Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study

Gilbert Koome; Faith Thuita; Thaddaeus Egondi; Martin Atela

doi:10.12688/f1000research.54658.2

Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study

F1000Res. 2021 Aug 11:10:795. doi: 10.12688/f1000research.54658.2. eCollection 2021.

Authors

Gilbert Koome¹, Faith Thuita¹, Thaddaeus Egondi², Martin Atela³

Affiliations

¹ School of Public Health, University of Nairobi, Nairobi, 00200, Kenya.
² Strathmore Institute of Mathematical Sciences, Strathmore University, Nairobi, 00200, Kenya.
³ Peterhouse, University of Cambridge, Cambridge, Cambridge, UK.

Abstract

Background: Low and medium income countries (LMICs) such as Kenya experience nearly three times more cases of traumatic brain injury (TBI) compared to high income countries (HICs). This is primarily exacerbated by weak health systems especially at the pre-hospital care level. Generating local empirical evidence on TBI patterns and its influence on patient mortality outcomes is fundamental in informing the design of trauma-specific emergency medical service (EMS) interventions at the pre-hospital care level. This study determines the influence of TBI patterns and mortality. Methods: This was a case-control study with a sample of 316 TBI patients. Data was abstracted from medical records for the period of January 2017 to March 2019 in three tertiary trauma care facilities in Kenya. Logistic regression was used to assess influence of trauma patterns on TBI mortality, controlling for patient characteristics and other potential confounders. Results: The majority of patients were aged below 40 years (73%) and were male (85%). Road traffic injuries (RTIs) comprised 58% of all forms of trauma. Blunt trauma comprised 71% of the injuries. Trauma mechanism was the only trauma pattern significantly associated with TBI mortality. The risk of dying for patients sustaining RTIs was 2.83 times more likely compared to non-RTI patients [odds ratio (OR) 2.83, 95% confidence interval (CI) 1.62-4.93, p=0.001]. The type of transfer to hospital was also significantly associated with mortality outcome, with a public hospital having a two times higher risk of death compared to a private hospital [OR 2.18 95%CI 1.21-3.94, p<0.009]. Conclusion: Trauma mechanism (RTI vs non-RTI) and type of tertiary facility patients are transferred to (public vs private) are key factors influencing TBI mortality burden. Strengthening local EMS trauma response systems targeting RTIs augmented by adequately resourced and equipped public facilities to provide quality lifesaving interventions can reduce the burden of TBIs.

Keywords: Patient Characteristics; Trauma Patterns; Trauma mortality; Traumatic Brain Injuries; pre-hospital Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain Injuries, Traumatic*
Case-Control Studies
Emergency Medical Services*
Female
Health Resources
Humans
Male
Retrospective Studies

Grants and funding

The study was undertaken as part of a PhD Course/programme with full tuition grant from the Higher Education Loans Board (HELB) of Kenya. However, the authors declared that no grants were involved in supporting this research work.