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Habte YW, Shao B, Pajer HB, Ma KL, Abicho TB, Feleke Y, Bizuneh YA, Laeke T, Tirsit A, Spader HS. Profile of Patients Receiving Computed Tomography Scans for Mild Traumatic Brain Injury in a Tertiary Care Hospital in Ethiopia. World Neurosurg 2024; 186:e673-e682. [PMID: 38608809 DOI: 10.1016/j.wneu.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a leading contributor to emergency department (ED) mortalities in Ethiopia. Mild TBI patients comprise half of all TBI patients presenting for care in Ethiopia and have a high potential for recovery. As such, context-specific care-improving strategies may be highly impactful for this group of patients. OBJECTIVE This study examines the presentation and disposition of mTBI patients who received a computed tomography scan of the head upon arrival at the largest teaching hospital in Ethiopia. METHODS A retrospective cohort study was conducted from 2018 to2021 including patients >13 years old with a head injury and a Glasgow Coma Score of 13-15 who obtained a computed tomography scan of the head. Variables were collected from medical charts and single and multivariable analyses assessed outcomes of clinically important TBI (ciTBI) requiring a neurosurgical procedure or admission. RESULTS A total of 193 patients were included. They were predominantly young men with no comorbidities, injured in road traffic accidents or by assault, had stable vital signs and were treated in lower-acuity ED areas. A minority demonstrated focal deficits, and 29.5% of patients had ciTBI. Most patients were discharged from the ED, but 13% were taken for operative neurosurgical procedures and 10.4% were admitted to the neurosurgery ward for observation. ED stays ranged from 8 hours to 10 days, as patients waited for CT availability, neurosurgical decision, or transportation. Female sex was independently protective of ciTBI. Self-referral status was independently protective against operative intervention. Female sex and self-referral status were independently protective of a disposition of admission and/or going to the operating room. CONCLUSIONS This study characterizes the mTBI subgroup of head injury patients in Ethiopia's busiest ED: predominantly healthy young men with low-acuity presentations and only a fraction with abnormal neurological examinations. Nonetheless, about one-third had ciTBI and a minority were taken for neurosurgical procedures or admission, with female sex and self-referral identified as protective factors. Meanwhile, many patients stayed in the ED for days due to social or other nonmedical reasons. As TBI care in Ethiopia continues to improve, optimizing care for the mTBI subgroup is tantamount given their high recovery potential. This care will benefit from efficiently identifying those who need intervention or hospital level of care, and discharging those who do not.
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Affiliation(s)
| | - Belinda Shao
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Hengameh B Pajer
- Department of Emergency Medicine, HCA Houston Kingwood, Houston, Texas, USA
| | - Kevin L Ma
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | | | | | | | - Tsegazeab Laeke
- Addis Ababa University, College of Health Sciences, Black Lion Specialized Hospital, Addis Ababa, Ethiopia
| | - Abenezer Tirsit
- Addis Ababa University, College of Health Sciences, Black Lion Specialized Hospital, Addis Ababa, Ethiopia
| | - Heather S Spader
- Department of Neurosurgery, University of Virginia, Charlottesville Virginia, USA.
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Dibera GB, Yizengaw MA, Yadeta GL, Iticha DD, Gamachu B, Legesse BT. Clinical characteristics and outcomes of traumatic brain injury in patients admitted to surgical ward of Jimma Medical Center, Southwest Ethiopia: a prospective observational follow-up study. BMJ Open 2024; 14:e080598. [PMID: 38307533 PMCID: PMC10836355 DOI: 10.1136/bmjopen-2023-080598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To assess the Clinical Characteristics and Outcomes of Traumatic Brain Injury in Patients Admitted to the Surgical Ward of Jimma Medical Center, Southwest Ethiopia from January to July 2022. DESIGN AND SETTING A hospital-based prospective observational study was conducted among 175 patients admitted with Traumatic Brain Injury at Jimma Medical Center from January to July 2022. Data were collected by structured questionnaires and a convenient sampling technique was used. For data entry, Epidata V.4.6.0.5 software was used and exported to Stata V.14.0.2 for analysis. The Cox regression model was fitted to evaluate the predictors of mortality and variables with a p value <0.05 at 95% CI were taken as statistically significant predictors. RESULTS The incidence of in-hospital mortality was 22 (12.6%). The mean length of hospital stay was 6 days. In-hospital complications were recorded in 32.0% of patients. A Glasgow Coma Scale (GCS) score of <8 on admission (adjusted HR (AHR)=6.2, 95% CI 0.75 to 51), hyperthermia (AHR: 1.7, 95% CI 1.02 to 3.05) and lack of prehospital care (AHR: 3.2, 95% CI 2.2 to 8.07) were predictors of mortality in patients with traumatic brain injury. CONCLUSION In-hospital mortality was recorded in over one-tenth of patients with traumatic brain injury. The GCS score of <8 on admission, hyperthermia and lack of prehospital care positively affected the outcome of patients with traumatic brain injury. Screening of patients for hyperthermia and antipsychotics should be strengthened to reduce death. However, a multicentred study is needed for further evidence. Giving priority to the patients with those predictors will decrease the number of deaths.
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Affiliation(s)
| | | | | | | | - Busha Gamachu
- Department of Pharmacy, Wollega University, Nekemte, Ethiopia
| | - Bruck Tesfaye Legesse
- Department of Pediatrics and Neonatal Nursing, Wollega University, Nekemte, Ethiopia
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Demlie TA, Alemu MT, Messelu MA, Wagnew F, Mekonen EG. Incidence and predictors of mortality among traumatic brain injury patients admitted to Amhara region Comprehensive Specialized Hospitals, northwest Ethiopia, 2022. BMC Emerg Med 2023; 23:55. [PMID: 37226098 DOI: 10.1186/s12873-023-00823-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/17/2023] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Traumatic brain injury is a substantial cause of mortality and morbidity with a higher burden in low and middle-income countries due to healthcare systems that are unable to deliver effectively the acute and long-term care the patients require. Besides its burden, there is little information on traumatic brain injury-related mortality in Ethiopia, especially in the region. Therefore, this study aimed to assess the incidence and predictors of mortality among traumatic brain injury patients admitted to comprehensive specialized hospitals in the Amhara region, northwest Ethiopia, 2022. METHODS An institution-based retrospective follow-up study was conducted among 544 traumatic brain injury patients admitted from January 1, 2021, to December 31, 2021. A simple random sampling method was used. Data were extracted using a pre-tested and structured data abstraction sheet. Data were entered, coded, and cleaned into EPi-info version 7.2.0.1 software and exported to STATA version 14.1 for analysis. The Weibull regression model was fitted to determine the association between time to death and covariates. Variables with a P-value < 0.05 were declared statistically significant. RESULTS The overall incidence of mortality among traumatic brain injury patients was 1.23 per 100 person-day observation [95% (CI: 1.0, 1.5)] with a median survival time of 106 (95% CI: 60, 121) days. Age [AHR: 1.08 (95% CI; 1.06, 1.1)], severe traumatic brain injury [AHR: 10 (95% CI; 3.55, 28.2)], moderate traumatic brain injury [AHR: 9.2 (95% CI 2.97, 29)], hypotension [AHR: 6.9 (95% CI; 2.8, 17.1)], coagulopathy [AHR: 2.55 (95% CI: 1.27, 5.1)], hyperthermia [AHR: 2.79 (95% CI; 1.4, 5.5)], and hyperglycemia [AHR: 2.28 (95% CI; 1.13, 4.6)] were positively associated with mortality while undergoing neurosurgery were negatively associated with mortality [AHR: 0.47 (95% CI; 0.27-0 0.82)]. CONCLUSION The overall incidence of mortality was found to be high. Age, severe and moderate traumatic brain injury, hypotension at admission, coagulopathy, presence of associated aspiration pneumonia, undergoing a neurosurgical procedure, episode of hyperthermia, and hyperglycemia during hospitalization were the independent predictors of time to death. Therefore, interventions to reduce mortality should focus on the prevention of primary injury and secondary brain injury.
