Introduction: Traumatic Brain Injury (TBI) is the number one reason for death and disability in young adults worldwide. Accurate TBI data from sub-Saharan Africa are lacking. We describe TBI mortality at a Tanzanian referral hospital.
Methods: Patients with TBI admitted to the intensive care unit and to any ward were followed for 14 days or until discharge. The primary outcome was mortality. Univariate logistic regression was used to determine factors associated with death.
Results: Between September 2013 and March 2015, 162 patients were enrolled. The majority was male (84%). The most common cause of injury was road traffic accidents (66.1%). The median age was 28 years [IQR 15-42] for males and 38 years [IQR 25-50] for females. Severe TBI (GCS<9) occurred in 47%, moderate in 22%, and mild in 31% of patients. Of severe TBI 27.6% were admitted to the ICU. CT imaging was performed in 53% of all patients and 55.3% of patients with severe TBI. Neither intracranial pressure nor continuous blood pressure monitoring were available for any patient. Craniotomy was performed in 42.0%. Mortality for all TBI patients was 24% and 36.8% for severe TBI. The GCS of patients alive at discharge was 13.8 (+/- 2.0). Low GCS, abnormal pupils, and mechanical ventilation were associated with higher mortality.
Conclusions: TBI predominantly affects young males in Tanzania and mortality is more than twice that in developed countries. Our data indicate that routine ICU care, CT imaging, and ICP and blood pressure monitoring are underutilized or unavailable. This may contribute to the overall high mortality of patients with severe TBI in Tanzania. We are therefore working to increase access to these interventions in order to decrease the high mortality related to TBI in Tanzania.
Patient Care: Our findings highlight the burden of traumatic brain injury and the opportunity to improve basic treatment methods to decrease mortality.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the importance of traumatic brain injury as a global health problem 2) discuss in small groups the essential package of interventions necessary and available to care for patients with traumatic brain injury in an under resource setting 3) identify the current need for significant investment in traumatic brain injury treatment to decreased worldwide therapy.