Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda.
Traumatic brain injury (TBI) is a leading cause of death and disability. Patients with TBI in low and middle-income countries have worse outcomes than patients in high-income countries. We evaluated important clinical indicators associated with mortality for patients with TBI at University Teaching Hospital of Kigali, Kigali, Rwanda.



A prospective consecutive sampling of patients with TBI presenting to University Teaching Hospital of Kigali Accident and Emergency Department was screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, and visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, and repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in a multivariate logistic regression model and refined via backward elimination.



Between October 7, 2013, and April 6, 2014, 684 patients were enrolled; 14 (2%) were excluded because of incomplete data. Of patients, 81% were male with mean age of 31 years (range, 10-89 years; SD 11.8). Most patients (80%) had mild TBI (Glasgow Coma Scale [GCS] score 13-15); 10% had moderate (GCS score 9-12) and 10% had severe (GCS score 3-8) TBI. Multivariate logistic regression determined that GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were significantly associated with death.



GCS score <13, hypoxia, bradycardia, tachycardia, and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality.
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: krebse@gmail.com.
Elizabeth
E
Krebs
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Charles J
CJ
Gerardo
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Lawrence P
LP
Park
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Joao Ricardo
JR
Nickenig Vissoci
University Teaching Hospital of Kigali, Kigali, Rwanda.
Jean Claude
JC
Byiringiro
University Teaching Hospital of Kigali, Kigali, Rwanda.
Fidele
F
Byiringiro
University Teaching Hospital of Kigali, Kigali, Rwanda; School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Stephen
S
Rulisa
Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
Nathan M
NM
Thielman
Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Catherine A
CA
Staton
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001919:Bradycardia / Q000401:mortality; D000070642:Brain Injuries, Traumatic / Q000401:mortality*; D002648:Child; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D000860:Hypoxia / Q000401:mortality; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda; D013610:Tachycardia / Q000401:mortality; D055815:Young Adult
Rwanda; Traumatic brain injury