Introduction: Trauma is a serious global health problem, accounting for more deaths than HIV, tuberculosis, and malaria combined [1]. In developed countries, prompt intervention has been shown to improve outcomes in head trauma [2-3]. However, due to unsafe roads, lack of emergency transport, and lack of surgical and critical care services, developing countries account for more than 90% of trauma-related deaths worldwide [4]. We are working to expand head trauma capacity at Mbarara Regional Referral Hospital in Uganda. Our goals are 1) to provide technical expertise in basic trauma neurosurgery; 2) to establish a baseline of needs and outcomes; and 3) to foster ongoing academic collaboration, infrastructure, and research skills, providing the foundation for further studies to improve trauma care on a larger scale.
Methods: We traveled to Mbarara with a cranial drill and trained the surgeons in its use and maintenance, as well as basic techniques such as exploratory burrholes and frontotemporal craniotomy. Additionally, we reviewed local needs and adapted published guidelines for management of acute head trauma. Finally, we established a plan for academic collaboration, beginning with an electronic data collection system that will allow tracking of outcomes.
Results: Despite limited resources, Mbarara Hospital cares for over 2,000 surgical admissions per year. Head trauma is the primary cause of mortality among surgical patients, causing 35% of deaths. The hospital is working to overcome barriers to providing effective trauma care. We have begun electronic data collection, and our group is be providing technical and administrative assistance including database creation and maintenance, research methodology, and statistical analysis. We hope to publish this data within the next 6 months to 1 year.
Conclusions: Neurosurgeons can help scale up head trauma care in low-resource countries by identifying specific needs, providing technical assistance, establishing sustainable data collection methods, and fostering academic infrastructure and collaboration with local surgeons.
Patient Care: By being involved in international health initiatives, neurosurgeons can contribute to improving trauma and critical care in developing countries.
Learning Objectives: 1. To show that neurosurgeons can make an important contribution to global health by identifying and addressing local needs.
2. To demonstrate the importance of data collection to quantify the burden of head trauma in developing countries, and gauge the success of interventions.
References: 1. Injuries and Violence: The Facts. World Health Organization. (Accessed December 17, 2011, at http://www.who.int/violence_injury_prevention/key_facts/en/index.html.)
2. Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 15. Surgical treatment of pediatric intracranial hypertension. Pediatr Crit Care Med 2003;4:S56-9.
3. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007;24 Suppl 1:S1-106.
4. Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet 2006;367:1533-40.