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Affiliation(s)
- Tiruye Azene Demlie
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mahlet Temesgen Alemu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fasil Wagnew
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- National Center for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Schenck HE, Joackim P, Lazaro A, Wu X, Gerber LM, Stieg PE, Härtl R, Shabani H, Mangat HS. Affordability impacts therapeutic intensity of acute management of severe traumatic brain injury patients: An exploratory study in Tanzania. BRAIN & SPINE 2023; 3:101738. [PMID: 37383438 PMCID: PMC10293321 DOI: 10.1016/j.bas.2023.101738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/30/2023]
Abstract
Introduction Quality health care in low and middle-income countries (LMICs) is constrained by financing of care. Research question What is the effect of ability to pay on critical care management of patients with severe traumatic brain injury (sTBI)? Material and Methods Data on sTBI patients admitted to a tertiary referral hospital in Dar-es-Salaam, Tanzania, were collected between 2016 and 2018, and included payor mechanisms for hospitalization costs. Patients were grouped as those who could afford care and those who were unable to pay. Results Sixty-seven patients with sTBI were included. Of those enrolled, 44 (65.7%) were able to pay and 15 (22.3%) were unable to pay costs of care upfront. Eight (11.9%) patients did not have a documented source of payment (unknown identity or excluded from further analysis). Overall mechanical ventilation rates were 81% (n=36) in the affordable group and 100% (n=15) in the unaffordable group (p=0.08). Computed tomography (CT) rates were 71.6% (n=48) overall, 100% (n=44) and 0% respectively (p<0.01); Surgical rates were 16.4% (n=11) overall, 18.2% (n=8) vs. 13.3% (n=2) (p=0.67) respectively. Two-week mortality was 59.7% overall (n=40), 47.7% (n=21) in the affordable group and 73.3% (n=11) in the unaffordable group (p=0.09) (adjusted OR 0.4; 95% CI: 0.07-2.41, p=0.32). Discussion and Conclusion Ability to pay appears to have a strong association with the use of head CT and a weak association with mechanical ventilation in the management of sTBI. Inability to pay increases redundant or sub-optimal care, and imposes a financial burden on patients and their relatives.
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Affiliation(s)
| | - Pascal Joackim
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Albert Lazaro
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Xian Wu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Linda M. Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, USA
| | - Philip E. Stieg
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Halinder S. Mangat
- Department of Neurosurgery, Weill Cornell Brain & Spine Institute, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
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Teshome AA, Ayehu GW, Yitbark GY, Abebe EC, Mengstie MA, Seid MA, Molla YM, Baye ND, Amare TJ, Abate AW, Yazie TS, Setargew KH. Prevalence of post-concussion syndrome and associated factors among patients with traumatic brain injury at Debre Tabor Comprehensive Hospital, North Central Ethiopia. Front Neurol 2022; 13:1056298. [PMID: 36479054 PMCID: PMC9721360 DOI: 10.3389/fneur.2022.1056298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 02/16/2024] Open
Abstract
Introduction The occurrence of three or more of the following signs and symptoms, such as headache, dizziness, exhaustion, irritability, sleeplessness, difficulties in concentrating, or memory problems, following a head injury is referred to as post-concussion syndrome (PCS). Even though post-concussion syndrome has not been studied in Ethiopia, the productive age group is frequently affected by health issues related to head trauma, which either directly or indirectly affect the growth of the nation. Objective To assess the prevalence and associated factors of post-concussion syndrome among patients with traumatic brain injury at Debre Tabor Comprehensive Hospital, Debre Tabor, North Central Ethiopia. Methods A successive sampling technique was used to conduct a hospital-based cross-sectional study on 405 traumatic brain injury patients at Debre Tabor Comprehensive Hospital from January 1, 2022, to May 30, 2022. SPSS version 25 was used to analyze the data. The factors connected to post-concussion syndrome were found using bivariate and multivariable logistic regression analysis. Statistical significance was determined by a P-value of ≤ 0.05. Results During the data collection period, 405 cases in total were interviewed, with a 98% response rate. More than half (60.7%) of patients were married, with the majority of patients (39.8%) falling between the ages of 18 and 29. At least three post-concussion syndrome symptoms were present in 42.8% of subjects. A history of comorbidities, GCS levels of 8 or below, 9 to 12 at the time of presentation, brain neuroimaging findings, and having fair or poor social support were found to be substantially linked with PCS in multivariate logistic regression. Conclusion About 41.5% of study participants had at least three symptoms of PCS. The Glasgow coma scale level at the time of presentation, the reason for the injury, social support, and the site of the injury were all significantly associated with the occurrence of PCS.
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Affiliation(s)
- Assefa Agegnehu Teshome
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getachew Yideg Yitbark
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yalew Melkamu Molla
- Department of Pediatrics and Child Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nega Dagnaw Baye
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tadeg Jemere Amare
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Agmas Wassie Abate
- Department of Psychiatry, Dr. Amebachew Memorial Hospital, Tach Gaynt, Ethiopia
| | - Taklo Semineh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Shiferaw SM, Mengistie EA, Aknaw GM, Amare AT, Azanaw KA. Incidence and Predictors of Aspiration Pneumonia Among Traumatic Brain Injury in Northwest Ethiopia. OPEN ACCESS EMERGENCY MEDICINE 2022; 14:85-98. [PMID: 35280842 PMCID: PMC8906894 DOI: 10.2147/oaem.s335927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background A significantly greater proportion of patients who die due to aspiration pneumonia were diagnosed with in-hospital aspiration pneumonia (19%). The incidence and major predictors are not known clearly, especially in Ethiopia. Objective To determine the incidence and predictors of aspiration pneumonia among adult traumatic brain injury patients at Felege Hiwot comprehensive specialized hospital, Bahir Dar, North west Ethiopia, in 2021. Methods An institution-based retrospective study was conducted from all admitted adult traumatic brain injury patients at Felege Hiwot comprehensive specialized hospital from January 1, 2015 to December 31, 2020 for 51 days of survival. Descriptive statistics, Kaplan–Meier survival curve log rank test, and the Cox proportional hazard regression model were used. Results A total of 396 adult patients diagnosed and admitted with traumatic brain injury in the past 5 years were included. Seventy patients (17.67%) developed aspiration pneumonia, providing an incidence rate of 32.39 (95% CI=25-62–40.94) per 1,000 person days of observation. Independent predictors were being referred for AHR (2.43; 95% CI=1.12–5.25), nasogastric tube insertion AHR (3.02; 95% CI=1.43–6.39), and baseline Glasgow coma scale <8 AHR (3.88; 95% CI=1.42–10.062). Conclusion Having a nasogastric tube and low baseline Glasgow coma scale were significant predictors. This improves prehospital and hospital care during transportation and admission time.
