3D.002\u2005Delays and determinants of traumatic brain injury care outcome in low-income Uganda

Abstract

Background Increasing traumatic brain injury (TBI) has paralleled need for decompression surgery for acute subdural (ASDH) and acute extradural haematoma (AEDH). Knowledge of key determinants of clinical outcomes inclusive of delays is mandatory to guide treatment protocols. Objective To determine the thirty-day clinical outcomes and predictor variables for patients with extra-axial haematoma at Mulago National Referral Hospital in Uganda. Methods Prospective observational cohort study of 109 patients with Computed Tomography (CT) confirmed extra-axial haematoma. Ethical Clearance was obtained from School of Medicine Research and Ethics Committee of Makerere University (REC REF. 2018–185). Admitted patients were followed-up for Glasgow Outcome Scale (GOS) and final disposition. Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence-interval, regarding p Results No participant received surgery within six hours of decision making. The overall proportion of favourable outcome was 71.7% (n=71), with 42.3% (n=11) and 81.7% (n=58) for ASDH and AEDH respectively (p=0.111). Factors associated with a favourable outcome were: Admission Systolic BP>90 mmHg [IRR=0.88 (0.26–0.94) 95%CI, p=0.032), Oxygen saturation>90% [IRR=0.5 (0.26–0.94) 95%CI, p=0.030] and Diagnosis AEDH [IRR=0.53 (0.30–0.92) 95%CI, p= 0.025). Moderate [IRR=4.57 (1.15–18.06) 95%CI, P=0.03] and severe TBI [IRR=6.79 (2.32–19.86) 95%CI, p Conclusion The study revealed that amidst delays, post resuscitation GCS, Systolic BP, Oxygen circulation and diagnosis of AEDH at admission, are the most important determinants of outcome for patients with extra-axial intracranial haematoma. These findings are valuable for triaging teams in resource constrained settings.