| dc.description.abstract |
<p>Traumatic brain injury (TBI) is a leading cause of death and disability worldwide
and this burden is increasing exponentially and will surpass many other diseases by
2020. The burden of TBI rests primarily in low and middle-income countries where they
are woefully under resourced. Kilimanjaro Christian Medical Center (KCMC) in Moshi,
Tanzania a neurosurgical referral center for 11 million people in the northwest of
the country represents many other under resourced settings as they have limited diagnostic
capacity (no computed tomography) and no trained neurosurgeon. In order to address
understand how to address the burden of TBI at KCMC this project aims to describe
the epidemiology and clinical presentation of TBI patients and determine predictors
of death. This information will inform the next step of creating a KCMC specific clinical
practice guideline or management plan for TBI patients in order to standardize and
improve clinical care. This project utilized a retrospective review of de-identified
data from a newly established Acute TBI Care Registry at KCMC that was developed for
quality improvement. Three months of data was extracted yielding 190 patients who
suffered TBI most of which were men (4:1 ratio) between 15 and 44 years of age and
were motorcycle drivers. Alcohol use at the time of injury occurred for 28% of the
patients almost exclusively among men. The mortality rates were high at 12% for all
patients, 13% for admitted patients, and over 70% for those admitted to the Intensive
Care Unit. Predictors of mortality were low Glasgow Coma scale on admission and hypotension.
Further analysis with a large sample size is necessary to understand the impact of
hypoxemia on mortality. Predictors of morbidity were low Glasgow Coma scale only.
Further analysis should be planned with a larger sample size in order to improve the
accuracy of these findings.</p>
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