Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
Neurosurgery Unit, Surgery Department, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
World Neurosurg. 2021 May;149:e460-e468. doi: 10.1016/j.wneu.2021.02.003. Epub 2021 Feb 7.
Traumatic brain injury (TBI) is a public health problem in Ethiopia. More knowledge about the epidemiology and neurosurgical management of TBI patients is needed to identify possible focus areas for quality improvement and preventive efforts.
This prospective cross-sectional study (2012-2016) was performed at the 4 teaching hospitals in Addis Ababa, Ethiopia. All surgically treated TBI patients were included, and data on clinical presentation, injury types, and trauma causes were collected.
We included 1087 patients (mean age 29 years; 8.7% females; 17.1% <18 years old). Only 15.5% of TBIs were classified as severe (Glasgow Coma Scale score 3-8). Depressed skull fracture (44.9%) and epidural hematoma (39%) were the most frequent injuries. Very few patients had polytrauma (3.1%). Assault was the most common injury mechanism (69.9%) followed by road traffic accidents (15.8%) and falls (8.1%). More than 80% of patients came from within 200 km of the hospitals, but the median time to admission was 24 hours. Most assault victims (80.4%) were injured >50 km from the hospitals, whereas 46% of road traffic accident victims came from the urban area. Delayed admission was associated with higher Glasgow Coma Scale scores and nonsevere TBI (P < 0.01).
The injury panorama, delayed admission, and small number of operations performed for severe TBI are linked to a substantial patient selection bias both before and after hospital admission. Our results also suggest that there should be a geographical framework for tailored guidelines, preventive efforts, and development of prehospital and hospital services.
创伤性脑损伤（TBI）是埃塞俄比亚的一个公共卫生问题。为了确定质量改进和预防工作的可能重点领域，需要更多关于 TBI 患者的流行病学和神经外科学管理的知识。
这是一项前瞻性的横断面研究（2012-2016 年），在埃塞俄比亚亚的斯亚贝巴的 4 所教学医院进行。所有接受手术治疗的 TBI 患者均被纳入研究，并收集了临床表现、损伤类型和创伤原因等数据。
我们共纳入了 1087 名患者（平均年龄 29 岁；女性占 8.7%；17.1%的患者<18 岁）。只有 15.5%的 TBI 被归类为严重（格拉斯哥昏迷量表评分为 3-8）。颅骨凹陷性骨折（44.9%）和硬膜外血肿（39%）是最常见的损伤。很少有患者有多发性创伤（3.1%）。袭击是最常见的损伤机制（69.9%），其次是道路交通意外（15.8%）和跌倒（8.1%）。超过 80%的患者来自距离医院 200 公里以内的地区，但入院的中位数时间为 24 小时。大多数袭击受害者（80.4%）受伤地点距离医院>50 公里，而 46%的道路交通意外受害者来自市区。延迟入院与格拉斯哥昏迷量表评分较高和非严重 TBI 相关（P<0.01）。
损伤情况、延迟入院以及严重 TBI 手术数量较少，与入院前和入院后的患者选择偏倚都有很大关系。我们的研究结果还表明，应该有一个地理框架，为量身定制的指南、预防工作以及院前和医院服务的发展提供指导。
