Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda

World Neurosurg. 2017 Jun;102:571-582. doi: 10.1016/j.wneu.2017.03.001. Epub 2017 Mar 21.

Abstract

Objective: Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with mortality for patients with TBI at University Teaching Hospital of Kigali, Kigali, Rwanda.

Methods: A prospective consecutive sampling of patients with TBI presenting to University Teaching Hospital of Kigali Accident and Emergency Department was screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, and visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, and repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in a multivariate logistic regression model and refined via backward elimination.

Results: Between October 7, 2013, and April 6, 2014, 684 patients were enrolled; 14 (2%) were excluded because of incomplete data. Of patients, 81% were male with mean age of 31 years (range, 10-89 years; SD 11.8). Most patients (80%) had mild TBI (Glasgow Coma Scale [GCS] score 13-15); 10% had moderate (GCS score 9-12) and 10% had severe (GCS score 3-8) TBI. Multivariate logistic regression determined that GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were significantly associated with death.

Conclusions: GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality.

Keywords: Rwanda; Traumatic brain injury.

Publication types

  • Observational Study

MeSH terms

  • Accidents, Traffic
  • Adolescent
  • Adult
  • Aged
  • Bradycardia / mortality
  • Brain Injuries, Traumatic / mortality*
  • Child
  • Hospital Mortality
  • Hospitals, Teaching / statistics & numerical data
  • Hospitals, University / statistics & numerical data
  • Humans
  • Hypoxia / mortality
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Rwanda
  • Tachycardia / mortality
  • Young Adult