The Epidemiology and Predictors of Worse Outcome for Traumatic Brain Injury Patients at Kilimanjaro Christian Medical Center, Moshi Tanzania

Lynch, Catherine Ann
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Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and this burden is increasing exponentially and will surpass many other diseases by 2020. The burden of TBI rests primarily in low and middle-income countries where they are woefully under resourced. Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania a neurosurgical referral center for 11 million people in the northwest of the country represents many other under resourced settings as they have limited diagnostic capacity (no computed tomography) and no trained neurosurgeon. In order to address understand how to address the burden of TBI at KCMC this project aims to describe the epidemiology and clinical presentation of TBI patients and determine predictors of death. This information will inform the next step of creating a KCMC specific clinical practice guideline or management plan for TBI patients in order to standardize and improve clinical care. This project utilized a retrospective review of de-identified data from a newly established Acute TBI Care Registry at KCMC that was developed for quality improvement. Three months of data was extracted yielding 190 patients who suffered TBI most of which were men (4:1 ratio) between 15 and 44 years of age and were motorcycle drivers. Alcohol use at the time of injury occurred for 28% of the patients almost exclusively among men. The mortality rates were high at 12% for all patients, 13% for admitted patients, and over 70% for those admitted to the Intensive Care Unit. Predictors of mortality were low Glasgow Coma scale on admission and hypotension. Further analysis with a large sample size is necessary to understand the impact of hypoxemia on mortality. Predictors of morbidity were low Glasgow Coma scale only. Further analysis should be planned with a larger sample size in order to improve the accuracy of these findings.