Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

Ssebakumba, Mbaaga K.; Herman, Lieve; Olweny, Francis; Mabweijano, Jacqueline; Kiryabwire, Joel

doi:10.1186/s41984-020-0073-4

Cited by 14 publications

(39 citation statements)

References 28 publications

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“…The most common cause of injury was road traffic collision (64.7%) followed by violence from assault and falls from height. These findings are similar to those of ( Ssebakumba et al, 2020 ) who in their study of subdural and extradural hematomas at Mulago National Referral Hospital in Uganda found that 52.6% were caused by road traffic crashes. Also in a study of causes of unintentional TBIs, Zia et al (2019) found that these were mainly due to road traffic crashes (88.9%) and falls (11.1%).…”

Section: Discussionsupporting

confidence: 91%

“…This compares with similar studies done in Uganda. In a study by Ssebakumba et al (2020) , the median age affected by TBI was 29 years (IQR 23–36) with a male:female ratio of 10:1. Another study by Tran et al (2015) found that males aged 15–29 years comprised the predominant demographic with a male:female ratio of 4.5:1.…”

Section: Discussionmentioning

confidence: 99%

“…Although these could contribute to the trauma death triad resulting from secondary brain ischemic insults, we were not able to do invasive intracranial pressure monitoring in our low resource setting but rather to provide the minimum affordable health care package of pulse-oximetry for oxygen circulation, fluids to correct hypotension, mannitol for cerebral edema, anti-convulsants and oxygenation. These measures had been proven to improve TBI outcomes in our setting ( Ssebakumba et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Adjusting the sample size for finite population, where Na is the adjusted population size, ne is the estimated sample size, and n is the population under study (120) Thus a sample size of 91 participants was considered. According to a cohort study that assessed the outcome of TBI patients with acute subdural and extradural hematoma at Mulago National Referral Hospital, 9.1% were lost to follow-up during 30 days period ( Ssebakumba et al, 2020 ). Adding 9.1% loss to follow-up to 91 yielded a final sample size of 99 participants.…”

Section: Methodsmentioning

confidence: 99%

“…In low-income country settings, severe TBI cases may not reach hospitals, which increases the likelihood of under-reporting ( Ssebakumba et al, 2020 ). In Uganda, head injuries are one of the top four most common admission diagnoses, contributing to 45.3% of patients admitted to intensive care units and 75% of the injury specific mortality rate ( Hsia et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

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Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda

Matovu

Kirya

Galukande

et al. 2021

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Background Traumatic brain injury (TBI) is a growing public health concern that can be complicated with an acute stress response. This response may be assessed by monitoring blood glucose levels but this is not routine in remote settings. There is a paucity of data on the prevalence of hyperglycemia and variables associated with mortality after severe TBI in Uganda. Objective We aimed to determine the prevalence of hyperglycemia in patients with severe TBI and variables associated with 30-day mortality at Mulago National Referral Hospital in Uganda. Methods We consecutively enrolled a cohort 99 patients patients with severe TBI. Serum glucose levels were measured at admission and after 24 h. Other study variables included: mechanism of injury, CT findings, location and size of hematoma, and socio-demographics. The main outcome was mortality after 30 days of management and this was compared in patients with hyperglycemia more than 11.1 mmol/L to those without. Results Most patients (92.9%) were male aged 18–30 years (47%). Road Traffic Collisions were the most common cause of severe TBI (64.7%) followed by assault (17.1%) and falls (8.1%). Nearly one in six patients were admitted with hyperglycemia more than 11.1 mmol/L. The mortality rate in severe TBI patients with hyperglycemia was 68.8% (OR 1.47; 95% CI [0.236–9.153]; P = 0.063) against 43.7% in those without hyperglycemia. The presence of hypothermia (OR 10.17; 95% CI [1.574–65.669]; P = 0.015) and convulsions (OR 5.64; 95% CI [1.541–19.554]; P = 0.009) were significant predictors of mortality. Conclusion Hypothermia and convulsions at admission were major predictors of mortality in severe TBI. Early hyperglycemia following severe TBI appears to occur with a tendency towards high mortality. These findings justify routine glucose monitoring and could form the basis for establishing a blood sugar control protocol for such patients in remote settings.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%