Predictors of mortality among severe traumatic brain injury patients admitted at Mulago Hospital. A retrospective cross-sectional study

Abstract

Introduction Severe traumatic brain injury (STBI) contributes significantly to death and disability especially in low and middle income countries. However, little is known about the mortality rate and its predictors among these patients in Uganda. Therefore, the study aimed to assess mortality rate and its predictors among patients with STBI admitted at Mulago national referral Hospital. Methods.Record review of patients’ charts was performed for selected patients who presented with severe TBI between January 2022 to December 2022 at Mulago national referral Hospital, Uganda. In-hospital management and mortality were recorded. Severe head injury was defined as a Glasgow Coma Scale (GCS) score of 8 and below. Results. A total of 325 patient files were reviewed of which, 245 (75.4%) were male. Median age of the participants was 29 years. 37.5% were boda boda riders while 20.9% were alcohol users. Road traffic accidents (76.3%) was the main cause of TBI. 44.3% of the participants were admitted to High Dependence Unit (HDU), 23.4% to Intensive Care Unit (ICU) and 32.3% to the general ward. Proportion of mortality of the participants with severe TBI was 35.4%. The predictors of mortality for patients with severe TBI in this study were; admission GCS (RR=0.73, P<0.01, 95%CI=0.64-0.82), pupil size and reactivity (RR=1.31, P=0.01 95%CI=1.11-1.52) and destination ward of the patient on admission (RR=1.49, P=0.04, 95%CI=1.31-1.59). Conclusion.The proportion of deaths among patients with severe TBI was high. The predictors proposed by this study for this mortality were GCS less than 8, pupillary size and reactivity and final ward (disposition). Severe TBI in a resource-limited setting remains a major challenge and affects mainly young males. Key words: Severe Traumatic brain injury, Mortality rate, predictors. Mulago National Referral hospital.