Departments of Emergency Medicineand Neurosurgery.
Department of Neurosurgery, Brown University, Providence, Rhode Island, USA.
World Neurosurg. 2024 Jun;186:e673-e682. doi: 10.1016/j.wneu.2024.04.028. Epub 2024 Apr 10.
Traumatic brain injury (TBI) is a leading contributor to emergency department (ED) mortalities in Ethiopia. Mild TBI patients comprise half of all TBI patients presenting for care in Ethiopia and have a high potential for recovery. As such, context-specific care-improving strategies may be highly impactful for this group of patients.
This study examines the presentation and disposition of mTBI patients who received a computed tomography scan of the head upon arrival at the largest teaching hospital in Ethiopia.
A retrospective cohort study was conducted from 2018 to2021 including patients >13 years old with a head injury and a Glasgow Coma Score of 13-15 who obtained a computed tomography scan of the head. Variables were collected from medical charts and single and multivariable analyses assessed outcomes of clinically important TBI (ciTBI) requiring a neurosurgical procedure or admission.
A total of 193 patients were included. They were predominantly young men with no comorbidities, injured in road traffic accidents or by assault, had stable vital signs and were treated in lower-acuity ED areas. A minority demonstrated focal deficits, and 29.5% of patients had ciTBI. Most patients were discharged from the ED, but 13% were taken for operative neurosurgical procedures and 10.4% were admitted to the neurosurgery ward for observation. ED stays ranged from 8 hours to 10 days, as patients waited for CT availability, neurosurgical decision, or transportation. Female sex was independently protective of ciTBI. Self-referral status was independently protective against operative intervention. Female sex and self-referral status were independently protective of a disposition of admission and/or going to the operating room.
This study characterizes the mTBI subgroup of head injury patients in Ethiopia's busiest ED: predominantly healthy young men with low-acuity presentations and only a fraction with abnormal neurological examinations. Nonetheless, about one-third had ciTBI and a minority were taken for neurosurgical procedures or admission, with female sex and self-referral identified as protective factors. Meanwhile, many patients stayed in the ED for days due to social or other nonmedical reasons. As TBI care in Ethiopia continues to improve, optimizing care for the mTBI subgroup is tantamount given their high recovery potential. This care will benefit from efficiently identifying those who need intervention or hospital level of care, and discharging those who do not.
在埃塞俄比亚，创伤性脑损伤（TBI）是导致急诊科（ED）死亡的主要原因。轻度 TBI 患者占所有 TBI 患者的一半，他们在埃塞俄比亚接受治疗，有很高的康复潜力。因此，针对这一群体的特定于情境的改善护理策略可能具有重大影响。
本研究检查了在埃塞俄比亚最大的教学医院就诊的轻度 TBI 患者在接受头部计算机断层扫描（CT）后的就诊和处置情况。
本研究为 2018 年至 2021 年期间进行的回顾性队列研究，纳入标准为年龄＞13 岁、头部受伤、格拉斯哥昏迷评分（GCS）为 13-15 分且接受头部 CT 扫描的患者。从病历中收集变量，并进行单变量和多变量分析，以评估需要神经外科手术或住院治疗的临床重要性 TBI（ciTBI）的结局。
共纳入 193 例患者。他们主要是年轻男性，没有合并症，在道路交通或袭击中受伤，生命体征稳定，在低危 ED 区域接受治疗。少数患者有局灶性缺陷，29.5%的患者有 ciTBI。大多数患者从 ED 出院，但 13%的患者接受了手术神经外科治疗，10.4%的患者因观察需要转入神经外科病房。ED 住院时间从 8 小时到 10 天不等，因为患者需要等待 CT 检查、神经外科决策或转运。女性为 ciTBI 的独立保护因素。自行转诊为手术干预的独立保护因素。女性和自行转诊为住院或手术的独立保护因素。
本研究描述了埃塞俄比亚最繁忙的 ED 中头部受伤患者的轻度 TBI 亚组：主要是健康的年轻男性，表现为低危，仅有少数患者出现异常神经检查。然而，约三分之一的患者有 ciTBI，少数患者接受神经外科手术或住院治疗，女性和自行转诊被确定为保护因素。同时，许多患者由于社会或其他非医疗原因在 ED 停留数天。随着埃塞俄比亚 TBI 护理的不断改善，优化对 mTBI 亚组的护理至关重要，因为他们有很高的康复潜力。这种护理将受益于有效地识别那些需要干预或医院级别的护理，并对那些不需要的患者进行出院处理。
