Long-term follow-up of pediatric head trauma patients treated at Mulago National Referral Hospital in Uganda

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>There is a paucity of literature on long-term neurosurgical outcomes in sub-Saharan Africa, and as neurosurgical services expand in each country, it would be beneficial to understand the impact of these services on the national population. Since follow-up can be inconsistent, the authors here used the novel method of telephone surveys to conduct the first-ever long-term follow-up in Uganda to elucidate the outcomes of pediatric head trauma patients treated at the national referral hospital.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A prospectively maintained database of pediatric head trauma patients treated at the Mulago National Referral Hospital (MNRH) between 2014 and 2015 included 232 patients eligible for this study. Quality of life was assessed through phone surveys conducted by a Ugandan collaborator on site who performed all interviews with the guardian listed at the time of hospital admission, using each participant’s language.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Phone interviews were completed for 142 patients, resulting in a 61% response rate. Including inpatient deaths, the mortality rate was 10%. Almost half of the patients (48%) did not return to MNRH postdischarge, and 37% received no subsequent healthcare at all. Including inpatient deaths, the average Extended Glasgow Outcome Scale–Pediatric Revision (GOSE-Peds) scores for patients with severe, moderate, and mild head trauma were 5.68 ± 2.85, 4.79 ± 2.38, and 3.12 ± 2.08, respectively, at 1 year postinjury and 5.56 ± 2.58, 4.00 ± 2.45, and 2.21 ± 1.49, respectively, at 2 years postinjury.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>This first-ever long-term follow-up of pediatric head trauma patients in Uganda confirmed the feasibility of a novel phone follow-up method for patients throughout Uganda. The results at 2 years showed poor long-term recovery in patients who suffered moderate or severe head trauma but good recovery in patients who suffered mild head trauma. However, there was greater overall disability than that in comparable head trauma studies in the US. The current study lays the groundwork for phone follow-up in low- and middle-income countries as a viable way to obtain outcome data.</jats:p></jats:sec>

Psychosocial Quality of Life After Traumatic Brain Injury Among Children in Uganda&nbsp;

“…Of the different domains of psychosocial functioning, we found that social functioning was the most favorable outcome in our children. This compared closely with a previous study done earlier by Vaca et al in Mulago Hospital, who found that 91% of pediatric TBI patients reported being friendly at 1-year post-injury (8). We postulate that the good social outcome may be explained by the strong family and society ties that are still present in African settings.…”

“…We noted that patients with moderate and severe TBI were more likely to suffer from psychosocial de cits long after the injury. The negative effects of more severe forms of TBI have been exhaustively documented by other authors (6,8,16,21,23,24). Babikian et al in their meta-analysis reported that psychosocial functioning in children with severe TBI continued to deviate so greatly from an uninjured control at more than 2 years post-injury (22).…”

“…Preliminary studies in Uganda have shown that at 1-year post-injury 65% of TBI children had returned to baseline performance, and most children had a good social functioning at 1-year post-injury, andabout 28% of those children report some degree of physical disability (8). However, there are limited studies done to assess the overall psychosocial outcomes in children with TBI long after the injury.…”

Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury

“…Because long-term follow-up in LMICs can be challenging due to a lack of established infrastructure, we utilized previously validated phone surveys to assess long-term recovery of neurocognitive function to understand the risk of subsequent TBI-related sequelae. 11,17,18…”

Estimated incidence and case fatality rate of traumatic brain injury among children (0–18 years) in Sub-Saharan Africa. A systematic review and meta-analysis

“…After excluding duplicates, 200 articles were eligible. Thirty (30) complete articles were evaluated for eligibility and 13 papers (n = 40685) [ 4 , 17 , 12 , 23 – 32 ] met the inclusion criteria and were included in the final qualitative and meta-analysis. However, 4 studies [ 26 , 29 – 31 ] were included in the meta-analysis for the pooled incidence ( Fig 1 ).…”