Burden, Predictors and Short-Term Outcomes of Traumatic Brain Injury Among Patients Admitted to Ugandan Intensive Care Units
American Journal of Clinical and Experimental Medicine
Volume 8, Issue 4, July 2020, Pages: 77-83
Received: Jun. 15, 2020;
Accepted: Aug. 3, 2020;
Published: Aug. 13, 2020
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Agnes Wabule, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Kavuma Arthur Mwanje, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Daniel Obua, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Janat Tumukunde, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Jane Nakibuuka, Directorate of Medical Services, Mulago National Referral Hospital, Kampala, Uganda
Samuel Kizito, Department of Clinical Epidemiology & Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda
Peter Kaahwa Agaba, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Mary Theresa Nabukenya, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Emmanuel Timarwa Ayebale, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Arthur Kwizera, Department of Anaesthesia & Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
Severe Traumatic brain injury (STBI) is a leading cause of morbidity and mortality among young individuals worldwide with worse outcomes being registered in low-income countries. Brain trauma foundation recommends the management of patients with TBI in the intensive care unit (ICU) to prevent secondary brain injury for improved outcome. However, Uganda being a low-income country, still grapples with the availability of ICU resources and space. Information regarding burden, predictors and short-term outcomes of ICU patients with TBI in Uganda has never been reconnoitered. A multicenter prospective observational cohort was conducted between 2013 to 2015 at four Ugandan ICUs. During the study period, we consecutively enrolled 387 critically ill, adult patients with TBI to determine the burden, predictors and short term outcomes in these patients. Baseline demographics, clinical and treatment parameters were recorded and followed till discharge from ICU or death. Of 387 patients enrolled in the study, 277 (71.6%) had moderate TBI, while 113 (29.2%) patients had STBI. The highest burden of TBI was recorded among patients assaulted through mob violence, recorded at 17/21 (81.0%), as shown in table 5. The overall mortality was at 34.4% (95/277) among patients with moderate or severe TBI, and 46.9% (53/113) among patients with STBI alone. Mortality was relatively higher among patients brought by the police, and those brought in at night. Multivariate analysis showed patient intubation, lack of antibiotic use, failure to transfuse, tracheostomy tube not inserted, and being involved in RTA or sustaining a fall were significantly associated with mortality among patients with TBI. We found a high burden of TBI and mortality among ICU patients. Despite limited resources in the local setting, inexpensive and locally available measures can reduce on the length of patient’s stay in the ICU and eventually decrease on the mortality. Improvement in prehospital as well as early trauma and airway care, antibiotic use, blood transfusion plus public health safety measures may reduce on the burden of TBI as well as improve outcomes.
Kavuma Arthur Mwanje,
Peter Kaahwa Agaba,
Mary Theresa Nabukenya,
Emmanuel Timarwa Ayebale,
Burden, Predictors and Short-Term Outcomes of Traumatic Brain Injury Among Patients Admitted to Ugandan Intensive Care Units, American Journal of Clinical and Experimental Medicine.
Vol. 8, No. 4,
2020, pp. 77-83.
Wouter Peeters, R. v. d. B., Suzanne Polinder, Alexandra Brazinova, and H. F. L. A. I. R. M. Ewout W. Steyerberg, Epidemiology of traumatic brain injury in Europe. Acta Neurochir, 2015. 157.
J. K. C Emejulu, C. M. I., C. E. Agbasoga, C. N. Ogbuagu, Traumatic brain injury in accident and emergency department of a tertiary hospital in Nigeria. East and central african journal of surgery, 2010. 15 (2).
Tran, T. M., et al., Distribution and Characteristics of Severe Traumatic Brain Injury at Mulago National Referral Hospital in Uganda. World Neurosurgery, 2015. 83 (3).
Bob Roozenbeek, A. I. R. M. a. D. K. M., Changing patterns in the epidemiology of traumatic brain injury. Nature reviews: Neurology, 2013. 9.
WHO | Injuries and violence: the facts [Internet]. [cited 2020 Aug 1]. Available from: https://www.who.int/violence_injury_prevention/key_facts/en/.
Hsia, R. Y., et al., Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy. international Journal of emergency medicine, 2010. 3: p. 8.
Marek Majdan, D. P., Alexandra Brazinova, Martin Rusnak, Daan Nieboer, Valery Feigin, Andrew Maas, Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health 2016; 1: e76–83, 2016. 1.
Farid Sadaka, T. M. Q., Rekha Lakshmanan and Ashok Palagiri, Management of Traumatic Brain Injury in the Intensive Care Unit, in Traumatic brain injury, F. Sadaka, Editor. 2014, intechopen. p. 592.
Iftikhar Ali Raja, A. H. V., Mubasher Ahmed, Neurotrauma in Pakistan. world journal of surgery, 2001. 25: p. 8.
