Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital

Abdelgadir, Jihad; Smith, Emily R.; Punchak, Maria; Vissoci, João Ricardo Nickenig; Staton, Catherine A.; Muhindo, Alex; Kitya, David; Park, Lawrence P.; Haglund, Michael M.

doi:10.1016/j.wneu.2017.03.019

Cited by 43 publications

(39 citation statements)

References 20 publications

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“…This study showed a shorter average length of hospital stay and the majority of patients spent less than 7 days from admission time contrasting to a study in Switzerland which was relatively longer. However, this study is comparable to another conducted in the same setting though in paediatrics population (5). We postulate our shorter average length of hospital stay was probably in uenced by untimely access to critical care services, hence early mortality.…”

Section: Length Of Hospital Staysupporting

confidence: 72%

“…Our study ndings were different from the study conducted at MRRH except for the length of hospital stay, which was relatively comparable. The difference could have been due to the study duration and study age group (5) Outcomes of Severe Traumatic Brain Injury…”

Section: Prevalence Of Severe Traumatic Brain Injurymentioning

confidence: 99%

“…Traumatic brain injury (TBI) is a common cause of death in Intensive Care Units and Emergency ward primarily caused by RTA (Road Tra c Accidents), followed by falls and assaults with severe traumatic brain injury (STBI) (GCS ≤ 8) estimated as a signi cant cause of neurological morbidity and mortality accounting for 1.5 million deaths annually (1)(2)(3)(4). According to different studies done in Uganda, TBI accounted for most of the neurosurgical admissions at 87.0% and mortality rate of 13.0% (5) while the prevalence of STBI was at 9.0% (6). In Tanzania, the prevalence of STBI was higher at 33.0% (7) and in Malawi and Burkina Faso, the prevalence of STBI was 33.0% and 14.0% respectively (8,9).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Glasgow Outcome Scale score of severe head injury in Mbarara regional referral hospital: A retrospective study

Odwar¹,

Okidi²,

Kayanga³

et al. 2020

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Background: Traumatic brain injury (TBI) is a common cause of death in the Intensive care units and emergency departments with an estimated annual global mortality of 1.5 million people as a result of severe TBI. The prevalence of TBI varies according to regions. Despite this, there is limited data on the outcomes of patients following severe traumatic brain injury in southwestern Uganda. Herein, we studied the prevalence and outcome of severe traumatic brain injury at Mbarara Regional Referral Hospital (MRRH) at discharge.Methods: A retrospective chart review of all TBI over six months (August 2016 - February 2017). The primary outcome was the Glasgow Outcome Scale (GOS) score at discharge. A favorable outcome was either good recovery or moderate disability while unfavorable outcome was severe disability, persistent vegetative state or death. Bivariate and multivariate logistic regression analyses were used to determine the factors associated with GOS score at discharge. Data were analyzed using STATA v13.0.Results: A total of 196 hospital records of TBI patients were reviewed, 80 (40.8%) patients had severe TBI, with the average length of hospital stay at 4.3 ± 2.9 days. The mean patients' age was 35 ± 14 years with the most affected age group being 18 - 34 years (58.8%). The GOS score at discharge were; death (42.5%), persistent vegetative state (0%), severe disability (1.3%), moderate disability (3.8%) and good recovery (52.5%). Pupil size and response had a dose-response relationship with unfavorable outcome when both pupils were dilated and non-reactive to light and had a higher odd ratio (OR=6.05) and strongly associated with unfavorable outcome (p=0.011). However, surgery and seizure prophylaxis were significantly associated with favorable outcome (p=0.033), (p=0.016) and a lesser odd ratio (OR=0.29),(OR=0.31) of having unfavorable outcome respectively. Conclusion: Mbarara regional referral hospital, the prevalence of STBI is still high. Both surgery and seizure prophylaxis were associated with favorable outcome at discharge. However, unfavorable outcome was mainly seen amongst patients who develop a complication.

