Epidemiology and Predictors of Mortality of Traumatic Brain Injury at Kigali University Teaching Hospital Accident and Emergency Department

Abstract

Background:Traumatic Brain Injury (TBI) is a leading cause of death and disability. TBI patients in low and middle- income countries (LMIC) have twice the odds of death than in high-income countries. There is limited data describing the epidemiology and mortality predictors for TBI in LMIC. Objective:Determine epidemiology and predictors of mortality in TBI patients at Kigali University Teaching Hospital Accident and Emergency Department (KUTH A&E). Methods:Consecutive, injured KUTH A&E patients were prospectively screened for inclusion by reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were <10 years old, presenting >48 hours after injury, or repeat visits. Data were assessed for association with death using logistic regression. Significant variables were included in an adjusted multivariable logistic regression model then refined via backwards elimination until all variables were significant at P <0.05.Results:684 patients enrolled between October 7, 2013 and April 6, 2014. 12 (2%) were excluded due to incomplete data. 81% were male with mean age of 31.5 years (range 10 - 89). Most patients (75%) had mild TBI (Glasgow Coma Score (GCS) 14-15), while 15% had moderate (GCS 9-13), and 10% had severe TBI (GCS 3-8). Multivariable logistic regression and refinement by backwards elimination determined that GCS <14, hypoxia, tachycardia and age >50 years predicted mortality.Conclusion:GCS <14, hypoxia, tachycardia and age >50 years were associated with mortality among TBI patients at KUTH A&E. These findings can guide clinicians in prioritizing care for patients at highest risk of mortality.