Delays in emergency department intervention for patients with traumatic brain injury in Uganda

Amber Mehmood; Armaan Ahmed Rowther; Olive Kobusingye; Hussein Ssenyonjo; Nukhba Zia; Adnan A Hyder

doi:10.1136/tsaco-2021-000674

Delays in emergency department intervention for patients with traumatic brain injury in Uganda

Trauma Surg Acute Care Open. 2021 Aug 26;6(1):e000674. doi: 10.1136/tsaco-2021-000674. eCollection 2021.

Authors

Amber Mehmood^{1

2}, Armaan Ahmed Rowther³, Olive Kobusingye⁴, Hussein Ssenyonjo⁵, Nukhba Zia², Adnan A Hyder⁶

Affiliations

¹ College of Public Health, University of South Florida, Tampa, Florida, USA.
² International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
³ Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁴ Trauma, Injury, & Disability Unit, Makerere University's School of Public Health, Kampala, Uganda.
⁵ Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
⁶ Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.

Abstract

Background: In Sub-Saharan African countries, the incidence of traumatic brain injury (TBI) is estimated to be many folds higher than the global average and outcome is hugely impacted by access to healthcare services and quality of care. We conducted an analysis of the TBI registry data to determine the disparities and delays in treatment for patients presenting at a tertiary care hospital in Uganda and to identify factors predictive of delayed treatment initiation.

Methods: The study was conducted at the Mulago National Referral Hospital, Kampala. The study included all patients presenting to the emergency department (ED) with suspected or documented TBI. Early treatment was defined as first intervention within 4 hours of ED presentation-a cut-off determined using sensitivity analysis to injury severity. Descriptive statistics were generated and Pearson's χ² test was used to assess the sample distribution between treatment time categories. Univariable and multivariable logistic regression models with <0.05 level of significance were used to derive the associations between patient characteristics and early intervention for TBI.

Results: Of 3944 patients, only 4.6% (n=182) received an intervention for TBI management within 1 hour of ED presentation, whereas 17.4% of patients (n=708) received some treatment within 4 hours of presentation. 19% of those with one or more serious injuries and 18% of those with moderate to severe head injury received care within 4 hours of arrival. Factors independently associated with early treatment included young age, severe head injury, and no known pre-existing conditions, whereas older or female patients had significantly less odds of receiving early treatment.

Discussion: With the increasing number of patients with TBI, ensuring early and appropriate management must be a priority for Ugandan hospitals. Delay in initiation of treatment may impact survival and functional outcome. Gender-related and age-related disparities in care should receive attention and targeted interventions.

Level of evidence: Prognostic and epidemiological study; level II evidence.

Keywords: brain injuries; health care disparities; outcomes; quality of care; traumatic.

Grants and funding

T32 GM136577/GM/NIGMS NIH HHS/United States