Jessica Eaton1, Asma Bilal Hanif2, Joanna Grudziak3, Anthony Charles4. 1. UNC - Project Malawi, Lilongwe, Malawi. 2. Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi. 3. Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA. 4. UNC - Project Malawi, Lilongwe, Malawi; Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: anthchar@med.unc.edu.
Abstract
BACKGROUND: Trauma accounts for 4.7 million deaths each year, with an estimated 90% of these occurring in low- and middle-income countries (LMICs). Approximately half of trauma-related deaths are caused by central nervous system injury. Because a thorough understanding of traumatic brain injury (TBI) in LMICs is essential to mitigate TBI-related mortality, we established a clinical and radiographic database to characterize TBI in our low-income setting. METHODS: This is a review of prospectively collected data from Kamuzu Central Hospital, a tertiary care center in the capital of Malawi. All patients admitted from October 2016 through May 2017 with a history of head trauma, altered consciousness, and/or radiographic evidence TBI were included. We performed descriptive statistics, a Cox regression analysis, and a survival analysis. RESULTS: There were 280 patients who met inclusion criteria; of these, 80.5% were men. The mean age was 28.8 ± 16.3 years. Median Glasgow Coma Scale (GCS) score was 12 (interquartile range, 8-15). Road traffic crashes constituted the most common injury mechanism (60.7%). There were 148 (52.3%) patients who received a computed tomography scan, with the most common findings being contusions (26.1%). Of the patients, 88 (33.0%) had severe TBI, defined as a GCS score ≤8, of whom 27.6% were intubated and 10.3% received tracheostomies. Overall mortality was 30.9%. Of patients who survived, 80.1% made a good recovery. Female sex was protective, and the only significant predictor of poor functional outcome was presence of severe TBI (hazard ratio, 2.98; 95% confidence interval, 1.79-4.95). CONCLUSIONS: TBI represents a significant part of the global neurosurgical burden of disease. Implementation of proven in-hospital interventions for these patients is critical to attenuate TBI-related morbidity and mortality.
BACKGROUND:Trauma accounts for 4.7 million deaths each year, with an estimated 90% of these occurring in low- and middle-income countries (LMICs). Approximately half of trauma-related deaths are caused by central nervous system injury. Because a thorough understanding of traumatic brain injury (TBI) in LMICs is essential to mitigate TBI-related mortality, we established a clinical and radiographic database to characterize TBI in our low-income setting. METHODS: This is a review of prospectively collected data from Kamuzu Central Hospital, a tertiary care center in the capital of Malawi. All patients admitted from October 2016 through May 2017 with a history of head trauma, altered consciousness, and/or radiographic evidence TBI were included. We performed descriptive statistics, a Cox regression analysis, and a survival analysis. RESULTS: There were 280 patients who met inclusion criteria; of these, 80.5% were men. The mean age was 28.8 ± 16.3 years. Median Glasgow Coma Scale (GCS) score was 12 (interquartile range, 8-15). Road traffic crashes constituted the most common injury mechanism (60.7%). There were 148 (52.3%) patients who received a computed tomography scan, with the most common findings being contusions (26.1%). Of the patients, 88 (33.0%) had severe TBI, defined as a GCS score ≤8, of whom 27.6% were intubated and 10.3% received tracheostomies. Overall mortality was 30.9%. Of patients who survived, 80.1% made a good recovery. Female sex was protective, and the only significant predictor of poor functional outcome was presence of severe TBI (hazard ratio, 2.98; 95% confidence interval, 1.79-4.95). CONCLUSIONS: TBI represents a significant part of the global neurosurgical burden of disease. Implementation of proven in-hospital interventions for these patients is critical to attenuate TBI-related morbidity and mortality.
Authors: Morgan L Prust; Amir Mbonde; Clio Rubinos; Gentle S Shrestha; Morenikeji Komolafe; Deanna Saylor; Halinder S Mangat Journal: Neurocrit Care Date: 2022-07-16 Impact factor: 3.532
Authors: Robert Manning Smith; Valentina Cambiano; Tim Colbourn; Joseph H Collins; Matthew Graham; Britta Jewell; Ines Li Lin; Tara D Mangal; Gerald Manthalu; Joseph Mfutso-Bengo; Emmanuel Mnjowe; Sakshi Mohan; Wingston Ng'ambi; Andrew N Phillips; Paul Revill; Bingling She; Mads Sundet; Asif Tamuri; Pakwanja D Twea; Timothy B Hallet Journal: Inj Epidemiol Date: 2022-07-12
Authors: Julia Dixon; Grant Comstock; Jennifer Whitfield; David Richards; Taylor W Burkholder; Noel Leifer; Nee-Kofi Mould-Millman; Emilie J Calvello Hynes Journal: Afr J Emerg Med Date: 2020-06-16
Authors: Cyrus Elahi; Thiago Augusto Hernandes Rocha; Núbia Cristina da Silva; Francis M Sakita; Ansbert Sweetbert Ndebea; Anthony Fuller; Michael M Haglund; Blandina T Mmbaga; João Ricardo Nickenig Vissoci; Catherine A Staton Journal: Neurosurg Focus Date: 2019-11-01 Impact factor: 4.047
Authors: Anelia A Y Kassi; Anil K Mahavadi; Angelica Clavijo; Daniela Caliz; Stephanie W Lee; Aminul I Ahmed; Shoji Yokobori; Zhen Hu; Markus S Spurlock; Joseph M Wasserman; Karla N Rivera; Samuel Nodal; Henry R Powell; Long Di; Rolando Torres; Lai Yee Leung; Andres Mariano Rubiano; Ross M Bullock; Shyam Gajavelli Journal: Front Neurol Date: 2019-01-17 Impact factor: 4.086