PW 2509 Time to treatment for traumatic brain injury patients in moshi, tanzania. (November 2018) - Vissoci, Joao Ricardo Nickenig
Abstract : Background: Annually, over 10 million people worldwide suffer a traumatic brain injury (TBI). Using Kilimanjaro Christian Medical Center's (KCMC) TBI Clinical Registry, we aim to evaluate the impact of time to treatment for TBI patients presenting to the KCMC emergency department. Method: A secondary analysis of all KCMC TBI Registry patients between May 2013-August 2016 included demographics, vital signs, Glasgow Coma Score (severe 3–8, moderate 9–12 or mild 13–15), time to critical interventions and Glasgow Outcome Score (GOS) (poor 1–3, good 4–5). We use descriptive statistics and linear regression analysis to assess for associations with improved GOS. Results: Of the 3209 total patients, most (82.1%) were males who suffered road traffic injuries (67.4%) with an average age of 32.1 (SD16.6). 386 (12%) patients had a severe TBI, GCS 3–8. 2798 (87%) of patients saw a physician within one hour of arrival and 1267 (39.5%) had lab testing within an hour of seeing a physician. Overall, 10.15% of patients had poor outcome. Linear regression analysis showed that moderate and severe GCS were the largest predictors of a poor outcome with OR of 8.4 (5.8–12.2) and 38.8 (28.6–53.1) respectively. When stratifying by GCS, for moderate and severe GCS patients, delay or absence of receiving a CT scan (OR 2.3, 1.6–8.5) and oxygen (OR 2.7, 1.15–6.7) were associated with poor outcomes. Conclusions: Most TBI patients at KCMC are young men, suffering road traffic injuries and who see a physician within one hour of arrival at the hospital. Initial GCS is the best predictor of a poor outcome. Delay to CT scan and oxygen were predictors of poor outcome for patients with moderate and severe GCS.