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Affiliation(s)
- Sahlu Mitku Shiferaw
- Department of Adult Health Nursing, Debre Tabor Health Science College, Debre Tabor, Ethiopia
- Correspondence: Sahlu Mitku Shiferaw, Department of Adult Health Nursing, Debre Tabor Health Science College, Po Box 83, Debre Tabor, Amhara Region, Ethiopia, Email
| | - Emiru Ayalew Mengistie
- Department of Adult Health, Nursing College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getasew Mulatu Aknaw
- Department of Emergency Medicine and Critical Care, Nursing College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kefyalew Amogne Azanaw
- Department of Reproductive and Child Health, Debre Tabor Health Science College, Debre Tabor, Ethiopia
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Stubbs DJ, Davies BM, Menon DK. Chronic subdural haematoma: the role of peri‐operative medicine in a common form of reversible brain injury. Anaesthesia 2022; 77 Suppl 1:21-33. [DOI: 10.1111/anae.15583] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 01/08/2023]
Affiliation(s)
- D. J. Stubbs
- University Division of Anaesthesia Department of Medicine Addenbrooke’s Hospital Cambridge UK
| | - B. M. Davies
- Department of Academic Neurosurgery Addenbrooke’s Hospital Cambridge UK
| | - D. K. Menon
- University Division of Anaesthesia Department of Medicine Addenbrooke’s Hospital Cambridge UK
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Dhufera HT, Jbaily A, Verguet S, Tolla MT, Johansson KA, Memirie ST. Financial risk of road traffic trauma care in public and private hospitals in Addis Ababa, Ethiopia: A cross-sectional observational study. Injury 2022; 53:23-29. [PMID: 34819231 PMCID: PMC8745336 DOI: 10.1016/j.injury.2021.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 10/05/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Road traffic injuries are among the most important causes of morbidity and mortality and cause substantial economic loss to households in Ethiopia. This study estimates the financial risks of seeking trauma care due to road traffic injuries in Addis Ababa, Ethiopia. METHODS This is a cross-sectional survey on out-of-pocket (OOP) expenditures related to trauma care in three public and one private hospital in Addis Ababa from December 2018 to February 2019. Direct medical and non-medical costs (2018 USD) were collected from 452 trauma cases. Catastrophic health expenditures were defined as OOP health expenditures of 10% or more of total household expenditures. Additionally, we investigated the impoverishment effect of OOP expenditures using the international poverty line of $1.90 per day per person (adjusted for purchasing power parity). RESULTS Trauma care seeking after road traffic injuries generate catastrophic health expenditures for 67% of households and push 24% of households below the international poverty line. On average, the medical OOP expenditures per patient seeking care were $256 for outpatient visits and $690 for inpatient visits per road traffic injury. Patients paid more for trauma care in private hospitals, and OOP expenditures were six times higher in private than in public hospitals. Transport to facilities and caregiver costs were the two major cost drivers, amounting to $96 and $68 per patient, respectively. CONCLUSION Seeking trauma care after a road traffic injury poses a substantial financial threat to Ethiopian households due to lack of strong financial risk protection mechanisms. Ethiopia's government should enact multisectoral interventions for increasing the prevention of road traffic injuries and implement universal public finance of trauma care.
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Affiliation(s)
- Hailu Tamiru Dhufera
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Abdulrahman Jbaily
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Mieraf Taddesse Tolla
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Solomon Tessema Memirie
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Amare AT, Tesfaye TD, Ali AS, Woelile TA, Birlie TA, Kebede WM, Tassew SF, Chanie ES, Fleke DG. Survival status and predictors of mortality among traumatic brain injury patients in an Ethiopian hospital: A retrospective cohort study. Afr J Emerg Med 2021; 11:396-403. [PMID: 34703730 PMCID: PMC8524110 DOI: 10.1016/j.afjem.2021.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/22/2021] [Accepted: 06/01/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Traumatic brain injury is a major global public health problem causing substantial mortality among the adult population. Hence, this study aimed to determine the predictors of mortality among adult traumatic brain injury patients in Felegehiwot Comprehensive Specialized Hospital in Northwest Ethiopia during 2020. METHODS A retrospective cohort study was conducted at Felegehiwot Comprehensive Specialized Hospital using anonymized patient data obtained from chart review. Descriptive statistics were used to summarise the patient characteristics. The Kaplan-Meier survival curve and log-rank test were used to test for differences in survival status among groups. The Cox proportional hazards regression model was used at the 5% level of significance to determine the net effect of each explanatory variable on time to death. RESULTS In total, 338 patients aged ≥15 years and diagnosed with traumatic brain injury were included in the analysis. Among these patients, 103 (30.45%) died, giving a crude death rate of 25.53 per 1000 (95% CI: 21.05-30.98) person-days of follow-up. The overall median survival time was 44 days. The independent predictors of mortality after diagnosis of traumatic brain injury were admission Glasgow coma scale score ≤ 8 (adjusted hazard ratio (AHR): 4.85; 95% confidence interval (CI): 1.73-13.62), bilateral non-reactive pupils at admission (AHR: 2.00 (95% CI: 1.10-3.71), elevated systolic blood pressure at admission (AHR: 0.31; 95% CI:0.11-0.86), elevated diastolic blood pressure at admission (AHR: 3.54; 95% CI: 1.33-9.43), and haematoma evacuation (AHR: 0.42; 95% CI: 0.16-0.90). DISCUSSION The Survival status of traumatic brain injury patients was relatively low in this study. Glasgow coma scale score, bilateral non-reactive pupils, and elevated blood pressure were significant predictors of mortality. Further prospective follow-up studies that include residence and occupation are recommended.
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Affiliation(s)
- Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Debre-Tabor, Ethiopia
| | - Tadesse Dagget Tesfaye
- Department of Adult Health Nursing, College of Health Sciences, Bahir-Dar University, Bahir-Dar, Ethiopia
| | - Awole Seid Ali
- Department of Adult Health Nursing, College of Health Sciences, Bahir-Dar University, Bahir-Dar, Ethiopia
| | - Tamiru Alene Woelile
- Department of Pediatrics and Neonatal Nursing, College of Health Sciences, Wolaita-Sodo University, Ethiopia
| | - Tekalign Amera Birlie
- Department of Adult Health Nursing, College of Health Sciences, Debre-Tabor University, Debre-Tabor, Ethiopia
| | - Worku Misganew Kebede
- Department of Adult Health Nursing, College of Health Sciences, Debre-Berhan University, Debre-Berhan, Ethiopia
| | - Sheganew Fetene Tassew
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre-Tabor University, Debre-Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre-Tabor University, Debre-Tabor, Ethiopia
| | - Dejen Getaneh Fleke
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre-Tabor University, Debre-Tabor, Ethiopia
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Sawa B, Assoumane I, Ngoko Y, Chaibou Sode H, Sanoussi S. Delays in a traumatic brain injury: A case report. Trop Doct 2021; 52:147-150. [PMID: 34841985 DOI: 10.1177/00494755211055539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a case highlighting bottlenecks on the care chain for a victim of an open traumatic brain injury. Risks of severe complications, infectious in particular, escalate with every hour.
