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

Abstract

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.

Systematic media review: A novel method to assess mass-trauma epidemiology in absence of databases—A pilot-study in Rwanda

“…In our findings, car and bus passengers were most affected, and pedestrians and bicyclists were involved in 15.1% and 4.1% of MCIs, respectively, likely reflecting the fact that road-traffic accidents amounting to MCIs will be less likely to involve pedestrians compared to road-traffic accidents in general. This is lower than a study from Kigali where pedestrians were involved in 35% of accidents in 2012–2016 [ 42 ], although differences between Kigali City and national data may be explained by differences in urban-rural environments. The sharp decrease of road traffic accidents may be explained by the national road safety initiative, launched in 2004, where new laws were introduced to penalize excessive speed and drunk driving, and campaigns to raise awareness regarding road safety, and mandating speed governors on all public buses [ 43 ].…”

Trends in Neurotrauma Epidemiology, Management, and Outcomes during the COVID-19 Pandemic in Kigali, Rwanda

“… 6 In Kigali, the capital of Rwanda, CNS trauma is responsible for two-thirds of mortalities responded to by pre-hospital emergency medical services. 7 …”

Developing Sustainable Prehospital Pediatric Care in Rwanda

“…Our collaboration in Rwanda, a country of 12 million people, 42% of whom are younger than the age of 16 years, has focused on trauma and emergency medical service capacity building for many years. [15][16][17][18][19][20][21][22] Pediatric injuries are common in Rwanda, with 20 deaths per 100,000 people. 23 The most common pediatric injuries are falls, road traffic crashes, burns, and assault.…”