Determinants of emergency department disposition of patients with traumatic brain injury in Uganda

Results from a registry

Amber Mehmood, Nukhba Zia, Olive Kobusingye, Rukia H. Namaganda, Hussein Ssenyonjo, Joel Kiryabwire, Adnan A. Hyder

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere000253
JournalTrauma Surgery and Acute Care Open
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2018

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Uganda
Registries
Hospital Emergency Service
Wounds and Injuries
Glasgow Coma Scale
Logistic Models
Traumatic Brain Injury
Demography
Closed Head Injuries
Craniocerebral Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Determinants of emergency department disposition of patients with traumatic brain injury in Uganda : Results from a registry. / Mehmood, Amber; Zia, Nukhba; Kobusingye, Olive; Namaganda, Rukia H.; Ssenyonjo, Hussein; Kiryabwire, Joel; Hyder, Adnan A.

In: Trauma Surgery and Acute Care Open, Vol. 3, No. 1, e000253, 01.01.2018.

Research output: Contribution to journalArticle

Mehmood, Amber ; Zia, Nukhba ; Kobusingye, Olive ; Namaganda, Rukia H. ; Ssenyonjo, Hussein ; Kiryabwire, Joel ; Hyder, Adnan A. / Determinants of emergency department disposition of patients with traumatic brain injury in Uganda : Results from a registry. In: Trauma Surgery and Acute Care Open. 2018 ; Vol. 3, No. 1.
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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.",
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