Clinical Characteristics and Treatment of Patients with Traumatic Brain Injury in an Urban Referral Hospital in Uganda; Determining Opportunities for Improved Patient Care

Introduction: Traumatic Brain Injury(TBI) is a global health problem with higher morbidity and mortality in low-income countries(LICs). In Uganda, TBI is among the top ten leading causes of death.
The objective of the study was to investigate the clinical characteristics, treatment, and short-term outcomes of patients diagnosed with TBI, admitted at St. Francis Hospital, Nsambya (SFHN), Kampala, Uganda, an urban regional referral Hospital, offering private not-for-profit services including neurosurgical care.

Methods: We performed a retrospective cross-sectional study at SFHN, reviewing files of patients diagnosed with TBI admitted from January 2021 to December 2022. All our patients had a head CT scan done at diagnosis. We documented patient demographics, TBI causes, treatments, and patient outcomes at discharge.

Results: We admitted 350 patients with TBI, the median age was 29 (IQR;23-45) years, and 6% (21/350) were children under 18 years. Over three-quarters (272/350) of patients were male. Using the Glasgow Coma Score, 19%(68/350), 29% (101/350), and 52% (181/350) had severe, moderate, and mild TBI respectively. The majority of cases were caused by road traffic accidents 64%(225/350) or assaults 25%(88/350). 25%(88/350) of patients required neurological surgery, with half (43/88) of these patients requiring Craniotomy. The median time from admission to surgery was 12 (IQR; 9-24) hours. About one-third of patients (29/88) experienced surgery delays exceeding 24 hours, primarily attributed to financial constraints in 66% of patients or the unavailability of a neurosurgeon at admission in 34% of patients. Of all patients admitted with TBI, there were 13 deaths (4%) before discharge and all these patients had severe TBI at admission or required neurological surgery.

Conclusion : Most TBI victims are young adult males and mostly sustain these injuries due to road traffic accidents or assaults. Delays in surgery, often due to financial constraints or lack of a neurosurgeon on duty, were associated with adverse patient outcomes.