Determinants of the outcome on traumatic brain injury patients at Kenyatta National Hospital

Abstract

Introduction: Traumatic brain injury (TBI) is among the leading causes of admissions in hospitals globally. TBI has been attributed with significant morbidity, mortality and disability. Most injuries have mainly been attributed to motor accidents and falls from heights.

Traumatic brain injuries represent a significant and growing disease burden in the developing world, and one of the leading causes of death in economically active adults in many low- and middle-income countries.

In Kenya, motor vehicle accidents, assaults and motorcycle are significant causes. Per vehicle mile travelled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving vehicles and 8 times more likely to be injured. neurological injury progresses over hours and days, resulting in a secondary injury. Inflammatory and neurotoxic processes result in vasogenic fluid accumulation within the brain, contributing to raised intracranial pressure, hypoperfusion, and cerebral ischaemia a secondary injury may be amenable to intervention. Almost one-third of patients who die after a TBI will talk or obey commands before their death.

Physiological insults, Hypoxia, hypotension, hyper - or hypocapnia, hyper - or hypoglycaemia have all been shown to increase the risk of secondary brain injury

Objectives: To determine the patients’ factor, clinical care and systems factor affecting outcome of Traumatic Brain Injury (TBI) patients at Kenyatta National Hospital. Which led to a poor outcome of above 40 years, casual laborers, Polytrauma and time lapse from trauma to hospitalization experienced. The clinical care factors indicating good outcome which included; diagnosis and medication, Nursing care and clinical setting A&E, CCU. Length of hospitalization >10 days. Protocols factors; Patients in surgical wards recording poor outcome.

Design: The rationale for using purposive sampling was to be able to distinguish between traumatic brain injury patients, who did not have any neurological problems before the injury, and those who had suffered neurological problems prior to trauma. A descriptive cross-sectional design, Purposive sampling and Quantitative approach to data collection, analysis and presentation was adopted.

Setting: The study was carried out at the Accident and Emergency department (A&E), Critical care unit (CCU) and surgical wards of Kenyatta National Hospital (KNH).

Subjects: Patients with TBI within 72 hours of injury, aged between 18- 65 years and should have had no previous neurological problem.

Results: Patient factors; that led to poor outcome; above 40 years (p=0.042), casual laborers (p=0.043), Polytrauma (p=0.042) and time lapse from trauma to hospitalization (p=0.051). The clinical care factors indicated good outcome which included; diagnosis and medication (p=0.001), Nursing care (p=0.055) and clinical setting A&E (p=0.051), CCU (p=0.032). Length of hospitalization >10 days (p=0.050). Protocols factors; Patients in surgical wards had poor outcome (p=0.051).

Conclusion: Patient factor's influenced outcome of TBI, Intensive care and longer time of hospitalization is paramount for better outcome.

Recommendation: Setup of a Trauma Neuro Ward and training of Neuro Teams to facilitate professional and quality care to improve outcome of Traumatic Brain Injury patients