Authors: Seul Ku; Silvia Vaca, BS; Bina Kakusa, BS; Linda Xu, MD; Arjun Pendharkar, MD; Juliet Nalwanga; Joel Kiryabwire; Hussein Ssenyonjo; John Mukasa; Michael Muhumuza; Michael Haglund; Gerald Grant, MD (Palo Alto, CA)
Neurosurgical outcomes studies in low- and middle-income countries (LMICs) are limited despite global health efforts to increase availability of neurosurgical services. This study evaluates long-term outcomes of traumatic brain injury (TBI) patients presenting to Mulago National Referral Hospital (MNRH) neurosurgery ward in Uganda.
A prospective database of 1274 TBI patients presenting to MNRH from 2014-2015 was reviewed for in-patient clinical data. Patients available for follow-up were reached through phone survey in the participant’s language.
Of 1274 adult patients, 302 (23.7%) died in-patient with higher mortality rates amongst patients with increased age and lower admission Glasgow Coma Scale (GCS) score. These patients were also less likely to have received surgical treatment.
Of the 972 discharged patients, 591 (61%) patients were available at follow-up, of whom 53 (9%) were deceased. Median survival was 18.6 months and 5 months for patients alive and deceased at follow-up, respectively. Deceased patients were more likely to be older, have needed a tracheostomy in-patient, have had lower admission and discharge GCS, and had a longer median length of stay. Patient age (HR: 1.03, 95% CI: 1.009-1.05), in-patent tracheostomy (HR: 4.38; 1.05-16.7) and discharge GCS (HR: 0.71, 0.53-0.94) remained significant predictors of survival time in multivariate analyses. There were no differences in outcomes based on surgical interventions.
Only 63.8% of the surviving patients followed-up with a health care provider after their initial hospitalization. Patients with moderate to severe disability were more likely to seek follow-up care compared to those in recovery (p < .0001).
Age, tracheostomy placement, and discharge GCS were significant predictors of survival, whereas surgical intervention was not. Further research efforts are needed to track patient outcomes and validate the beneficial impact of global health efforts in neurosurgery. This study establishes a baseline for ongoing tracking of head trauma outcomes in Uganda.