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Affiliation(s)
- Brice Sawa
- Neurosurgery Department, 92977Niamey National Hospital, Niamey, Niger
| | - Ibrahim Assoumane
- Neurosurgery Department, 92977Niamey National Hospital, Niamey, Niger.,Faculty of Health Sciences, 486604Abdou Moumouni University, Niamey, Niger
| | - Yvan Ngoko
- Neurosurgery Department, 92977Niamey National Hospital, Niamey, Niger
| | | | - Samuila Sanoussi
- Neurosurgery Department, 92977Niamey National Hospital, Niamey, Niger.,Faculty of Health Sciences, 486604Abdou Moumouni University, Niamey, Niger
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11
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Spears CA, Adil SM, Kolls BJ, Muhumza ME, Haglund MM, Fuller AT, Dunn TW. Surgical intervention and patient factors associated with poor outcomes in patients with traumatic brain injury at a tertiary care hospital in Uganda. J Neurosurg 2021; 135:1569-1578. [PMID: 33770754 DOI: 10.3171/2020.9.jns201828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors. METHODS Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13-15), moderate TBI (moTBI; GCS scores 9-12), and severe TBI (sTBI; GCS scores 3-8). Poor outcomes constituted Glasgow Outcome Scale scores 2-3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10. RESULTS Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23-0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04-0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14-0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17-1.17). CONCLUSIONS In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient's admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.
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Affiliation(s)
- Charis A Spears
- 1Duke University Division of Global Neurosurgery and Neurology, Durham
- 2Duke University School of Medicine, Durham, North Carolina
| | - Syed M Adil
- 1Duke University Division of Global Neurosurgery and Neurology, Durham
- 2Duke University School of Medicine, Durham, North Carolina
| | - Brad J Kolls
- 1Duke University Division of Global Neurosurgery and Neurology, Durham
- 3Department of Neurology
| | | | - Michael M Haglund
- 1Duke University Division of Global Neurosurgery and Neurology, Durham
- 2Duke University School of Medicine, Durham, North Carolina
- 5Department of Neurosurgery, Duke University Medical Center, Durham
- 6Duke University Global Health Institute, Durham
| | - Anthony T Fuller
- 1Duke University Division of Global Neurosurgery and Neurology, Durham
- 2Duke University School of Medicine, Durham, North Carolina
- 5Department of Neurosurgery, Duke University Medical Center, Durham
- 6Duke University Global Health Institute, Durham
| | - Timothy W Dunn
- 1Duke University Division of Global Neurosurgery and Neurology, Durham
- 5Department of Neurosurgery, Duke University Medical Center, Durham
- 7Duke Forge, Duke University School of Medicine, Durham; and
- 8Department of Statistical Science, Duke University, Durham, North Carolina
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Incidence and predictors of mortality among patients with head injury admitted to Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: A retrospective follow-up study. PLoS One 2021; 16:e0254245. [PMID: 34411116 PMCID: PMC8376017 DOI: 10.1371/journal.pone.0254245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Head injury is the leading cause of morbidity and mortality throughout the world, especially in resource-limited countries including Ethiopia. However, little is known about the mortality rate and its predictors among these patients in Ethiopia. Thus, the study aims to assess the incidence rate of mortality and its predictors among patients with head injury admitted at Hawassa University Comprehensive Specialized Hospital. Methods Institutional based retrospective follow-up study was conducted among 1220 randomly selected head injury patients admitted from July 2017 to July 2019. Bivariable and multivariable Cox regression models were fitted to identify the predictors of mortality. Proportionality assumption was tested by a global test based on the Schoenfeld residuals test. Results The incidence of the mortality rate was 2.26 (95%CI: 1.9–2.6) per 100-person day observation. The independent predictors of time to death were age above 65 years (AHR:3.49, 95%CI:1.63, 7.48), severe TBI (AHR: 8.8, 95%CI:5.13, 15.0), moderate TBI (AHR:3, 95%CI:1.73,5.31), hypotension (AHR:1.72, 95%CI: 1.11,2.66), hypoxia (AHR:1.92, 95%CI: 1.33,2.76), hyperthermia (AHR:1.8, 95%CI: 1.23,2.63) and hypoglycemic (AHR:1.94, 95%CI: 1.34, 2.81) positively associated with mortality, while underwent neurosurgery was negatively associated with mortality (AHR: 0.25, 95% CI: 0.11,0.53). Conclusion The incidence of mortality rate among head injury patients was high. Older age, moderate and severe TBI, hypotension and hypoxia at admission, neurosurgical procedure, and the episode of hyperthermia and hypoglycemia during hospitalization were the independent predictors of mortality among head injury patients. Therefore, intervention to reduce earlier deaths should focus on the prevention of secondary brain insults.
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Tesfaw A, Eshetu M, Teshome F, Fenta E, Gelaw M, Mihret G, Atiklt G, Yosef T. Prevalence of Head Injury Among Trauma Patients at Debre Tabor Comprehensive Specialized Hospital, North Central Ethiopia. OPEN ACCESS SURGERY 2021. [DOI: 10.2147/oas.s321404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Traumatic Brain Injury-Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2021; 153:109-130.e23. [PMID: 34166832 DOI: 10.1016/j.wneu.2021.06.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) is unknown. To fill this gap, we conducted a review that aimed to characterize the causes of pTBI in LMICs, and their reported associated mortality and morbidity. METHODS A systematic review was conducted. MEDLINE, Embase, Global Health, and Global Index Medicus were searched from January 2000 to May 2020. Observational or experimental studies on pTBI of individuals aged between 0 and 16 years in LMICs were included. The causes of pTBI and morbidity data were descriptively analyzed, and case fatality rates were calculated. PROSPERO ID CRD42020171276. RESULTS A total of 136 studies were included. Fifty-seven studies were at high risk of bias. Of the remaining studies, 170,224 cases of pTBI were reported in 32 LMICs. The odds of having a pTBI were 1.8 times higher (95% confidence interval, 1.6-2.0) in males. The odds of a pTBI being mild were 4.4 times higher (95% confidence interval, 1.9-6.8) than a pTBI being moderate or severe. Road traffic accidents were the most common cause (n = 16,275/41,979; 39%) of pTBIs. On discharge, 24% of patients (n = 4385/17,930) had a reduction in their normal mental or physical function. The median case fatality rate was 7.3 (interquartile range, 2.1-7.7). CONCLUSIONS Less than a quarter (n = 32) of all LMICs have published high-quality data on the volume and burden of pTBI. From the limited data available, young male children are at a high risk of pTBIs in LMICs, particularly after road traffic accidents.
