Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource Poor Setting

Abstract

BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The incidence of TBI in low- and middle-income countries (LMICs) is disproportionately high, with an associated increased risk of mortality from TBI relative to high-income countries. Although computed tomography is the diagnostic method of choice, this is often unavailable in LMICs. Exploratory burr holes may provide a suitable choice for diagnosis and treatment of TBI. METHODS We performed a retrospective review of prospectively collected data at KCH, a tertiary care center in Lilongwe, Malawi. All trauma patients presenting between June 2012 and July 2015 with a deteriorating level of consciousness and localizing signs and who underwent exploratory burr holes were included. Additionally, we included all patients admitted with TBI, requiring higher-level care during 2011. No patients underwent exploratory burr hole during this time. We performed logistic regression to identify predictors of mortality in the total population of TBI patients. RESULTS Among the 241 patients who presented to KCH with TBI requiring higher-level care, the total mortality was 16.4%. More than half (163, or 68%) underwent exploratory burr hole with a mortality of 6.8%. Mortality in patients who did not undergo exploratory burr hole was 43.9%. Upon adjusted logistic regression, not undergoing exploratory burr hole significantly increased the odds of mortality (odds ratio = 12.0, P = 0.000, 95% confidence interval = 4.48–31.9). CONCLUSION Exploratory burr holes remain an important diagnostic and therapeutic procedure for TBI in LMICs. Exploratory burr hole technique should be integrated into general surgery education to attenuate TBI-related mortality.

Challenges and opportunities for effective data collection in global neurosurgery: traumatic brain injury surveillance experience in Malawi

“…4 For example, we published a retrospective study, using data made available by a local neurosurgeon, to evaluate the effectiveness of exploratory burr holes in the reduction of mortality in patients with severe traumatic brain injury and localizing signs when CT scanners were unavailable. 3,7 These data were accessible because the local neurosurgeon kept separate records of her own, making the data more complete than normal Malawian hospital records. However, as we highlighted in the publication, the discordant nature of the UNC trauma database used to gather a control group of patients with severe TBI allowed for an imperfect comparison, at best, which may have affected our analysis.…”

An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis

“…As of 2010, there were only 12 papers examining TBI management in non-high-income settings, only 1 of which was from a low-income country. 2,21 Despite a recent increase in published data on TBI management and outcomes in LMICs, 9,10,13,22,27 there are no previous studies applying survival analyses to inpatient TBI outcomes data.…”

maxSIMhealth: An Interconnected Collective of Manufacturing, Design, and Simulation Labs to Advance Medical Simulation Training

“…When a patient suffers a traumatic head injury (THI), such as an expanding epidural hematoma (EDH), or subdural hematoma (SDH), usually, a neurosurgeon will take an urgent operative intervention to relieve pressure on the brain and control hemorrhaging [ 56 , 74 ]. When this happens in rural and remote areas where neurosurgeons may not be readily available, surgical intervention by community general surgeons (CGS) may be required to prevent progressive neurological impairment or possible death of the patient [ 34 , 78 , 87 ]. Even with the remote assistance by a skilled neurosurgeon through video call, the stress of an emergency and a CGS’s rare hands-on experience may increase the risk of surgical complications [ 56 ].…”