Profile and outcome of patients with traumatic brain injury in Rwanda

Abstract

Introduction: Traumatic Brain Injury (TBI) is one of the most severe types of injury and constitutes a significant public health problem globally. Road Traffic Accident is the most common cause of TBI mainly in low and middle income countries. TBI can range from mild to severe TBI with the later causing long term overwhelming impairments. Although we continue to encounter the challenges of this devastating condition, available literature has not given due attention on TBI in our settings.

Objectives: the aim of this study was to provide the profile and outcome of Traumatic Brain Injury in Rwanda. Methods: This is a prospective study from July 2018 to February 2019. This study was conducted at four referral hospitals in Rwanda (i.e. Centre Hospitalier Universitaire de Kigali, King Faisal Hospital, Rwanda Military Hospital and Centre Hospitalier Universitaire de Butare). This study was carried out in two phases. The first phase was two months’ enrolment of patients. The second phase was a prospective outcome assessment of enrolled patients. Ethical clearance was obtained from the IRB of the School of Medicine and Health Sciences of the University of Rwanda and ethics committee of the respective hospitals. Results and Analysis: There were 102 enrolled patients with TBI. The mean age was 28.6 years (Range 1-70). Male to female ratio was 3:1. Road traffic accident was responsible for 70% of all TBI, bicycle and motorcycle accidents were by far the leading mechanism of injury accounting for 82.8% of all road traffic accidents. The time between 17:00’ to 19:59’was by far the most frequent time to encounter RTA-related TBI. Majority of patients sustained mild TBI (65.7%), while moderate TBI and severe TBI accounted for18.6% and 15.7% respectively. The lesions found on CT scan were epidural hematoma in 25 patients (24.5%), brain contusion in 24 patients (23.5%) and acute subdural hematoma in 12 patients (11.7%).Patients from North and Western province were likely to have a delayed access to neurosurgical management. The mean duration of hospitalization was 8 days. The severity of TBI was an important determinant of length of hospitalization. The overall mortality rate was 11.1%. In addition, mortality increased with the severity of TBI, with mortality in severe TBI being 56.25% compared to 11% in moderate TBI and 0% in mild TBI respectively. Conclusion: This is the only multicenter TBI study that has extensively explored the profile and outcome of TBI in Rwanda. Stricter regulations of road traffic and better access to neurosurgical care are of paramount significance to address the burden of TBI in Rwanda