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Denu ZA, Osman MY, Bisetegn TA, Biks GA, Gelaye KA. Prevalence and risk factors for road traffic injuries and mortalities in Ethiopia: systematic review and meta-analysis. Inj Prev 2021; 27:384-394. [PMID: 33579673 DOI: 10.1136/injuryprev-2020-044038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Road traffic injuries, which are responsible for premature deaths and functional losses, are the leading causes of unintentional injuries in Ethiopia. As most studies on road traffic injuries, so far, have been either local or regional, it is believed that combining the regional or local data to get nationally representative information could help programme implementers in setting priorities. OBJECTIVE The aim of this review was to estimate the proportion of road traffic injuries, mortality and risk factors for the problem among all age groups in Ethiopia. DATA SOURCES A systematic review of articles using MEDLINE/PubMed SCOPUS Web of Science and science direct was conducted. Additional studies were identified via manual search. STUDY SELECTION Only studies that reported road traffic injuries and/or mortalities for all age groups were included in this review. DATA SYNTHESIS All pooled analyses were based on random-effect models. Twenty-six studies for the prevalence of RTIs (n=37 424), 24 studies for road traffic injuries (RTI) mortality, (n=38 888), 9 studies for prevalence of fracture among RTIs (n=2817) and 5 studies for the prevalence of post-traumatic stress disorder (n=1733) met our inclusion criteria. Driving in the dark increased severity of injury by 1.77, 95% CI 1.60 to 1.95). The certainty of the evidence was assessed using GRADEpro Guideline Development Tool. CONCLUSION In this review, the burden of road traffic injuries and mortalities remains high in Ethiopia. Human factors are the most common causes of the problem in Ethiopia. The existing safety regulations should be re-evaluated and supported by continuous behavioural interventions. PROSPERO REGISTRATION NUMBER CRD42019124406.
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Affiliation(s)
- Zewditu Abdissa Denu
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Mensur Yassin Osman
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Communication and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health Policy and Management, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
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Elahi C, Rocha TAH, da Silva NC, Sakita FM, Ndebea AS, Fuller A, Haglund MM, Mmbaga BT, Nickenig Vissoci JR, Staton CA. An evaluation of outcomes in patients with traumatic brain injury at a referral hospital in Tanzania: evidence from a survival analysis. Neurosurg Focus 2020; 47:E6. [PMID: 31675716 DOI: 10.3171/2019.7.focus19316] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if patients with traumatic brain injury (TBI) in low- and middle-income countries who receive surgery have better outcomes than patients with TBI who do not receive surgery, and whether this differs with severity of injury. METHODS The authors generated a series of Kaplan-Meier plots and performed multiple Cox proportional hazard models to assess the relationship between TBI surgery and TBI severity. The TBI severity was categorized using admission Glasgow Coma Scale scores: mild (14, 15), moderate (9-13), or severe (3-8). The authors investigated outcomes from admission to hospital day 14. The outcome considered was the Glasgow Outcome Scale-Extended, categorized as poor outcome (1-4) and good outcome (5-8). The authors used TBI registry data collected from 2013 to 2017 at a regional referral hospital in Tanzania. RESULTS Of the final 2502 patients, 609 (24%) received surgery and 1893 (76%) did not receive surgery. There were significantly fewer road traffic injuries and more violent causes of injury in those receiving surgery. Those receiving surgery were also more likely to receive care in the ICU, to have a poor outcome, to have a moderate or severe TBI, and to stay in the hospital longer. The hazard ratio for patients with TBI who underwent operation versus those who did not was 0.17 (95% CI 0.06-0.49; p < 0.001) in patients with moderate TBI; 0.2 (95% CI 0.06-0.64; p = 0.01) for those with mild TBI, and 0.47 (95% CI 0.24-0.89; p = 0.02) for those with severe TBI. CONCLUSIONS Those who received surgery for their TBI had a lower hazard for poor outcome than those who did not. Surgical intervention was associated with the greatest improvement in outcomes for moderate head injuries, followed by mild and severe injuries. The findings suggest a reprioritization of patients with moderate TBI-a drastic change to the traditional practice within low- and middle-income countries in which the most severely injured patients are prioritized for care.
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Affiliation(s)
- Cyrus Elahi
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,2Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Thiago Augusto Hernandes Rocha
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,3Pan American Health Organization, World Health Organization, Brasilia
| | - Núbia Cristina da Silva
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,4Methods Analytics and Technology for Health (MATH) Consortium, Belo Horizonte, Brazil
| | | | | | - Anthony Fuller
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,2Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Michael M Haglund
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,2Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - João Ricardo Nickenig Vissoci
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,2Duke Global Health Institute, Duke University, Durham, North Carolina.,6Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Catherine A Staton
- 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.,2Duke Global Health Institute, Duke University, Durham, North Carolina.,6Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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First Report of Traumatic Brain Injury in Luanda, Angola. World Neurosurg 2020; 143:e362-e364. [PMID: 32730976 DOI: 10.1016/j.wneu.2020.07.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a global problem and is the greatest contributor to death and disability among all trauma-related injuries worldwide. Road traffic accidents are an important cause of TBI. The purpose of this paper is to present the first data on TBI in Angola. METHODS This was a retrospective study of the clinical and radiologic profile of patients admitted to the intensive care unit of a tertiary hospital in Luanda, Angola, from January 2018 to December 2018. The medical records of patients with moderate and severe TBI admitted to the intensive care unit were reviewed. The inclusion criteria were adult patients who suffered from TBI. The exclusion criteria were incomplete medical records, pediatric age, and mild TBI. RESULTS We included 29 patients (6 female) with a mean age of 31 years. Of them, 31% visited the hospital without an ambulance (using private or commercial vehicles), 58.6% suffered from severe TBI, and the mortality rate in our sample was 34.5%. Road accident was the most frequent cause of trauma. CONCLUSIONS This first report of TBI in Angola reveals major problems with TBI management, road accident prevention, prehospital management, and loss of lives of young patients.
