Mangat Halinder S, Wu Xian, Gerber Linda M, Shabani Hamisi K, Lazaro Albert, Leidinger Andreas, Santos Maria M, McClelland Paul H, Schenck Hanna, Joackim Pascal, Ngerageza Japhet G, Schmidt Franziska, Stieg Philip E, Hartl Roger
Departments of1Neurology.
2Neurological Surgery, Weill Cornell Brain and Spine Institute, and.
J Neurosurg. 2021 Jan 22;135(4):1190-1202. doi: 10.3171/2020.8.JNS201243. Print 2021 Oct 1.
Given the high burden of neurotrauma in low- and middle-income countries (LMICs), in this observational study, the authors evaluated the treatment and outcomes of patients with severe traumatic brain injury (TBI) accessing care at the national neurosurgical institute in Tanzania.
A neurotrauma registry was established at Muhimbili Orthopaedic Institute, Dar-es-Salaam, and patients with severe TBI admitted within 24 hours of injury were included. Detailed emergency department and subsequent medical and surgical management of patients was recorded. Two-week mortality was measured and compared with estimates of predicted mortality computed with admission clinical variables using the Corticoid Randomisation After Significant Head Injury (CRASH) core model.
In total, 462 patients (mean age 33.9 years) with severe TBI were enrolled over 4.5 years; 89% of patients were male. The mean time to arrival to the hospital after injury was 8 hours; 48.7% of patients had advanced airway management in the emergency department, 55% underwent cranial CT scanning, and 19.9% underwent surgical intervention. Tiered medical therapies for intracranial hypertension were used in less than 50% of patients. The observed 2-week mortality was 67%, which was 24% higher than expected based on the CRASH core model.
The 2-week mortality from severe TBI at a tertiary referral center in Tanzania was 67%, which was significantly higher than the predicted estimates. The higher mortality was related to gaps in the continuum of care of patients with severe TBI, including cardiorespiratory monitoring, resuscitation, neuroimaging, and surgical rates, along with lower rates of utilization of available medical therapies. In ongoing work, the authors are attempting to identify reasons associated with the gaps in care to implement programmatic improvements. Capacity building by twinning provides an avenue for acquiring data to accurately estimate local needs and direct programmatic education and interventions to reduce excess in-hospital mortality from TBI.
鉴于低收入和中等收入国家（LMICs）神经创伤负担沉重，在这项观察性研究中，作者评估了在坦桑尼亚国家神经外科研究所接受治疗的重度创伤性脑损伤（TBI）患者的治疗情况及预后。
在达累斯萨拉姆的穆希姆比利骨科研究所建立了神经创伤登记处，纳入受伤后24小时内入院的重度TBI患者。记录患者在急诊科的详细情况以及随后的内科和外科治疗情况。测量两周死亡率，并与使用重型颅脑损伤后皮质类固醇随机化（CRASH）核心模型根据入院临床变量计算出的预测死亡率估计值进行比较。
在4.5年的时间里，共纳入462例重度TBI患者（平均年龄33.9岁）；89%为男性。受伤后平均到达医院的时间为8小时；48.7%的患者在急诊科接受了高级气道管理，55%的患者接受了头颅CT扫描，19.9%的患者接受了手术干预。不到50%的患者使用了颅内高压的分级药物治疗。观察到的两周死亡率为67%，比基于CRASH核心模型预期的高出24%。
坦桑尼亚一家三级转诊中心重度TBI的两周死亡率为67%，显著高于预测估计值。较高的死亡率与重度TBI患者连续护理过程中的差距有关，包括心肺监测、复苏、神经影像学检查和手术率，以及可用药物治疗的使用率较低。在正在进行的工作中，作者试图确定与护理差距相关的原因，以实施计划性改进。通过结对进行能力建设为获取数据提供了一条途径，以便准确估计当地需求，并指导计划性教育和干预措施，以降低TBI导致的过高住院死亡率。