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Section: Length Of Hospital Staysupporting

confidence: 72%

Section: Prevalence Of Severe Traumatic Brain Injurymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Glasgow Outcome Scale score of severe head injury in Mbarara regional referral hospital: A retrospective study

Odwar¹,

Okidi²,

Kayanga³

et al. 2020

Preprint

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“…In a study of all neurosurgical conditions conducted in southern Uganda, it was found that 76·1 per cent of TBI was in younger individuals aged 19–40 years, mainly men. The findings of the present study were similar, with 79·9 per cent of TBI occurring in people under 40 years of age, predominantly males.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting mortality after traumatic brain injury in a resource-poor setting

et al. 2019

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Background Traumatic brain injury (TBI) is a major cause of long‐term disability and economic loss to society. The aim of this study was to assess the factors affecting mortality after TBI in a resource‐poor setting. Methods Chart review was performed for randomly selected patients who presented with TBI between 2013 and 2017 at St Mary's Hospital, Lacor, northern Uganda. Data collected included demographic details, time from injury to presentation, and vital signs on arrival. In‐hospital management and mortality were recorded. Severe head injury was defined as a Glasgow Coma Scale score below 9. Results A total of 194 patient charts were reviewed. Median age at time of injury was 27 (i.q.r. 2–68) years. The majority of patients were male (M : F ratio 4·9 : 1). Some 30·9 per cent of patients had severe head injury, and an associated skull fracture was observed in 8·8 per cent. Treatment was mainly conservative in 94·8 per cent of patients; three patients (1·5 per cent) had burr‐holes, four (2·1 per cent) had a craniotomy, and three (1·5 per cent) had skull fracture elevation. The mortality rate was 33·0 per cent; 46 (72 per cent) of the 64 patients who died had severe head injury. Of the ten surgically treated patients, seven died, including all three patients who had a burr‐hole. In multivariable analysis, factors associated with mortality were mean arterial pressure (P = 0·012), referral status (P = 0·001), respiratory distress (P = 0·040), severe head injury (P = 0·011) and pupil reactivity (P = 0·011). Conclusion TBI in a resource‐poor setting remains a major challenge and affects mainly young males. Decisions concerning surgical intervention are compromised by the lack of both CT and intracranial pressure monitoring, with consequent poor outcomes.

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“…Further details about acquisition of data have been described elsewhere. 2 Approval for the study was obtained from Makerere University School of Medicine Research and Ethics Committee, Mbarara University of Science and Technology Research Ethics Committee, and Duke University Health System Institutional Review Board.…”

Section: Sample and Settingmentioning

confidence: 99%

Trends in neurosurgical care in Western Uganda: an interrupted time series analysis

Abdelgadir

Elahi

Corley

et al. 2018

Neurosurgical Focus

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OBJECTIVEIn addition to the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low- and middle-income countries, especially in Uganda. In this study, the authors aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda and assess the long-term impact of the institutional collaboration between Mulago National Referral Hospital and Duke University.METHODSAn interrupted time series is a quasi-experimental design used to evaluate the effects of an intervention on longitudinal data. The authors applied this design to evaluate the trends in monthly mortality rates for neurosurgery patients at Mbarara Regional Referral Hospital (MRRH) from March 2013 to October 2015. They used segmented regression and autoregressive integrated moving average models for the analysis.RESULTSOver the study timeframe, MRRH experienced significant increases in referrals received (from 117 in 2013 to 211 in 2015), neurosurgery patients treated (from 337 in 2013 to 625 in 2015), and operations performed (from 61 in 2013 to 173 in 2015). Despite increasing patient volumes, the hospital achieved a significant reduction in hospital mortality during 2015 compared to prior years (p value = 0.0039).CONCLUSIONSThis interrupted time series analysis study showed improving trends of neurosurgical care in Western Uganda. There is a steady increase in volume accompanied by a sharp decrease in mortality through the years. Multiple factors are implicated in the significant increase in volume and decrease in mortality, including the addition of a part-time neurosurgeon, improvement in infrastructure, and increased experience. Further in-depth prospective studies exploring seasonality and long-term outcomes are warranted.

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Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital

Cited by 43 publications

References 20 publications

Prevalence and Glasgow Outcome Scale score of severe head injury in Mbarara regional referral hospital: A retrospective study

Prevalence and Glasgow Outcome Scale score of severe head injury in Mbarara regional referral hospital: A retrospective study

Factors affecting mortality after traumatic brain injury in a resource-poor setting

Trends in neurosurgical care in Western Uganda: an interrupted time series analysis

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