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Bedry T, Tadele H. Pattern and Outcome of Pediatric Traumatic Brain Injury at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: Observational Cross-Sectional Study. Emerg Med Int 2020; 2020:1965231. [PMID: 32399303 PMCID: PMC7204112 DOI: 10.1155/2020/1965231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/26/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is the most common cause of death/disability in children. The Glasgow coma scale and other parameters are used for treatment/follow-up of TBI. Childhood TBI data are scarce from sub-Saharan Africa. The study aimed to determine the pattern and predictors of the TBI outcome in Southern Ethiopia. METHODS An observational cross-sectional study was conducted from September 2017 to September 2018 at Hawassa University Hospital. Structured questionnaires were used for data collection. Significant associations were declared at a P value of <0.05. RESULTS There were 4,258 emergency room (ER) visits during the study period, and TBI contributed to 317 (7.4%) cases. The mean age of study subjects was 7.66 ± 3.88 years. Boys, predominantly above 5 years of age, comprise 218 (68.8%) of the study subjects with a male to female ratio of 2.2 : 1. Pedestrian road traffic accidents (RTA), 120 (37.9%), and falls, 104 (32.8%), were the commonest causes of TBI. Mild, moderate, and severe TBI were documented in 231 (72.9%), 61 (19.2%), and 25 (7.9%) of cases, respectively. Most of the TBI cases presented within 24 hrs of injury, 258 (81.4%). Recovery with no neurologic deficit, 267 (84.2%); focal neurologic deficit, 30 (9.5%); depressed mentation, 10 (3.2%); and death, 10 (3.2%), were documented. Signs of increased intracranial pressure (ICP) at admission [AOR: 1.415 (95% CI: 1.4058-9.557)], severe TBI [AOR: 2.553 (95% CI: 1.965-4.524)], presence of hyperglycemia [AOR: 2.318 (95% CI: 1.873-7.874)], and presence of contusion, diffuse axonal injury (DAI), or intracranial bleeding on the head computed tomography (CT) scan [AOR: 2.45 (95% CI: 1.811-7.952)] predicted poor TBI outcome. CONCLUSION TBI contributed to 7.4% of pediatric ER visits. Pedestrian RTA and falls, early presentation (<24 hours of injury), and mild form of TBI among boys were the most common documented patterns. ICP, hyperglycemia, severe TBI, and presence of contusion, DAI, or intracranial bleeding on head CT predicted poor outcome. Strategies to ensure road safety and to prevent falls and animal-related injuries and TBI follow-up for ICP and glycemic controls are recommended.
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Affiliation(s)
- Tuji Bedry
- Department of Pediatrics and Child Health, College of Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Henok Tadele
- Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, Agrawal A, Adeleye AO, Shrime MG, Rubiano AM, Rosenfeld JV, Park KB. Estimating the global incidence of traumatic brain injury. J Neurosurg 2019; 130:1080-1097. [PMID: 29701556 DOI: 10.3171/2017.10.jns17352] [Citation(s) in RCA: 1170] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 10/18/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI)-the "silent epidemic"-contributes to worldwide death and disability more than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, the authors sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups. METHODS Open-source epidemiological data on road traffic injuries (RTIs) were used to model the incidence of TBI using literature-derived ratios. First, a systematic review on the proportion of RTIs resulting in TBI was conducted, and a meta-analysis of study-derived proportions was performed. Next, a separate systematic review identified primary source studies describing mechanisms of injury contributing to TBI, and an additional meta-analysis yielded a proportion of TBI that is secondary to the mechanism of RTI. Then, the incidence of RTI as published by the Global Burden of Disease Study 2015 was applied to these two ratios to generate the incidence and estimated case volume of TBI for each WHO region and WB income group. RESULTS Relevant articles and registries were identified via systematic review; study quality was higher in the high-income countries (HICs) than in the low- and middle-income countries (LMICs). Sixty-nine million (95% CI 64-74 million) individuals worldwide are estimated to sustain a TBI each year. The proportion of TBIs resulting from road traffic collisions was greatest in Africa and Southeast Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in Southeast Asia (1.5% of the population per year) and Europe (1.2%). The overall incidence of TBI per 100,000 people was greatest in North America (1299 cases, 95% CI 650-1947) and Europe (1012 cases, 95% CI 911-1113) and least in Africa (801 cases, 95% CI 732-871) and the Eastern Mediterranean (897 cases, 95% CI 771-1023). The LMICs experience nearly 3 times more cases of TBI proportionally than HICs. CONCLUSIONS Sixty-nine million (95% CI 64-74 million) individuals are estimated to suffer TBI from all causes each year, with the Southeast Asian and Western Pacific regions experiencing the greatest overall burden of disease. Head injury following road traffic collision is more common in LMICs, and the proportion of TBIs secondary to road traffic collision is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions with higher-quality data, specifically in North America and Europe.
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Affiliation(s)
- Michael C Dewan
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 2Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center
| | - Abbas Rattani
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 3Meharry Medical College, School of Medicine, Nashville, Tennessee
| | | | - Ronnie E Baticulon
- 5University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Ya-Ching Hung
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
| | - Maria Punchak
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 6David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Amit Agrawal
- 7Department of Neurosurgery, Narayana Medical College, Nellore, Andhra Pradesh, India
| | - Amos O Adeleye
- 8Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan
- 9Department of Neurological Surgery, University College Hospital, Ibadan, Nigeria
| | - Mark G Shrime
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
- 10Office of Global Surgery and Health, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Andrés M Rubiano
- 11Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia
| | - Jeffrey V Rosenfeld
- 12Department of Neurosurgery, Alfred Hospital
- 13Department of Surgery, Monash University, Melbourne, Australia; and
- 14Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kee B Park
- 1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine
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Gebru AA, Mosadeghrad AM, Sari AA, Tafesse TB, Kahsay WG. Prevalence, pattern, magnitude and associated factors of trauma in the Emergency Department at Health Institutes in Ethiopia: A systematic review. Hum Antibodies 2019; 27:1-10. [PMID: 30909202 DOI: 10.3233/hab-190363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is one of the important public health problems that causes significant economic and social crisis with more than 10% of all disease cases are associated with it. We aimed to identify and describe the prevalence, patterns, magnitude and associated factors of trauma in the Emergency Department at Health Institute in Ethiopia. METHODS In this systematic review, we searched for peer-reviewed and grey literature publications reporting the prevalence, pattern, magnitude and associated factors of trauma between 2000 and 2019. The documents which recruited are directly related to trauma and emergency department. In this regard, we searched databases of PubMed, Elsevier, Science directed, MEDLINE, and Google scholar by using Google as searching engine. Furthermore, publication with secondary data and not in English was excluded. FINDINGS A total of 9,768 injured participants were included in the studies, of which 71.2% (6950) were males. Among the injured participants, 53.4% of cases were living in Addis Ababa followed by Gondar and Jimma with 20.3% and 11.3% cases, respectively. Severe road traffic accident, occupational injury, and surgical patients were among the major risk factors of trauma. The mortality rate of the trauma case fatality was reached about 4%. The majority of the studies (37.5%) analyzed the pattern and magnitude of trauma among patients seen at emergency outpatient department of health institutes in Ethiopia. The largest percentage of studies (62.5%) relied on systematic random sampling. Thirty eight percent of the reviewed studies were utilized retrospective approaches to address the research questions. An completed the registry forms and/or Kampla Trauma Score (KTS), which accounted for 37.5% of articles on prevalence, pattern, magnitude and associated factors of trauma in the emergency was the most commonly used strategy. The majority (75%) of the reviewed studies were used both descriptive statistics and bivarate and multivariate logistic regression for data analysis. The majority 6950 (71%) of the participants who have been included in those reviewed articles were male and 2818 (29%) were female by gender. Meanwhile, the majority 5 (62.5%) of reviewed studies had included < 1000 injured persons. CONCLUSION The degree and types of injuries in different hospitals in Ethiopia was considerably high and its casualty is also under predictable. Therefore, a variety of actions including policy decision should be implemented in order to minimize the incidence of trauma at department of emergency care center in the country.
