Abstract
BackgroundIncreasing traumatic brain injury (TBI) has paralleled the need for decompression surgery for acute subdural (ASDH) and acute extradural haematoma (AEDH). Knowledge of key determinants of clinical outcomes of such patients is mandatory to guide treatment protocols.ObjectiveTo determine the 30-day clinical outcomes and predictor variables for patients with extra-axial hematomas at Mulago National Referral Hospital in Uganda.MethodsProspective observational cohort study of 109 patients with computed tomography (CT) confirmed extra-axial hematomas. Ethical clearance was obtained from the School of Medicine Research and Ethics Committee of College of Health Sciences, Makerere University (REC REF. 2018-185). Admitted patients were followed-up and reassessed for Glasgow Outcome Scale (GOS) and final disposition. Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence interval, regarding p < 0.05 as statistically significant.ResultsThe overall proportion of favorable outcome was 71.7% (n = 71), with 42.3% (n = 11) and 81.7% (n = 58) for ASDH and AEDH, respectively (p = 0.111). Factors associated with a favorable outcome were admission systolic BP > 90 mmHg [IRR = 0.88 (0.26–0.94) 95%CI, p = 0.032), oxygen saturation > 90% [IRR = 0.5 (0.26–0.94) 95%CI, p = 0.030] and diagnosis AEDH [IRR = 0.53 (0.30–0.92) 95%CI, p = 0.025). Moderate TBI [IRR = 4.57 (1.15–18.06) 95%CI, p = 0.03] and severe TBI [IRR = 6.79 (2.32–19.86) 95%CI, p < 0.001] were significantly associated with unfavorable outcomes.ConclusionThe study revealed that post resuscitation GCS, systolic BP, oxygen circulation, and diagnosis of AEDH at admission are the most important determinants of outcome for patients with extra-axial intracranial hematomas. These findings are valuable for the triaging teams in resource-constrained settings.
Highlights
As the number of general trauma casualties increase worldwide, so do the number of patients with traumatic brain injury (TBI)
Socio-demographic and clinical characteristics of patients with extra-axial hematoma at Mulago National Referral Hospital (NRH) Of the 109 recruits, 9.1% (n = 10) were lost to follow-up whereas 99 (90.8%) data were complete for analysis
At the time of admission, over 38.4% (n = 38) of participants had at least an episode of projectile vomiting, and 24.2% (n = 24) had a pre-hospital convulsion whereas 3.3% (n = 3) had Cerebral spinal fluid (CSF) rhinorrhea and or otorrhea
Summary
As the number of general trauma casualties increase worldwide, so do the number of patients with traumatic brain injury (TBI). Over 827 (21%) had some form of TBI of which 15.7% (130) had a clinical radiological diagnosis of acute subdural or extradural haematoma, increasing the number of craniotomies and craniectomies for extra-axial haematoma by 3-fold in a period of 1year. Whereas this in part could be due to increased skilled personnel and diagnostic technology, the treatment outcomes of such patients and how such injuries impact on their quality of life should be studied. Knowledge of key determinants of clinical outcomes of such patients is mandatory to guide treatment protocols
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