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Determinants of emergency department disposition of patients with traumatic brain injury in Uganda: results from a registry
  1. Amber Mehmood1,
  2. Nukhba Zia1,
  3. Olive Kobusingye2,
  4. Rukia H Namaganda2,
  5. Hussein Ssenyonjo3,
  6. Joel Kiryabwire3,
  7. Adnan A Hyder1,4
  1. 1 Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 Makerere University’s School of Public Health, Kampala, Uganda
  3. 3 Department of Neurosurgery, Mulago Hospital, Kampala, Uganda
  4. 4 Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
  1. Correspondence to Dr Amber Mehmood, Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; amehmoo2{at}jhu.edu

Abstract

Background Traumatic brain injuries (TBIs) are a common cause of emergency department (ED) visits and hospital admissions in Kampala, Uganda. The objective of this study was to assess determinants of ED discharge disposition based on patient demographic and injury characteristics. Four ED outcomes were considered: discharge home, hospital admission, death, and others.

Methods This prospective study was conducted at Mulago National Referral Hospital, Kampala, Uganda, from May 2016 to July 2017. Patients of all age groups presenting with TBI were included. Patient demographics, external causes of injury, TBI characteristics, and disposition from EDs were noted. Injury severity was estimated using the Glasgow Coma Scale (GCS), Kampala Trauma Score (KTS), and the Revised Trauma Score (RTS). A multinomial logistic regression model was used to estimate conditional ORs of hospital admission, death, and other dispositions compared with the reference category “discharged home”.

Results A total of 3944 patients were included in the study with a male versus female ratio of 5.5:1 and a mean age of 28.5 years (SD=14.2). Patients had closed head injuries in 62.9% of cases. The leading causes of TBIs were road traffic crashes (58.8%) and intentional injuries (28.7%). There was no significant difference between the four discharge categories with respect to age, sex, mode of arrival, cause of TBI, place of injury, type of head injury, transport time, and RTS (p>0.05). There were statistically significant differences between the four discharge categories for a number of serious injuries, GCS on arrival, change in GCS, and KTS. In a multinomial logistic regression model, change in GCS, area of residence, number of serious injuries, and KTS were significant predictors of ED disposition.

Discussion This study provides evidence that ED disposition of patients with TBI is differentially affected by injury characteristics and is largely dependent on injury severity and change in GCS during ED stay.

Level of evidence Level II.

  • traumatic brain injury
  • glasgow coma scale
  • head injury
  • uganda
  • kampala trauma score
  • revised trauma score
  • outcomes

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors AM conceptualized the study, analyzed the data, and developed the article drafts. NZ helped in designing the registry, data management and analysis, and contributed to article drafts. OK, RHN, HS, and JK led the data collection in Mulago Hospital, and participated in training and implementation of mHealth registry. AAH provided oversight during the study, as well as critical feedback for registry development, deployment, and article drafts. All authors read and approved the final article.

  • Funding This study was supported by grant (R21NS085094) to The Johns Hopkins University under the Global Brain Disorders Research award of the Fogarty International Center at the US National Institutes of Health (NIH). The funding agency had no role in study design, data collection, data analysis, data interpretation, or decision to submit this manuscript for publication. The corresponding author has full access to all the data in the study and has final responsibility for the decision to submit for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or participating institutions.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Ethical review and approval for this study is taken from the Institutional Review Boards of The Johns Hopkins School of Public Health, Makerere University School of Public Health and Uganda National Council. Oral informed consent was taken from all adult patients able to consent, assent from patients between 13 and 17 years of age, and permission from parent/guardian for all children under 17 years of age to participate in this research project. No personal identifiers were collected in the registry app or saved in the secure server.

  • Provenance and peer review Commissioned; internally peer reviewed.

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