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Affiliation(s)
- Addis Adera Gebru
- Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran.,Department of Nursing, Faculty of Health Sciences, Woldia University, Woldia, Ethiopia.,Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tadesse Bekele Tafesse
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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The burden of road traffic injury among trauma patients in Ethiopia: A systematic review and meta-analysis. Afr J Emerg Med 2019; 9:S3-S8. [PMID: 30976494 PMCID: PMC6440918 DOI: 10.1016/j.afjem.2019.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/05/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022] Open
Abstract
Background Road traffic injury (RTI) is one of the main reasons for trauma-related admission in Ethiopian hospitals. Nationally representative data is needed to develop and implement the public health emergency management strategy. Therefore, this study was aimed to estimate the national pooled prevalence of RTI among trauma patients in Ethiopia. Methods PubMed, Excerpta Medica Database (EMBASE), psycEXTRA, and Google Scholar databases were searched. Heterogeneity of studies was assessed using the I2 statistics. Publication bias was checked by using funnel plot and Egger’s regression test. The DerSimonian and Laird's random-effects model was used to estimate the pooled prevalence. Subgroup analysis was conducted by age and region. The trend of RTI estimated as well. Results The pooled prevalence of RTI among trauma patients in Ethiopia was 31.5% (95% CI: 25.4%, 37.7%). Regional subgroup analysis showed that the pooled prevalence of RTI was 58.3% in the region of southern, nation, nationalities, and peoples (SNNPR) and 33.3% in Addis Ababa. Subgroup analysis based on patients age showed that the pooled prevalence of RTI was 51.7% in adults, 14.2% in children, and 32.6% in all age group. The time-trend analysis has shown an increasing burden of RTI in Ethiopian hospitals. Conclusion The burden of RTI among trauma patients was high. Therefore, strengthening road safety management throughout the country is needed to reduce RTI.
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An Epidemiological Analysis of Head Injuries in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112457. [PMID: 30400380 PMCID: PMC6265840 DOI: 10.3390/ijerph15112457] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/25/2018] [Accepted: 11/01/2018] [Indexed: 11/17/2022]
Abstract
Traumatic head injuries occur frequently in Taiwan, having catastrophic consequences for the victims, their families, and society as a whole. However, little is known about the risk factors at the population level in Taiwan. The primary aim of this study was to obtain more information on these variables and their relationships. Another aim was to analyze the effects of independent variables such as sex, age, residency, pre-existing conditions, mechanisms of injury, associated injuries, and severity on the probability of in-hospital death. Using the 2007–2008 total admissions claim dataset from Taiwan’s National Health Insurance system, total admissions due to acute head injury were selected for further analysis. The obtained data included patient demographics and trauma hospitalization rate. A total of 99,391 patients were admitted with head injury, 48,792 of which had moderate-to-severe head injury. There were 4935 cases recorded as in-hospital mortality and the standardized in-hospital mortality rate was 10.7 deaths per 100,000 person-years. The mortality rate increased with age. After adjustments, male sex, age older than 54 years, living in a rural area, lower monthly income, a Charlson comorbidity index greater than one, being a pedestrian hit by a motor vehicle, fall from a height, and having significant chest, abdominal, or lower extremity injury increased the risk of death during admission. This population-based analysis provides information about the incidence rate and death rate for admissions in Taiwan due to acute head injury and the factors that affect in-hospital mortality. Our results that highlight the risk factors for adverse outcome can help us prevent or improve rural area trauma care of head injury patients in the future.
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Eshete A, Taye F. Magnitude of Severe Head Injury and Its Associated Factors among Head Injury Patients in Gedeo Zone, Southern Ethiopia: A Two-Year Retrospective Study. Ethiop J Health Sci 2018; 28:323-330. [PMID: 29983532 PMCID: PMC6016352 DOI: 10.4314/ejhs.v28i3.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Severe head injury is a major public health threat that is the main cause of morbidity and mortality in all age groups of the world's populations including Ethiopia. In view of this, this study was assessed the severity of head injury and its contributing factors. METHODS A Two-year retrospective study was conducted at Dilla University Referral Hospital, from December 2014 to November 2016. All head injury patients admitted to the surgical ward were included. Bivariate and multivariate regression analyses were used to identify factors associated with severity of head injury. RESULTS A total of 106 eligible head injury patient charts were reviewed. The magnitude of severe head injury was 32.1%. Young populations, mainly males, were the highest risk groups, and road traffic accident was the main cause of severe head injury. In adjusted analysis, age interval greater than 45 years (aOR, 5.41; 95% CI:1.05-29.09), alcohol consumption before the trauma (aOR, 4.16, 95%CI: 1.18, 14.61), delayed presentation (beyond 24 hours) after injury (aOR, 4.717; 95% CI: 1.02-21.81), and respiratory rate greater than 30 breaths per minute (aOR, 7.34; 95% CI: 1.88-28.73) were significantly associated with severe head injury. CONCLUSIONS Severe head injury remains an important public health problem. Young adults were the highest risk groups of populations. Prevention of road traffic accidents, continuous awareness creation about the consequences of road traffic accident and close neurological monitoring offered by neuro-intensive care unit are recommended.
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Affiliation(s)
- Akine Eshete
- School of Public health, College of Health Sciences and Medicine, Dilla University, Ethiopia
| | - Fikirewold Taye
- Departments of Obstetrics and Gynecology, College of Health Sciences and Medicine, Dilla University, Ethiopia
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Eaton J, Hanif AB, Grudziak J, Charles A. Epidemiology, Management, and Functional Outcomes of Traumatic Brain Injury in Sub-Saharan Africa. World Neurosurg 2017; 108:650-655. [PMID: 28943422 DOI: 10.1016/j.wneu.2017.09.084] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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.
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Affiliation(s)
| | - Asma Bilal Hanif
- Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi
| | - Joanna Grudziak
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Anthony Charles
- 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.
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Chichom-Mefire A, Nwanna-Nzewunwa OC, Siysi VV, Feldhaus I, Dicker R, Juillard C. Key findings from a prospective trauma registry at a regional hospital in Southwest Cameroon. PLoS One 2017; 12:e0180784. [PMID: 28723915 PMCID: PMC5516986 DOI: 10.1371/journal.pone.0180784] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/21/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of trauma in Cameroon is limited. Regular, prospective injury surveillance can address the shortcomings of existing hospital administrative logs and medical records. This study aims to characterize trauma as seen at the emergency department (ED) of Limbe Regional Hospital (LRH) and assess the completeness of data obtained by a trauma registry. METHODS AND FINDINGS From January 2008 to October 2013, we prospectively captured data on injured patients using a strategically designed, context-relevant trauma registry instrument. Indicators around patient demographics, injury characteristics, delays in accessing care, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. About 5,617 patients, aged from 0.5-95years (median age of 26 years), visited the LRH ED with an injury; 67% were male. Students (27%) were the most affected occupation category. Road traffic injuries (RTIs) (56%), assault (22%), and domestic injuries (13%) were the leading causes of injury. Two-thirds of RTIs were motorcycle-related. Working in transportation (AOR 4.42, p<0.001) and law enforcement (AOR 1.73, p = 0.004) were significant predictors of having a RTI. The trauma registry showed a significant improvement in completeness of all data (p<0.001) and it improved over time compared with previous administrative records. However, proportions of missing data still ranged from 0.5% to 8.2% and involved respiratory rate or Glasgow Coma scale. CONCLUSIONS Implementation of a context-appropriate trauma registry in resource-constrained settings is feasible. Providing valuable, high-quality data, the trauma registry can inform trauma care quality improvement efforts and policy development. Study findings indicate the need for injury prevention interventions and policies that will prioritize high-risks groups, such as those aged 20-29 years, and those in occupations requiring frequent road travel. The high incidence of motorcycle-related injuries is concerning and calls for a proactive solution.
