section: Discussionsupporting

confidence: 90%

“…Globally TBI is projected to be the third leading cause of death and injury by world health organization in 2020 [2,5,6]. Pediatric TBI is reported to be the common cause of injury related death, and it commonly follows road traffic accidents and falls [7,8]. Western studies documented TBI contributing for 8.3% of pediatric emergency department(ED) visits, and commonly with mild severity [9,10].…”

Section: Introductionmentioning

confidence: 99%

Pattern and Outcome of Pediatric Traumatic Brain Injury: A Prospective Cohort Study at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

Bedry

Tadele

2019

Preprint

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Background Traumatic brain injury (TBI), a major public health problem, is the most common cause of death/disability in children. Glasgow coma scale is used to assess, decide treatment and follow up of TBI. TBI causes and outcome data are scarce from sub-Saharan Africa, non-existent from Ethiopia. We aimed to document pattern and predictors of childhood TBI outcome in a teaching hospital, Southern Ethiopia. METHODS Prospective cohort study was conducted from September 2017 to September 2018 among pediatrics TBI presented to Hawassa University Hospital. Data were collected by structured questionnaires and analyzed using SPSS version 20. Logistic regression was carried out and significant associations were declared at p-value of < 0.05. RESULT During 1year period there were 4258 emergency room(ER) visits, TBI contributed to 317(7.4%) cases. The mean age of study subjects was 7.66±3.88 years. Boys, predominantly above 5years of age, comprise 218(68.8%) of study subjects with male to female ratio of 2.2:1. Pedestrian RTA 119 (37.5%) and falls 104 (32.8%) were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231(72.9%), 61(19.2%), and 25(7.9%) of cases respectively. Most of TBI cases presented within 24hrs of injury 258(81.4%). Recovery with no neurologic deficit, 267(84.2%); focal neurologic deficit, 30(9.5%); depressed mentation, 10(3.2%) and death 10(3.2%) were documented. Presence of increased intracranial pressure(ICP) at admission [AOR: 1.415 (95% CI: 0.458-9.557)], severe TBI [AOR: 2.103 (95% CI: 0.965-4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 0.873-7.874)] and head computed tomographic(CT) scans of contusion, diffuse axonal injury (DAI) or intracranial bleeding [AOR: 2.45 (95% CI: 0.811-7.952)] were found to be predictors of TBI outcome. CONCLUSION TBI contributed to 7.4% of pediatric ER visits. Boys above 5years of age were highly affected. Pedestrian RTA and falls, early presentation (<24hrs of injury) and mild form of TBI were the common documented patterns. Presence of increased ICP, hyperglycemia, severe TBI and CT findings of contusion, DAI/intracranial bleeding were predictors of poor outcome. Public awareness on road safety, childhood safety in preventing falls/animal injuries, closer follow-up of TBI cases for ICP and glycemic controls are recommended.

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Mechanism of Pediatric Traumatic Brain Injury in Southwestern Uganda: A Prospective Cohort of 100 Patients

Cited by 14 publications

References 19 publications

Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study

Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study

Causes, clinical presentation, management, and outcomes of chronic subdural hematoma at Mbarara Regional Referral Hospital

Pattern and Outcome of Pediatric Traumatic Brain Injury: A Prospective Cohort Study at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia

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