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

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

Author information

1
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: krebse@gmail.com.
2
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
3
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
4
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
5
University Teaching Hospital of Kigali, Kigali, Rwanda.
6
University Teaching Hospital of Kigali, Kigali, Rwanda; School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
7
Duke Global Health Institute, Duke University, Durham, North Carolina, USA.

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

PMID:
28336445
PMCID:
PMC5681277
DOI:
10.1016/j.wneu.2017.03.001
[Indexed for MEDLINE]
Free PMC Article

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