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Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury.

Publication ,  Journal Article
Jin, MC; Kakusa, B; Ku, S; Vaca, SD; Xu, LW; Nalwanga, J; Kiryabwire, J; Ssenyonjo, H; Mukasa, J; Muhumuza, M; Fuller, AT; Haglund, MM; Grant, GA
Published in: J Neurosurg
July 3, 2020

OBJECTIVE: Traumatic brain injury (TBI) is a major cause of mortality and morbidity in Uganda and other low- and middle-income countries (LMICs). Due to the difficulty of long-term in-person follow-up, there is a paucity of literature on longitudinal outcomes of TBI in LMICs. Using a scalable phone-centered survey, this study attempted to investigate factors associated with both mortality and quality of life in Ugandan patients with TBI. METHODS: A prospective registry of adult patients with TBI admitted to the neurosurgical ward at Mulago National Referral Hospital was assembled. Long-term follow-up was conducted between 10.4 and 30.5 months after discharge (median 18.6 months). Statistical analyses included univariable and multivariable logistic regression and Cox proportional hazards regression to elucidate factors associated with mortality and long-term recovery. RESULTS: A total of 1274 adult patients with TBI were included, of whom 302 (23.7%) died as inpatients. Patients who died as inpatients received surgery less frequently (p < 0.001), had more severe TBI at presentation (p < 0.001), were older (p < 0.001), and were more likely to be female (p < 0.0001). Patients presenting with TBI resulting from assault were at reduced risk of inpatient death compared with those presenting with TBI caused by road traffic accidents (OR 0.362, 95% CI 0.128-0.933). Inpatient mortality and postdischarge mortality prior to follow-up were 23.7% and 9%, respectively. Of those discharged, 60.8% were reached through phone interviews. Higher Glasgow Coma Scale score at discharge (continuous HR 0.71, 95% CI 0.53-0.94) was associated with improved long-term survival. Tracheostomy (HR 4.38, 95% CI 1.05-16.7) and older age (continuous HR 1.03, 95% CI 1.009-1.05) were associated with poor long-term outcomes. More than 15% of patients continued to suffer from TBI sequelae years after the initial injury, including seizures (6.1%) and depression (10.0%). Despite more than 60% of patients seeking follow-up healthcare visits, mortality was still 9% among discharged patients, suggesting a need for improved longitudinal care to monitor recovery progress. CONCLUSIONS: Inpatient and postdischarge mortality remain high following admission to Uganda's main tertiary hospital with the diagnosis of TBI. Furthermore, posttraumatic sequelae, including seizures and depression, continue to burden patients years after discharge. Effective scalable solutions, including phone interviews, are needed to elucidate and address factors limiting in-hospital capacity and access to follow-up healthcare.

Duke Scholars

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Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

July 3, 2020

Volume

134

Issue

6

Start / End Page

1929 / 1939

Location

United States

Related Subject Headings

  • Young Adult
  • Uganda
  • Treatment Outcome
  • Time Factors
  • Registries
  • Quality of Life
  • Prospective Studies
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Middle Aged
 

Citation

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Jin, M. C., Kakusa, B., Ku, S., Vaca, S. D., Xu, L. W., Nalwanga, J., … Grant, G. A. (2020). Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury. J Neurosurg, 134(6), 1929–1939. https://doi.org/10.3171/2020.4.JNS193092
Jin, Michael C., Bina Kakusa, Seul Ku, Silvia D. Vaca, Linda W. Xu, Juliet Nalwanga, Joel Kiryabwire, et al. “Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury.J Neurosurg 134, no. 6 (July 3, 2020): 1929–39. https://doi.org/10.3171/2020.4.JNS193092.
Jin MC, Kakusa B, Ku S, Vaca SD, Xu LW, Nalwanga J, et al. Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury. J Neurosurg. 2020 Jul 3;134(6):1929–39.
Jin, Michael C., et al. “Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury.J Neurosurg, vol. 134, no. 6, July 2020, pp. 1929–39. Pubmed, doi:10.3171/2020.4.JNS193092.
Jin MC, Kakusa B, Ku S, Vaca SD, Xu LW, Nalwanga J, Kiryabwire J, Ssenyonjo H, Mukasa J, Muhumuza M, Fuller AT, Haglund MM, Grant GA. Long-term follow-up of neurosurgical outcomes for adult patients in Uganda with traumatic brain injury. J Neurosurg. 2020 Jul 3;134(6):1929–1939.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

July 3, 2020

Volume

134

Issue

6

Start / End Page

1929 / 1939

Location

United States

Related Subject Headings

  • Young Adult
  • Uganda
  • Treatment Outcome
  • Time Factors
  • Registries
  • Quality of Life
  • Prospective Studies
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Middle Aged