Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
Surgery Department, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
World Neurosurg. 2021 Jun;150:e316-e323. doi: 10.1016/j.wneu.2021.03.004. Epub 2021 Mar 8.
Traumatic brain injury (TBI) is an important cause of trauma-related mortality and morbidity in Ethiopia. There are significant resource limitations along the entire continuum of care, and little is known about the neurosurgical activity and patient outcomes.
All surgically treated TBI patients at the 4 teaching hospitals in Addis Ababa, Ethiopia were prospectively registered from October 2012 to December 2016. Data registration included surgical procedures, complications, reoperations, discharge outcomes, and mortality.
A total of 1087 patients were included. The most common procedures were elevation of depressed skull fractures (49.5%) and craniotomies (47.9%). Epidural hematoma was the most frequent indication for a craniotomy (74.7%). Most (77.7%) patients were operated within 24 hours of admission. The median hospital stay for depressed skull fracture operations or craniotomies was 4 days. Decompressive craniectomy was only done in 10 patients. Postoperative complications were seen in 17% of patients, and only 3% were reoperated. Cerebrospinal fluid leak was the most common complication (7.9%). The overall mortality was 8.2%. Diagnosis, admission Glasgow Coma Scale (GCS) score, surgical procedure, and complications were significant predictors of discharge GCS score (P < 0.01). Age, admission GCS score, and length of hospital stay were significantly associated with mortality (P ≤ 0.005).
The injury panorama, surgical activity, and outcome are significantly influenced by patient selection due to deficits within both prehospital and hospital care. Still, the neurosurgical services benefit a large number of patients in the greater Addis region and are qualitatively comparable with reports from high-income countries.
在埃塞俄比亚，创伤性脑损伤（TBI）是创伤相关死亡和发病的一个重要原因。在整个治疗过程中，资源都存在严重限制，人们对神经外科活动和患者结局知之甚少。
2012 年 10 月至 2016 年 12 月，前瞻性登记了埃塞俄比亚亚的斯亚贝巴 4 所教学医院所有接受手术治疗的 TBI 患者。数据登记包括手术程序、并发症、再次手术、出院结局和死亡率。
共纳入 1087 例患者。最常见的手术是凹陷性颅骨骨折抬高术（49.5%）和开颅术（47.9%）。硬膜外血肿是开颅术最常见的指征（74.7%）。大多数（77.7%）患者在入院后 24 小时内接受手术。凹陷性颅骨骨折手术或开颅术的中位住院时间为 4 天。仅对 10 例患者进行减压性颅骨切除术。17%的患者出现术后并发症，仅 3%的患者再次手术。脑脊液漏是最常见的并发症（7.9%）。总死亡率为 8.2%。诊断、入院格拉斯哥昏迷量表（GCS）评分、手术程序和并发症是出院 GCS 评分的显著预测因素（P<0.01）。年龄、入院 GCS 评分和住院时间与死亡率显著相关（P≤0.005）。
由于在院前和院内护理方面都存在缺陷，患者选择显著影响损伤情况、手术活动和结局。然而，神经外科服务使亚的斯亚贝巴地区的大量患者受益，并且在质量上与高收入国家的报告相当。
