Abstract:

Background: Severe traumatic brain injury (TBI) is the number one cause of death and disability among young adults worldwide. In Europe and North America adherence to brain trauma foundation (BTF) guidelines is considered essential in the management of severe TBI and has reduced mortality. Prospective TBI data from Sub-Saharan Africa is sparse and compliance with BTF guidelines and risk factors associated with death are unknown.

Methods: Patients with TBI hospitalized at Bugando medical centre, a Tanzanian tertiary referral hospital were recorded in a prospective registry for quality improvement purposes. Demographics, clinical characteristics, hospital care, mortality were recorded for 14 days and on the day of discharge.

Results: Between October 2014 and October 2015, 67 severe traumatic brain injury patients were registered. Mean age was 30 years, and the majority were male (52/67, 77.61%). Road traffic injuries were the most common cause of injury (43/67, 64%). More than half of the patients (39/67, 66.1%) were hospitalized on the same day as their injury. CT imaging was performed 35.8% (24/67), and 26.887 (18/67) were admitted to the ICU. Continuous blood pressure monitoring and intracranial pressure (ICP) monitoring were not performed for any patient. Thirty four percent (23/67) received hyperosmolar therapy and 19.40% (13/67) underwent craniotomy. Two-week mortality was 47.76% (32/67).

Conclusion: Pre-hospital and routine ICU care, CT imaging, blood pressure and ICP monitoring are underutilized or unavailable in the management of severe TBI in the tertiary referral hospital setting. TBI associated mortality is significantly higher than that is high-income countries. Improving outcomes after severe TBI will require concerted investment in pre-hospital care as well as improvement in availability of neuroimaging ICU resources and expertise in multidisciplinary care.