TY - JOUR
T1 - Determinants of emergency department disposition of patients with traumatic brain injury in Uganda
T2 - Results from a registry
AU - Mehmood, Amber
AU - Zia, Nukhba
AU - Kobusingye, Olive
AU - Namaganda, Rukia H.
AU - Ssenyonjo, Hussein
AU - Kiryabwire, Joel
AU - Hyder, Adnan A.
N1 - Funding Information:
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.
Publisher Copyright:
© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
PY - 2018/1
Y1 - 2018/1
N2 - 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.
AB - 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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U2 - 10.1136/tsaco-2018-000253
DO - 10.1136/tsaco-2018-000253
M3 - Article
C2 - 30623029
AN - SCOPUS:85061244724
SN - 2397-5776
VL - 3
JO - Trauma Surgery and Acute Care Open
JF - Trauma Surgery and Acute Care Open
IS - 1
M1 - e000253
ER -