Jihad Abdelgadir1, Emily R Smith2, Maria Punchak3, Joao Ricardo Vissoci4, Catherine Staton4, Alex Muhindo5, David Kitya6, Lawrence P Park7, Michael M Haglund8. 1. Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA. 2. Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA. Electronic address: emily.smith1@duke.edu. 3. Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; David Geffen School of Medicine at University of California, Los Angeles, California, USA. 4. Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Emergency Medicine, Duke University, Durham, North Carolina, USA. 5. Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda. 6. Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda. 7. Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA. 8. Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University, Durham, North Carolina, USA.
Abstract
BACKGROUND: The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only 2 public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to 1 of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population. METHODS: The study was conducted at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda. Demographics, clinical characteristics, and outcomes were retrospectively collected for all patients who presented to MRRH with a neurosurgical condition between January 2012 and September 2015. RESULTS: During the study period, 1854 patients presented to MRRH with a neurosurgical condition. More than half of the patients were between 19 and 40 years old, and the majority were males (76.1%). The overall median length of stay was 5 days (interquartile range: 2.5-10). The majority of admissions were due to trauma (87%), with almost 60% due to road traffic incidents. The overall mortality rate was 12.8%. A multivariable Cox proportional hazards model revealed that age, closed head injury, and admission Glasgow Coma Scale have a strong positive correlation with mortality while getting a diagnostic image and neurosurgical procedure were negatively correlated with mortality. CONCLUSION: Traumatic brain injury represented the majority of neurosurgical admissions at MRRH, disproportionately affecting young males. Age, closed head injury, admission Glasgow Coma Scale, getting a diagnostic image, and neurosurgical procedure were all independent predictors of mortality. Resource appropriate interventions throughout the health system are needed to meet the demand and improve outcomes.
BACKGROUND: The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only 2 public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to 1 of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population. METHODS: The study was conducted at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda. Demographics, clinical characteristics, and outcomes were retrospectively collected for all patients who presented to MRRH with a neurosurgical condition between January 2012 and September 2015. RESULTS: During the study period, 1854 patients presented to MRRH with a neurosurgical condition. More than half of the patients were between 19 and 40 years old, and the majority were males (76.1%). The overall median length of stay was 5 days (interquartile range: 2.5-10). The majority of admissions were due to trauma (87%), with almost 60% due to road traffic incidents. The overall mortality rate was 12.8%. A multivariable Cox proportional hazards model revealed that age, closed head injury, and admission Glasgow Coma Scale have a strong positive correlation with mortality while getting a diagnostic image and neurosurgical procedure were negatively correlated with mortality. CONCLUSION:Traumatic brain injury represented the majority of neurosurgical admissions at MRRH, disproportionately affecting young males. Age, closed head injury, admission Glasgow Coma Scale, getting a diagnostic image, and neurosurgical procedure were all independent predictors of mortality. Resource appropriate interventions throughout the health system are needed to meet the demand and improve outcomes.
Authors: Tessa L Concepcion; Emily R Smith; Mubarak Mohamed; Shugri Dahir; Edna Adan Ismail; Andrew J M Leather; Dan Poenaru; Henry E Rice Journal: World J Surg Date: 2019-11 Impact factor: 3.352
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Authors: Emily R Smith; Brittney J van de Water; Anna Martin; Sarah Jean Barton; Jasmine Seider; Christopher Fitzgibbon; Mathama Malakha Bility; Nelia Ekeji; Joao Ricardo Nickenig Vissoci; Michael M Haglund; Janet Prvu Bettger Journal: BMC Health Serv Res Date: 2018-09-20 Impact factor: 2.655
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Authors: Alhassan Abdul-Mumin; Theophilus T K Anyomih; Sheila A Owusu; Naomi Wright; Janae Decker; Kelli Niemeier; Gabriel Benavidez; Francis A Abantanga; Emily R Smith; Stephen Tabiri Journal: World J Surg Date: 2020-01 Impact factor: 3.352