Challenges and Solutions for Traumatic Brain Injury Management in a Resource-Limited Environment: Example of a Public Referral Hospital in Rwanda

Arjun Ramesh,Byiringiro Fidele,Francis Fezeu,Shayan Moosa,Daryl R Gress ,Agabe E Nkusi ,J Forrest Calland ,Saidu Ibrahim Ngulde ,Robin T Petroze ,Jeffrey S Young ,Elizabeth Krebs ,Sévérien Muneza

doi:10.7759/cureus.179

Abstract

Objectives: We evaluated treatment strategies for traumatic brain injury (TBI) management in both a high-income country (HIC) (University of Virginia Health System) and a low-income country setting (Kigali University Teaching Hospital). Methods: A review of the literature was performed to identify current strategies of TBI management in low and middle-income country (LMIC) settings. Additionally, personal communications with the neurosurgery and trauma teams at the University of Virginia (UVA) Medical Center and the Kigali University Teaching Hospital (KUTH) in Rwanda were employed. Results: At UVA, there are specific TBI treatment guidelines in place; however, these guidelines are somewhat resource intensive and might not be appropriate in a resource-limited setting. There are unpublished national neurosurgical guidelines that include sections on TBI management, but most physicians informally surveyed were unaware of the existence of these guidelines. Notably, a contextually relevant, institution-specific TBI guideline is in the process of being developed at KUTH. Conclusion: In an LMIC, such as Rwanda, interventions aimed at reducing the incidence of TBI, as well as predictive models to help allocate treatment resources, will likely help to improve outcomes in the short-term. Long-term improvement to provide outcomes similar to those seen in HIC will rely on increasing the supply of scarce resources, including trained neurosurgeons.

Highlights

Traumatic brain injury (TBI) is defined as "an acute brain injury resulting from mechanicalHow to cite this article Ramesh A, Fezeu F, Fidele B, et al (May 09, 2014) Challenges and Solutions for Traumatic Brain Injury Management in a Resource-Limited Environment: Example of a Public Referral Hospital in Rwanda
If the patient did suffer from those symptoms, he or she is seen in consultation with physical medicine and rehabilitation, speech therapy, and occupational therapy and is followed as an outpatient according to the recommendations of the consultants [9]
We have a goal of intracranial pressure (ICP) monitor placement within two hours, and we empirically raise the head of the bed to 30 degrees, even without the ICP monitor in place [9]

Summary

Introduction

Traumatic brain injury (TBI) is defined as "an acute brain injury resulting from mechanicalHow to cite this article Ramesh A, Fezeu F, Fidele B, et al (May 09, 2014) Challenges and Solutions for Traumatic Brain Injury Management in a Resource-Limited Environment: Example of a Public Referral Hospital in Rwanda. TBI is a major healthcare concern, which does not show regional predilection, but is universally found to be more common in adolescent to young males than other epidemiologic groups [2]. It is a major cause of disability and mortality in those younger than 40 years of age [2]. The incidence of TBI in the United States (US) has been quoted as 200 per 100,000 population from the National Head and Spinal Cord Survey, resulting in an estimated $50 billion 1990 US dollars in direct and indirect costs [2]. There is a lack of consensus on the incidence of TBI in low and middle-income countries (LMIC) [1], but one study found the hospitalization rate of neurotrauma as 316 per 100,000 in South Africa, making it an area of highest incidence worldwide [2]

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Results

Discussion

Conclusion