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撒哈拉以南非洲创伤性脑损伤的流行病学、管理及功能转归

Epidemiology, Management, and Functional Outcomes of Traumatic Brain Injury in Sub-Saharan Africa.

作者信息

Eaton Jessica, Hanif Asma Bilal, Grudziak Joanna, Charles Anthony

机构信息

UNC - Project Malawi, Lilongwe, Malawi.

Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi.

出版信息

World Neurosurg. 2017 Dec;108:650-655. doi: 10.1016/j.wneu.2017.09.084. Epub 2017 Sep 21.

Abstract

BACKGROUND

Trauma accounts for 4.7 million deaths each year, with an estimated 90% of these occurring in low- and middle-income countries (LMICs). Approximately half of trauma-related deaths are caused by central nervous system injury. Because a thorough understanding of traumatic brain injury (TBI) in LMICs is essential to mitigate TBI-related mortality, we established a clinical and radiographic database to characterize TBI in our low-income setting.

METHODS

This is a review of prospectively collected data from Kamuzu Central Hospital, a tertiary care center in the capital of Malawi. All patients admitted from October 2016 through May 2017 with a history of head trauma, altered consciousness, and/or radiographic evidence TBI were included. We performed descriptive statistics, a Cox regression analysis, and a survival analysis.

RESULTS

There were 280 patients who met inclusion criteria; of these, 80.5% were men. The mean age was 28.8 ± 16.3 years. Median Glasgow Coma Scale (GCS) score was 12 (interquartile range, 8-15). Road traffic crashes constituted the most common injury mechanism (60.7%). There were 148 (52.3%) patients who received a computed tomography scan, with the most common findings being contusions (26.1%). Of the patients, 88 (33.0%) had severe TBI, defined as a GCS score ≤8, of whom 27.6% were intubated and 10.3% received tracheostomies. Overall mortality was 30.9%. Of patients who survived, 80.1% made a good recovery. Female sex was protective, and the only significant predictor of poor functional outcome was presence of severe TBI (hazard ratio, 2.98; 95% confidence interval, 1.79-4.95).

CONCLUSIONS

TBI represents a significant part of the global neurosurgical burden of disease. Implementation of proven in-hospital interventions for these patients is critical to attenuate TBI-related morbidity and mortality.

摘要

背景

创伤每年导致470万人死亡,据估计其中90%发生在低收入和中等收入国家(LMICs)。约一半的创伤相关死亡由中枢神经系统损伤所致。由于全面了解低收入和中等收入国家的创伤性脑损伤(TBI)对于降低TBI相关死亡率至关重要,我们建立了一个临床和影像学数据库,以描述我们低收入环境中的TBI特征。

方法

这是一项对前瞻性收集的数据的回顾,数据来自马拉维首都的三级护理中心卡穆祖中央医院。纳入2016年10月至2017年5月期间入院的所有有头部创伤史、意识改变和/或TBI影像学证据的患者。我们进行了描述性统计、Cox回归分析和生存分析。

结果

有280名患者符合纳入标准;其中,80.5%为男性。平均年龄为28.8±16.3岁。格拉斯哥昏迷量表(GCS)中位数为12(四分位间距,8 - 15)。道路交通事故是最常见的损伤机制(60.7%)。148名(52.3%)患者接受了计算机断层扫描,最常见的发现是挫伤(26.1%)。在这些患者中,88名(33.0%)患有重度TBI,定义为GCS评分≤8,其中27.6%进行了插管,10.

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