Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda

Krebs, Elizabeth; Gerardo, Charles J.; Park, Lawrence P.; Vissoci, João Ricardo Nickenig; Byiringiro, Jean Claude; Byiringiro, Fidele; Rulisa, Stephen; Staton, Catherine A.; Thielman, Nathan M.

doi:10.1016/j.wneu.2017.03.001

Cited by 25 publications

(26 citation statements)

References 27 publications

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“…6 In Kigali, the capital city of Rwanda, TBIs are responsible for approximately 16% of injuries presenting to the University Teaching Hospital of Kigali (CHUK), with severe TBI patients having a mortality rate as high as 58%. 7,8 This made head injury the most common diagnosis in injury-related deaths in 2012. 8 The most common etiology of TBIs was found to be road traffic incidents (RTIs), which commonly involved motorcyclists and pedestrians.…”

Section: Introductionmentioning

confidence: 99%

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Rosenberg

Mukeshimana

Uwamahoro

et al. 2020

Prehosp. Disaster med.

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Introduction: Traumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d’Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda. Hypothesis/Problem: What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda? Methods: A retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data. Results: Patients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU. Conclusion: Currently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.

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Section: Introductionmentioning

confidence: 99%

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Rosenberg

Mukeshimana

Uwamahoro

et al. 2020

Prehosp. Disaster med.

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“…Injuries in Rwanda are associated with significant morbidity and mortality 5,6. Past studies in Rwanda have shown that most trauma victims are young men 5,6.…”

Section: Introductionmentioning

confidence: 99%

“…Injuries in Rwanda are associated with significant morbidity and mortality 5,6. Past studies in Rwanda have shown that most trauma victims are young men 5,6. Road traffic accidents (RTA), especially those involving motorcycles, were the most common mechanism for adults, while children were frequently injured as pedestrians 3.…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program

Mattson

Nteziryayo

Aluisio

et al. 2019

WestJEM

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Introduction: Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in lowand middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda. Methods: We conducted this pre-post study during two data collection periods at the UTH-K from November 2012 to July 2016. Data collection for MSI is limited and thus is specific to fractures. We included all patients with open, closed, or mixed fractures, hereafter referred to as MSI. Gathered information included demographics and outcomes including death, traumatic complications, and length of hospital stay, before and after the implementation of the EMTP. Results: We collected data from 3609 patients. Of those records, 691 patients were treated for fractures, and 674 of them had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). Patient demographics demonstrate that a majority of MSI cases are male (71.6% male vs 28.4% female) and young (64.3% below 35 years of age). Among mechanisms of injury, major causes included road traffic accidents (48.1%), falls (34.2%), and assault (6.0%). There was also an observed association between EMTP and trends of the three primary outcomes: a reduction of death in the emergency department (ED) from those with MSI by 89.9%, from 2.51% to 0.25% (p = 0.0077); a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p = 0.0211); and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p = 0.0437). Conclusion: This study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI. Residency training programs such as EMTP appear capable of reducing mortality, complications, and ED length of stay among those with MSI caused by fractures. Such findings underscore the efficacy and importance of investments in educating the next generation of health professionals to combat prevalent MSI within their communities. [

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“…Observational studies conducted in neighboring regions of Tanzania have found even higher proportions of surgery recipients among moderate and severe TBI patients [ 36 , 37 ]. Similar studies in Rwanda and Uganda have also documented higher rates of surgery among TBI patient cohorts [ 11 , 62 ]. It is possible that we observed a lower provision of surgery among our sample because patients in our registry did not need surgery.…”

Section: Discussionmentioning

confidence: 57%

An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country

et al. 2020

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Background Trauma is a leading cause of death and disability worldwide. In low-and middle-income countries (LMICs), trauma patients have a higher risk of experiencing delays to care due to limited hospital resources and difficulties in reaching a health facility. Reducing delays to care is an effective method for improving trauma outcomes. However, few studies have investigated the variety of care delays experienced by trauma patients in LMICs. The objective of this study was to describe the prevalence of pre-and in-hospital delays to care, and their association with poor outcomes among trauma patients in a low-income setting. Methods We used a prospective traumatic brain injury (TBI) registry from Kilimanjaro Christian Medical Center in Moshi, Tanzania to model nine unique delays to care. Multiple regression was used to identify delays significantly associated with poor in-hospital outcomes. Results Our analysis included 3209 TBI patients. The most common delay from injury occurrence to hospital arrival was 1.1 to 4.0 hours (31.9%). Most patients were evaluated by a physician within 15.0 minutes of arrival (69.2%). Nearly all severely injured patients needed and did not receive a brain computed tomography scan (95.0%). A majority of severely injured patients needed and did not receive oxygen (80.8%). Predictors of a poor outcome included delays to lab tests, fluids, oxygen, and non-TBI surgery.

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Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda

Cited by 25 publications

References 27 publications

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program

An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country

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