Abstract
Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.
Highlights
Trauma is a serious global public health problem.[1]
In the EU, over 1.5 million people are admitted to hospital for traumatic brain injury (TBI) annually, with Austria and Germany reporting about eight times more admissions compared to Portugal and Spain
We report the adjusted odds ratio (AOR) for mortality, after controlling for age, gender, trauma severity, presence of hypoxemia, presence of comorbidity, pre-hospital time, type of transfer tertiary facility and access to pre-hospital care
Summary
Trauma is a serious global public health problem.[1] Traumatic injuries (TIs) are estimated to account for 10% of all deaths and about 5.8 million deaths annually and at least 6% of Years Lived with Disability (YLD).[2,3] Low and medium-income countries (LMICs) account for about 90% of this global trauma disease burden.[4] Globally, traumatic brain injury (TBI) is the leading form of TI burden.[1] Currently, about 69 million people suffer from TBI annually, mainly from road traffic injuries (RTIs), violence and falls.[7,8] The estimated economic cost of RTIs in Europe is substantially high with an approximate range of 7500-1,200,00 US dollars.[5] Young persons aged less than 40 years are the most affected.[6] In the EU, over 1.5 million people are admitted to hospital for TBI annually, with Austria and Germany reporting about eight times more admissions compared to Portugal and Spain. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving
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