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3D.002 Delays and determinants of traumatic brain injury care outcome in low-income Uganda
  1. Scholar Herman Lule1,2,
  2. Mbaaga Ssebakumba3,
  3. Francis Olweny4,
  4. Jacquiline Mabweijano5,
  5. Joel Kiryabwire6
  1. 1Department of Surgery, Kampala International University P.O.Box 71, Bushenyi, Uganda
  2. 2Injury Epidemiology and Prevention (IEP) Research Group; P.O.Box 52; FI-20521 Turku, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Finland
  3. 3Department of General Surgery, School of Medicine, College of Health Sciences, Makerere University, P.o.Box 7072, Kampala, Uganda
  4. 4Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
  5. 5Department of Causality, Trauma and Emergency Medicine, Mulago National Referral and Teaching Hospital, P.o.Box 7051, Kampala, Uganda
  6. 6Department of Neurosurgery, Mulago National Referral Hospital and Teaching Hospital, P.o.Box 7051, Kampala, Uganda


Background Increasing traumatic brain injury (TBI) has paralleled need for decompression surgery for acute subdural (ASDH) and acute extradural haematoma (AEDH). Knowledge of key determinants of clinical outcomes inclusive of delays is mandatory to guide treatment protocols.

Objective To determine the thirty-day clinical outcomes and predictor variables for patients with extra-axial haematoma at Mulago National Referral Hospital in Uganda.

Methods Prospective observational cohort study of 109 patients with Computed Tomography (CT) confirmed extra-axial haematoma. Ethical Clearance was obtained from School of Medicine Research and Ethics Committee of Makerere University (REC REF. 2018–185). Admitted patients were followed-up for Glasgow Outcome Scale (GOS) and final disposition. Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence-interval, regarding p<0.05 as statistically significant.

Results No participant received surgery within six hours of decision making. The overall proportion of favourable outcome was 71.7% (n=71), with 42.3% (n=11) and 81.7% (n=58) for ASDH and AEDH respectively (p=0.111). Factors associated with a favourable outcome were: Admission Systolic BP>90 mmHg [IRR=0.88 (0.26–0.94) 95%CI, p=0.032), Oxygen saturation>90% [IRR=0.5 (0.26–0.94) 95%CI, p=0.030] and Diagnosis AEDH [IRR=0.53 (0.30–0.92) 95%CI, p= 0.025). Moderate [IRR=4.57 (1.15–18.06) 95%CI, P=0.03] and severe TBI [IRR=6.79 (2.32–19.86) 95%CI, p<0.001] were associated with unfavorable outcomes.

Conclusion The study revealed that amidst delays, post resuscitation GCS, Systolic BP, Oxygen circulation and diagnosis of AEDH at admission, are the most important determinants of outcome for patients with extra-axial intracranial haematoma. These findings are valuable for triaging teams in resource constrained settings.

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