Min Li, Z. Z., Gongjie Yu and Jianning Zhang, Epidemiology of Traumatic Brain Injury over the World: A Systematic Review. General Medicine: Open Access, 2016. 4 (5).
O. E. Idowu, a. O. A., Neurotrauma burden in a tropical urban conurbation level I trauma centre. Injury, 2014. 45.
E. A. Opondo and N. J. M. Mwangombe, Outcome of severe traumatic brain injury at a critical care unit: a review of 87 patients. The Annals of African Surgery, 2007. 1: p. 7.
Alexis F. Turgeon MD MSc, F. L. M. M., Jean-François Simard BSc, Damon C. Scales MD PhD, et al., Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. Journal of canadian medical association, 2011. 183 (14).
Helmy, A., M. Vizcaychipi, and A. K. Gupta, Traumatic brain injury: intensive care management. British Journal of anaesthesia, 2007. 99 (1): p. 11.
Kristin Elf; Pelle Nilsson; Per Enblad, Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Critical Care medicine, 2002. 30 (9).
Patel, H. C., et al., Specialist neurocritical care and outcome from head injury. Intensive Care Medicine 2002. 28.
Kesinger, M. R., et al., A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury, 2014. 45 (9): p. 1350-1354.
Atumanya P, Sendagire C, Wabule A, Mukisa J, Ssemogerere L, Kwizera A, et al. Assessment of the current capacity of intensive care units in Uganda; A descriptive study. J Crit Care. 2020 Feb; 55: 95–9.
R. J. Kruisselbrink, L. S., A. Kwizera, J. V. B Tindimwebwa, Mortality Rate And Associated Factors Among Intensive Care Unit Patients At Mulago Hospital, Uganda: A Prospective Cohort Study. American journal of respiratory and critical care medicine, 2014. 189.
Abdelgadir, J., et al., Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital. World Neurosurgery.
KU Tobi, A. A., SO Agbedia, Outcome of traumatic brain injury in the intensive care unit: a five-year review. Southern African Journal of Anaesthesia and Analgesia, 2016. 22 (5).
Staton, C. A., et al., A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward. Int J Inj Contr Saf Promot, 2015. 24 (1): p. 69-77.
Feigin, V. L., et al., Incidence of traumatic brain injury in New Zealand: a population-based study. The Lancet Neurology, 2012. 12 (1): p. 53-64.
Girling, K., Management of head injury in the intensive-care unit. Continuing Education in Anaesthesia, Critical Care & Pain 2004. 4 (2).
Scott. A. Marshall, G. S. F. L., Critical care managenent of traumatic brain injury, in Comprehensive critical care: Adult, R. R. T. Pamela R Roberts, Editor. 2012, Society of critical care medicine: united states of America.
Griesdale, D. E., et al., Glucose control and mortality in patients with severe traumatic brain injury. Neurocrit Care, 2009. 11 (3): p. 311-6.
Arabi, S. H. H. a. Y. M., Critical care management of severe traumatic brain injury in adults. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2012. 20 (12): p. 15.
Rostami, E., Glucose and the Injured Brain-Monitored in the Neurointensive Care Unit. Frontiers in Neurology, 2014. 5 (91).
Legrand, M. and D. Payen, Understanding urine output in critically ill patients. Annals of Intensive Care, 2011. 1: p. 13-13.
Mehmood A, Zia N, Hoe C, Kobusingye O, Ssenyojo H, Hyder AA. Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes. BMC Res Notes [Internet]. 2018 May 15 [cited 2020 Jul 17]; 11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5952367/.
Agrawal D, Raghavendran K, Schaubel DE, Mishra MC, Rajajee V. A Propensity Score Analysis of the Impact of Invasive Intracranial Pressure Monitoring on Outcomes after Severe Traumatic Brain Injury. J Neurotrauma. 2016 01; 33 (9): 853–8.
Rahmanian A, Haghnegahdar A, Rahmanian A, Ghaffarpasand F. Effects of Intracranial Pressure Monitoring on Outcome of Patients with Severe Traumatic Brain Injury; Results of a Historical Cohort Study. Bull Emerg Trauma [Internet]. 2014 Oct [cited 2020 Jul 17]; 2 (4): 151–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771290/.
Farahvar A, Gerber LM, Chiu Y-L, Carney N, Härtl R, Ghajar J. Increased mortality in patients with severe traumatic brain injury treated without intracranial pressure monitoring. J Neurosurg. 2012 Oct; 117 (4): 729–34.
Holland MC, Mackersie RC, Morabito D, Campbell AR, Kivett VA, Patel R, et al. The development of acute lung injury is associated with worse neurologic outcome in patients with severe traumatic brain injury. J Trauma. 2003 Jul; 55 (1): 106–11.