Effectiveness of clinical practice guidelines for acute management of traumatic brain injury at a regional referral hospital in Tanzania

Catherine A Staton 1,2, Samara Fox, Cyrus Elahi 2, Sarah Williams, Mark Mvungi 4, Frida Shayo , Mwemezi Kaino 4 4, Michael M Haglund 2, Randi H Griffin 6, Blandina T Mmbaga 2,5, Joao Ricardo Nickenig Vissoci
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Traumatic brain injury (TBI) is a significant cause of death and disability worldwide that disproportionately affects low- and middle-income countries where increasing injury rates are compounded by limited access to high quality care. Our study evaluated the impact of implementing TBI clinical practice guidelines (CPGs), proven intervention in high resource settings, on patient outcomes and health care provider knowledge at a low-resourced referral hospital in Moshi, Tanzania. Methods We used a pre-post quasi-experimental design to assess the impact of TBI CPGs implementation. An interrupted time series was used to compare pre/post-implementation TBI outcome trends and our primary outcome of interest was poor recovery (death or severe disability). Pre and post periods included 24 and 9 months respectively. Data was analyzed using segmented regression and an autoregressive integrated moving average (ARIMA) model. Healthcare providers were recruited to participate in pre/post surveys assessing knowledge of acute TBI management. Changes in pre/post scores were assessed using Wilcoxon signed-rank and McNemar’s



Pre-and post-implementation periods included 1438 and 448 patients respectively. Age, gender, and average GCS were not significantly different pre/post implementation. Poor recovery rate decreased from 15.4% to 12.1% after implementation. The segmented regression model found an increasing TBI poor recovery rate (PRR) prior to implementing CPGs (P 0.038) and a significant decrease in PRR after the implementation (P 0.005). The ARIMA model estimated 1.7% decrease in PRR per month after implementation. There was a significant improvement in provider knowledge scores post-intervention (Wilcoxon signed-rank test, P 0.001).


In addition to improved patient outcomes, this study observed significant improvement of health care provider knowledge regarding acute management of TBI patients following implementation of TBI CPGs. Findings provide encouraging results regarding the potential applicability and implementation capacity of TBI CPGs in resource-limited settings however more research is necessary to better understand the effects of implementing CPGs on health care delivery and patient outcomes.