000			03150nam a22003857a 4500
003			OSt
005			20240305193745.0
008			221206b |||||||| |||| 00| 0 eng d
028			_b Phone: +255 28 298 3384
028			_bFax: +255 28 298 3386
028			_b Email: vc@bugando.ac.tz
028			_bWebsite: www.bugando.ac.tz
040			_bEnglish _cDLC
041			_aEnglish
100			_aLuke R Smart _923177
245			_aSevere traumatic brain injury at a tertiary referral Center in Tanzania: epidemiology and adherence to brain Trauma Foundation guidelines
260			_aMwanza, Tanzania: _bElsevier & _bCatholic University of Health and Allied Sciences [CUHAS – Bugando] _c2017/9/1
300			_aPages 238-248
490			_v World neurosurgery Volume 105
520			_aAbstract: Background: Severe traumatic brain injury (TBI) is a major cause of death and disability worldwide. Prospective TBI data from sub-Saharan Africa are sparse. This study examines epidemiology and explores management of patients with severe TBI and adherence to Brain Trauma Foundation Guidelines at a tertiary care referral hospital in Tanzania. Methods: Patients with severe TBI hospitalized at Bugando Medical Centre were recorded in a prospective registry including epidemiologic, clinical, treatment, and outcome data. Results: Between September 2013 and October 2015, 371 patients with TBI were admitted; 33% (115/371) had severe TBI. Mean age was 32.0 years ± 20.1, and most patients were male (80.0%). Vehicular injuries were the most common cause of injury (65.2%). Approximately half of the patients (47.8%) were hospitalized on the day of injury. Computed tomography of the brain was performed in 49.6% of patients, and 58.3% were admitted to the intensive care unit. Continuous arterial blood pressure monitoring and intracranial pressure monitoring were not performed in any patient. Of patients with severe TBI, 38.3% received hyperosmolar therapy, and 35.7% underwent craniotomy. The 2-week mortality was 34.8%. Conclusions: Mortality of patients with severe TBI at Bugando Medical Centre, Tanzania, is approximately twice that in high-income countries. Intensive care unit care, computed tomography imaging, and continuous arterial blood pressure and intracranial pressure monitoring are underused or unavailable in the tertiary referral hospital setting. Improving outcomes after severe TBI will require concerted investment in prehospital care and improvement in availability of intensive care unit resources, computed tomography, and expertise in multidisciplinary care.
700			_a Roger Härtl _946672
700			_a Philip E Stieg _946673
700			_a Malik Fakhar _946674
700			_a Isidore Ngayomela _946675
700			_a Robert N Peck _922982
700			_a Xian Wu _946676
700			_aLinda M Gerber _946677
700			_a Halinder S Mangat _946678
700			_aEmmanuel Kanumba _946679
700			_a Benson Issarow _946680
700			_aGerald Mayaya _946681
700			_a Paul McClelland _946682
856			_uhttps://doi.org/10.1016/j.wneu.2017.05.101
942			_2ddc _cVM
999			_c19920 _d19920