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World Neurosurg. 2015 Mar;83(3):269-77. doi: 10.1016/j.wneu.2014.12.028. Epub 2014 Dec 19.

Distribution and characteristics of severe traumatic brain injury at Mulago National Referral Hospital in Uganda.

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Duke University Global Health Institute, Durham, North Carolina, USA.
Duke University Global Health Institute, Durham, North Carolina, USA; Duke University Medical School, Durham, North Carolina, USA.
Department of Neurosurgery, Mulago Hospital, Kampala, Uganda.
Duke University Global Health Institute, Durham, North Carolina, USA; Division of Neurosurgery, Department of Surgery, Duke University, Durham, North Carolina, USA. Electronic address:



Road traffic accidents are a leading cause of injury in low- and middle-income countries, where mortality rates are disproportionately higher. Patients with severe traumatic brain injury (TBI) tend to have very poor outcomes. To reduce the burden from severe TBI, we describe its distribution at Mulago National Referral Hospital (Kampala, Uganda) and identify the associations between outcomes and patient characteristics, offering insights into prevention and future research efforts to improve clinical care.


This is a single-institution, retrospective chart review including patients of all ages with a Glasgow Coma Scale (GCS) score of 8 or less (measured upon admission). A database was compiled to maximize all available clinical variables. Descriptive statistics and univariable and multivariable regression models were fitted to identify significant associations with outcome (died or discharged).


One hundred twenty patients were identified between July 1, 2008, and June 30, 2009. The cumulative incidence of admissions is 89 per 100,000. Thirty-one patients died in the hospital, yielding a 25.8% mortality rate. Motorcycle road traffic accident was the leading mechanism of injury, and males ages 15-29 years comprised the predominant demographic (42.5% of patients). Initial GCS, change in GCS score during hospital stay, and the presence of hematoma were strongest predictors of outcome.


Severe TBI was a common condition for injury-related hospital admissions at Mulago Hospital. The capacity for neurosurgery may have explained the relatively lower mortality rate than previously reported from Sub-Saharan Africa. Further investigations are needed. Targeted prevention programs focused on motorcycle users and helmet law enforcement should decrease the incidence of severe TBI.


Africa; Closed head injury; Epidemiology; Head injury; Incidence; Traumatic brain injuries

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