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Affiliation
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UNC -Project Malawi, Lilongwe, Malawi; Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, NC, USA. Electronic address: anthchar@med.unc.edu. |
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Abstract
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BACKGROUND: Trauma accounts for 4.7 million deaths each year, with an estimated 90% of these occurring in LMICs. Approximately half of trauma-related deaths are due to central nervous system injury.
OBJECTIVE: Because a thorough understanding of 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: 280 patients met inclusion criteria. 80.5% were male, and mean age was 28.8+16.3. Median GCS was 12 (IQR=8-15). Road traffic crashes constituted the most common injury mechanism (60.7%). 148, or 52.3%, of patients received a CT scan, with the most common findings being contusions (26.1%). 88 (33.0%) of patients had severe TBI, defined as a GCS of <8, of whom 27.6% were intubated, while 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 (HR=2.98, 95% CI=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.
Copyright © 2017. Published by Elsevier Inc.
Language: en |