Abstract

Background

Increasing traumatic brain injury (TBI) has paralleled the need for decompression surgery for acute subdural (ASDH) and acute extradural haematoma (AEDH). Knowledge of key determinants of clinical outcomes of such patients is mandatory to guide treatment protocols.

Objective

To determine the 30-day clinical outcomes and predictor variables for patients with extra-axial hematomas at Mulago National Referral Hospital in Uganda.

Methods

Prospective observational cohort study of 109 patients with computed tomography (CT) confirmed extra-axial hematomas. Ethical clearance was obtained from the School of Medicine Research and Ethics Committee of College of Health Sciences, Makerere University (REC REF. 2018-185). Admitted patients were followed-up and reassessed for Glasgow Outcome Scale (GOS) and final disposition. Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence interval, regarding p < 0.05 as statistically significant.

Results

The overall proportion of favorable outcome was 71.7% (n = 71), with 42.3% (n = 11) and 81.7% (n = 58) for ASDH and AEDH, respectively (p = 0.111). Factors associated with a favorable outcome were admission systolic BP > 90 mmHg [IRR = 0.88 (0.26–0.94) 95%CI, p = 0.032), oxygen saturation > 90% [IRR = 0.5 (0.26–0.94) 95%CI, p = 0.030] and diagnosis AEDH [IRR = 0.53 (0.30–0.92) 95%CI, p = 0.025). Moderate TBI [IRR = 4.57 (1.15–18.06) 95%CI, p = 0.03] and severe TBI [IRR = 6.79 (2.32–19.86) 95%CI, p < 0.001] were significantly associated with unfavorable outcomes.

Conclusion

The study revealed that post resuscitation GCS, systolic BP, oxygen circulation, and diagnosis of AEDH at admission are the most important determinants of outcome for patients with extra-axial intracranial hematomas. These findings are valuable for the triaging teams in resource-constrained settings.

Details

Title
Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda
Author
Ssebakumba, Mbaaga K 1 ; Lule Herman 2   VIAFID ORCID Logo  ; Olweny Francis 3 ; Mabweijano Jacqueline 4 ; Kiryabwire Joel 5 

1  Makerere University, Department of General Surgery, School of Medicine, College of Health Sciences, Kampala, Uganda (GRID:grid.11194.3c) (ISNI:0000 0004 0620 0548) 
2  Turku University Hospital and University of Turku, Turku Brain Injury Center, Division of Clinical Neural Sciences, Turku, Finland (GRID:grid.410552.7) (ISNI:0000 0004 0628 215X); Kampala International University Western Campus, Department of Surgery, Bushenyi, Uganda (GRID:grid.440478.b) (ISNI:0000 0004 0648 1247) 
3  Makerere University, Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Kampala, Uganda (GRID:grid.11194.3c) (ISNI:0000 0004 0620 0548) 
4  Mulago National Referral and Teaching Hospital, Department of Causality, Trauma and Emergency Medicine, Kampala, Uganda (GRID:grid.11194.3c) 
5  Mulago National Referral and Teaching Hospital, Department of Neurosurgery, Kampala, Uganda (GRID:grid.11194.3c) 
Publication year
2020
Publication date
Jan 2020
Publisher
Springer Nature B.V.
e-ISSN
2520-8225
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s41984-020-0073-4
ProQuest document ID
2344427004
Copyright
Egyptian Journal of Neurosurgery is a copyright of Springer, (2020). All Rights Reserved. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.