Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design

BMC Surgery

Research

Martin N. Kaddumukasa¹  Mark Kaddumukasa¹  Godfrey S. Bbosa²  Moses Galukande³  Joel Kiryabwire⁴  Doomwin Oscar Deogratius Obiga⁴  Juliet Nalwanga Sekabunga⁴  Hervé Monka Lekuya⁵  Larrey Kasereka Kamabu⁶  Victor Meza Kyaruzi⁷  Daniel Deng⁸  Eugene J. Cho⁹  Anthony T. Fuller^1,10  Arsene Daniel Nyalundja^1,11  Louange Maha Kataka^1,12 

[1] Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda;Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda;Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda;Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda;Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda;Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda;Department of Human Structure & Repair/ Neurosurgery, Faculty of Medicine, Ghent University, Ghent, Belgium;Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda;Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo;Department of Surgery, Makerere University College of Health Medicine, Mulago Upper Hill, Kampala, Uganda;Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania;Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC, USA;Duke University, Durham, NC, USA;Duke University, Durham, NC, USA;Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC, USA;Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of the Congo;Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo;

关键词: Traumatic expansive intracranial hematomas;    Burden;    Risk factors;    Neurosurgical outcomes;    And predictors of mortality;   

DOI  :  10.1186/s12893-023-02227-9

 received in 2023-03-03, accepted in 2023-10-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundExpansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH).MethodsA total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant.ResultsOf the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH.ConclusionEIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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