1School of Medicine and.
2Department of Neurosurgery, Stanford University, Palo Alto, California.
J Neurosurg. 2020 Jul 3;134(6):1929-1939. doi: 10.3171/2020.4.JNS193092. Print 2021 Jun 1.
Traumatic brain injury (TBI) is a major cause of mortality and morbidity in Uganda and other low- and middle-income countries (LMICs). Due to the difficulty of long-term in-person follow-up, there is a paucity of literature on longitudinal outcomes of TBI in LMICs. Using a scalable phone-centered survey, this study attempted to investigate factors associated with both mortality and quality of life in Ugandan patients with TBI.
A prospective registry of adult patients with TBI admitted to the neurosurgical ward at Mulago National Referral Hospital was assembled. Long-term follow-up was conducted between 10.4 and 30.5 months after discharge (median 18.6 months). Statistical analyses included univariable and multivariable logistic regression and Cox proportional hazards regression to elucidate factors associated with mortality and long-term recovery.
A total of 1274 adult patients with TBI were included, of whom 302 (23.7%) died as inpatients. Patients who died as inpatients received surgery less frequently (p < 0.001), had more severe TBI at presentation (p < 0.001), were older (p < 0.001), and were more likely to be female (p < 0.0001). Patients presenting with TBI resulting from assault were at reduced risk of inpatient death compared with those presenting with TBI caused by road traffic accidents (OR 0.362, 95% CI 0.128-0.933). Inpatient mortality and postdischarge mortality prior to follow-up were 23.7% and 9%, respectively. Of those discharged, 60.8% were reached through phone interviews. Higher Glasgow Coma Scale score at discharge (continuous HR 0.71, 95% CI 0.53-0.94) was associated with improved long-term survival. Tracheostomy (HR 4.38, 95% CI 1.05-16.7) and older age (continuous HR 1.03, 95% CI 1.009-1.05) were associated with poor long-term outcomes. More than 15% of patients continued to suffer from TBI sequelae years after the initial injury, including seizures (6.1%) and depression (10.0%). Despite more than 60% of patients seeking follow-up healthcare visits, mortality was still 9% among discharged patients, suggesting a need for improved longitudinal care to monitor recovery progress.
Inpatient and postdischarge mortality remain high following admission to Uganda's main tertiary hospital with the diagnosis of TBI. Furthermore, posttraumatic sequelae, including seizures and depression, continue to burden patients years after discharge. Effective scalable solutions, including phone interviews, are needed to elucidate and address factors limiting in-hospital capacity and access to follow-up healthcare.
创伤性脑损伤（TBI）是乌干达和其他中低收入国家（LMICs）死亡和发病的主要原因。由于长期亲自随访困难，因此关于 LMICs 中 TBI 的纵向结果的文献很少。本研究使用可扩展的以手机为中心的调查，试图调查与乌干达 TBI 患者的死亡率和生活质量相关的因素。
组装了在马拉戈国家转诊医院神经外科病房住院的成年 TBI 患者的前瞻性登记处。出院后进行了 10.4 至 30.5 个月的长期随访（中位数 18.6 个月）。统计分析包括单变量和多变量逻辑回归以及 Cox 比例风险回归，以阐明与死亡率和长期恢复相关的因素。
共纳入 1274 例成年 TBI 患者，其中 302 例（23.7％）在住院期间死亡。住院期间死亡的患者接受手术的频率较低（p <0.001），入院时 TBI 更严重（p <0.001），年龄较大（p <0.001），更可能是女性（p <0.0001）。与因道路交通意外引起的 TBI 患者相比，因袭击而引起的 TBI 患者的住院死亡风险降低（OR 0.362，95％CI 0.128-0.933）。住院死亡率和出院前的出院后死亡率分别为 23.7％和 9％。出院的患者中有 60.8％通过电话访谈联系。出院时格拉斯哥昏迷量表评分较高（连续 HR 0.71，95％CI 0.53-0.94）与长期生存改善相关。气管切开术（HR 4.38，95％CI 1.05-16.7）和年龄较大（连续 HR 1.03，95％CI 1.009-1.05）与预后不良相关。初始损伤后数年，超过 15％的患者仍患有 TBI 后遗症，包括癫痫发作（6.1％）和抑郁（10.0％）。尽管超过 60％的患者寻求随访医疗就诊，但出院患者的死亡率仍为 9％，这表明需要改善纵向护理以监测康复进展。
在乌干达主要的三级医院入院诊断为 TBI 后，住院和出院后的死亡率仍然很高。此外，外伤性后遗症，包括癫痫发作和抑郁，在出院后多年仍困扰着患者。需要有效的可扩展解决方案，包括电话访谈，以阐明和解决限制住院能力和获得后续医疗保健的因素。
