title: Early management of traumatic brain injury in a Tertiary hospital in Central Kenya: A clinical audit.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is mostly attributed to road traffic accidents in resource-poor areas. However, access to neurosurgical care is poor in these settings and patients in need of neurosurgical procedures are often managed by general practitioners or surgeons.
  
  
  METHODS
  A retrospective clinical audit of the initial management of patients with TBI in Thika Level 5 Hospital (TL5H), a Tertiary Hospital in Central Kenya. Seventeen audit criteria divided into five clinical domains were identified and patient case notes reviewed for compliance with each criterion. Data were analyzed separately for those below 13 years owing to differences in response to brain trauma in those below this age.
  
  
  RESULTS
  Overall, there was poor compliance with audit criteria in both groups. Among those below 13 years of age, only 3 out of 17 criteria achieved compliance and 4 out of 17 criteria achieved compliance for those above 13 years of age. Assessment for the need for a cervical radiograph (7.1% and 8.8% compliance) and administration of oxygen (21.4% and 20.6% compliance) had the worst performance in both groups.
  
  
  CONCLUSIONS
  Poor compliance to audit criteria indicates the low quality of care for patients with TBI in TL5H. Quality improvement strategies with follow-up audits are needed to improve care. There is a need to develop and enforce evidence-based protocols and guidelines for use in the management of patients with TBI in sub-Saharan Africa.
authors.affiliation: Department of Surgery, Thika Level 5 Hospital, Thika, Kenya; Evidence and Translation Unit, Afya Research Africa, Africa; Department of Surgery, Moi University, Eldoret, Kenya.
authors.forename: Clifford Chacha
authors.initials: CC
authors.lastname: Mwita
authors.affiliation: Department of Surgery, Thika Level 5 Hospital, Thika, Kenya; Department of Human Anatomy, Kenya Methodist University, Meru, Kenya.
authors.forename: Johnstone
authors.initials: J
authors.lastname: Muthoka
authors.affiliation: Department of Surgery, Thika Level 5 Hospital, Thika, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Maina
authors.affiliation: Department of Surgery, Thika Level 5 Hospital, Thika, Kenya.
authors.forename: Phillip
authors.initials: P
authors.lastname: Mulingwa
authors.affiliation: Department of Human Physiology, Kenyatta University, Nairobi, Kenya.
authors.forename: Samson
authors.initials: S
authors.lastname: Gwer
keywords: Clinical audit; head injury; traumatic brain injury