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Affiliation(s)
- Alain Chichom-Mefire
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Buea, Cameroon
| | - Obieze C. Nwanna-Nzewunwa
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Vincent Verla Siysi
- Department of Surgery, Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, Buea, Cameroon
| | - Isabelle Feldhaus
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Rochelle Dicker
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Catherine Juillard
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
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Abdelgadir J, Smith ER, Punchak M, Vissoci JR, Staton C, Muhindo A, Kitya D, Park LP, Haglund MM. Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital. World Neurosurg 2017; 102:526-532. [PMID: 28342925 DOI: 10.1016/j.wneu.2017.03.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 01/16/2023]
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.
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Affiliation(s)
- Jihad Abdelgadir
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Emily R Smith
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA.
| | - Maria Punchak
- 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
| | - Joao Ricardo Vissoci
- 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
| | - Catherine Staton
- 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
| | - Alex Muhindo
- Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - David Kitya
- Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Lawrence P Park
- Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Michael M Haglund
- 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
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Djientcheu V, Nguifo Fongang E, Owono Etoundi P, Esiene A, Motah M, Tchaleu C, Emakam E, Tonye R, Ngo Nonga B, Essiben X, Fouda PJ. Mortality of head injuries in Sub-Saharan African countries: The case of the university teaching hospitals of Cameroon. J Neurol Sci 2016; 371:100-104. [DOI: 10.1016/j.jns.2016.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 09/07/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
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Getachew S, Ali E, Tayler-Smith K, Hedt-Gauthier B, Silkondez W, Abebe D, Deressa W, Enquessilase F, Edwards JK. The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia. Public Health Action 2016; 6:66-71. [PMID: 27358798 DOI: 10.5588/pha.15.0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
Abstract
SETTING The emergency department (ED) of Zewditu Memorial Hospital, Addis Ababa, Ethiopia. OBJECTIVE To document the proportion, trend, characteristics and outcomes of road traffic injury (RTI) related ED admissions (⩾15 years) between 2014 and 2015. DESIGN A retrospective, cross-sectional study using routinely collected ED data. RESULTS Of 10 007 ED admissions, 779 (8%) were RTI cases; this proportion peaked in the month of January (11%). Medical records were available for 522 (67%) of these RTI cases. The median age was 28 years and 69% were males. The majority were pedestrians (69%) injured by an automobile (78%). On triage, 32% were classified as needing urgent/immediate intervention. Head injuries (20%) were the second most common injury after lower limb injuries (36%). ED outcomes were as follows: discharged (68%), hospitalised (17%), referred (17%) and died (1%). Among the 78 hospitalised cases, respectively 62% and 16% were admitted to the surgical and orthopaedic departments. Of 146 RTI cases with head injuries, 25% were hospitalised, of whom 82% were admitted to the surgical department. CONCLUSION Our findings can guide policy makers in referral hospitals in improving the planning of hospital resources and the prioritisation of public health needs linked to further urban development. A comprehensive plan to prevent RTIs, particularly among pedestrians in Addis Ababa, is urgently needed.
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Affiliation(s)
- S Getachew
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - E Ali
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - K Tayler-Smith
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - B Hedt-Gauthier
- Partners in Health/Inshuti Mu Buzima, Butaro, Burera District, Rwanda ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - W Silkondez
- National Tuberculosis Control Programme, Ministry of Health, Mbabane, Swaziland
| | - D Abebe
- Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - W Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - F Enquessilase
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - J K Edwards
- Médecins sans Frontières, Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg ; School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Wong JC, Linn KA, Shinohara RT, Mateen FJ. Traumatic brain injury in Africa in 2050: a modeling study. Eur J Neurol 2015; 23:382-6. [DOI: 10.1111/ene.12877] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J. C. Wong
- Department of Neurology; Massachusetts General Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
- Department of Neurology; Brigham and Women's Hospital; Boston MA USA
| | - K. A. Linn
- Department of Biostatistics and Epidemiology; University of Pennsylvania; Philadelphia PA USA
| | - R. T. Shinohara
- Department of Biostatistics and Epidemiology; University of Pennsylvania; Philadelphia PA USA
| | - F. J. Mateen
- Department of Neurology; Massachusetts General Hospital; Boston MA USA
- Harvard Medical School; Boston MA USA
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Mahdian M, Sehat M, Fazel MR, Moraveji A, Mohammadzadeh M. Epidemiology of Urban Traffic Accident Victims Hospitalized More Than 24 Hours in a Level III Trauma Center, Kashan County, Iran, During 2012-2013. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e28465. [PMID: 26101765 PMCID: PMC4475338 DOI: 10.5812/atr.4(2)2015.28465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/13/2015] [Accepted: 04/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Urban traffic accidents are an extensively significant problem in small and busy towns in Iran. This study tried to explore the epidemiological pattern of urban traffic accidents in Kashan and Aran-Bidgol cities, Iran. OBJECTIVES This study aimed to assess various epidemiological factors affecting victims of trauma admitted to a main trauma center in Iran. PATIENTS AND METHODS During a retrospective study, data including age, sex, injury type and pattern, outcome, hospital stay and treatment expenditures regarding urban Road Traffic Accidents (RTAs) for one year (March 2012-March 2013) were obtained from the registry of trauma research center, emergency medical services and deputy of health of Kashan University of Medical Sciences. One-way ANOVA and chi-square tests were used to analyze data using SPSS version 16.0. P value < 0.05 was considered significant. RESULTS A total of 1723 victims (82.6% male, sex ratio of almost 5:1) were considered in this study. Mortality rate in trauma cases hospitalized more than 24 hours during our study was 0.8%. Young motorcyclist men with the rate of more than 103 per 10000 were the most vulnerable group. The most common injury was head injury (73.6%) followed by lower limb injury (33.2%). A significant association was found between mechanism of injury and head, lower limb, multiple injuries and high risk age group. CONCLUSIONS Urban RTAs are one of the most important problems in Kashan and Aran-Bidgol cities, which impose a great economic burden on health system. Motorcyclists are the most vulnerable victims and multiple trauma and head injury are seen among them extensively.
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Affiliation(s)
- Mehrdad Mahdian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mojtaba Sehat
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mojtaba Sehat, Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3155620634, E-mail:
| | - Mohammad Reza Fazel
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Alireza Moraveji
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mahdi Mohammadzadeh
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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