دورية أكاديمية
Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design.
| العنوان: | Burden, risk factors, neurosurgical evacuation outcomes, and predictors of mortality among traumatic brain injury patients with expansive intracranial hematomas in Uganda: a mixed methods study design. |
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| المؤلفون: | Kamabu LK; Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda. kamabularry@gmail.com.; Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo. kamabularry@gmail.com.; Department of Surgery, Makerere University College of Health Medicine, Mulago Upper Hill, Kampala, Uganda. kamabularry@gmail.com., Bbosa GS; Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda., Lekuya HM; Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda.; Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda.; Department of Human Structure & Repair/ Neurosurgery, Faculty of Medicine, Ghent University, Ghent, Belgium., Cho EJ; Duke University, Durham, NC, USA., Kyaruzi VM; Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Nyalundja AD; Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu, Democratic Republic of the Congo., Deng D; Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC, USA., Sekabunga JN; Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda.; Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda., Kataka LM; Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo., Obiga DOD; Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda.; Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda., Kiryabwire J; Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda.; Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda., Kaddumukasa MN; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda., Kaddumukasa M; Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda., Fuller AT; Duke University, Durham, NC, USA.; Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC, USA., Galukande M; Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda. |
| المصدر: | BMC surgery [BMC Surg] 2023 Oct 25; Vol. 23 (1), pp. 326. Date of Electronic Publication: 2023 Oct 25. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BioMed Central Country of Publication: England NLM ID: 100968567 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2482 (Electronic) Linking ISSN: 14712482 NLM ISO Abbreviation: BMC Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BioMed Central, [2001- |
| مواضيع طبية MeSH: | Brain Injuries, Traumatic*/complications , Brain Injuries, Traumatic*/surgery , Contusions*/complications, Humans ; Male ; Young Adult ; Adult ; Middle Aged ; Female ; Prospective Studies ; Uganda/epidemiology ; Risk Factors ; Hematoma ; Postoperative Complications ; Glasgow Coma Scale |
| مستخلص: | Background: Expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) continue to be a public health problem in Uganda. Data is limited regarding the neurosurgical outcomes of TBI patients. This study investigated the neurosurgical outcomes and associated risk factors of EIH among TBI patients at Mulago National Referral Hospital (MNRH). Methods: A total of 324 subjects were enrolled using a prospective cohort study. Socio-demographic, risk factors and complications were collected using a study questionnaire. Study participants were followed up for 180 days. Univariate, multivariable, Cox regression analyses, Kaplan Meir survival curves, and log rank tests were sequentially conducted. P-values of < 0.05 at 95% Confidence interval (CI) were considered to be statistically significant. Results: Of the 324 patients with intracranial hematomas, 80.6% were male. The mean age of the study participants was 37.5 ± 17.4 years. Prevalence of EIH was 59.3% (0.59 (95% CI: 0.54 to 0.65)). Participants who were aged 39 years and above; PR = 1.54 (95% CI: 1.20 to 1.97; P = 0.001), and those who smoke PR = 1.21 (95% CI: 1.00 to 1.47; P = 0.048), and presence of swirl sign PR = 2.26 (95% CI: 1.29 to 3.95; P = 0.004) were found to be at higher risk for EIH. Kaplan Meier survival curve indicated that mortality at the 16-month follow-up was 53.4% (95% CI: 28.1 to 85.0). Multivariate Cox regression indicated that the predictors of mortality were old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, SDH, contusion, and EIH. Conclusion: EIH is common in Uganda following RTA with an occurrence of 59.3% and a 16-month higher mortality rate. An increased age above 39 years, smoking, having severe systemic disease, and the presence of swirl sign are independent risk factors. Old age, MAP above 95 mmHg, low GCS, complications such as infection, spasticity, wound dehiscence, CSF leaks, having a GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality. These findings imply that all patients with intracranial hematomas (IH) need to be monitored closely and a repeat CT scan to be done within a specific period following their initial CT scan. We recommend the development of a protocol for specific surgical and medical interventions that can be implemented for patients at moderate and severe risk for EIH. (© 2023. BioMed Central Ltd., part of Springer Nature.) |
| References: | Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21(11):1004–60. (PMID: 3618371210427240) Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg. 2002;96(1):109–16. (PMID: 11794591) Yatsushige H. Surgical management of a post-traumatic intracranial hematoma. No Shinkei Geka. 2021;49(5):977–85. (PMID: 34615757) Homnick A, Sifri Z, Yonclas P, Mohr A, Livingston D. The temporal course of intracranial hemorrhage progression: how long is observation necessary? Injury. 2012;43(12):2122–5. (PMID: 22658418) Rodriguez-Luna D, Rodriguez-Villatoro N, Juega JM, Boned S, Muchada M, Sanjuan E, et al. Prehospital systolic blood pressure is related to intracerebral hemorrhage volume on admission. Stroke. 2018;49(1):204–6. (PMID: 29167387) Cepeda S, Gómez PA, Castaño-Leon AM, Martínez-Pérez R, Munarriz PM, Lagares A. Traumatic intracerebral hemorrhage: risk factors associated with progression. J Neurotrauma. 2015;32(16):1246–53. (PMID: 25752340) An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke. 2017;19(1):3–10. (PMID: 281784085307940) Sharma M, Mittal RS, Sharma A, Gandhi A. Posttraumatic Contusion: Clinical and Radiologic Factors for Progression in Early Postinjury Period. Indian J Neurotrauma. 2016;13:001–006. Yadav YR, Basoor A, Jain G, Nelson A. Expanding traumatic intracerebral contusion/hematoma. Neurol India. 2006;54(4):377–81. (PMID: 17114846) White CL, Griffith S, Caron JL. Early progression of traumatic cerebral contusions: characterization and risk factors. J Trauma. 2009;67(3):508–14 discussion 14-5. (PMID: 19741392) Narayan RK, Maas AI, Servadei F, Skolnick BE, Tillinger MN, Marshall LF. Progression of traumatic intracerebral hemorrhage: a prospective observational study. J Neurotrauma. 2008;25(6):629–39. (PMID: 18491950) Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM. Hemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma. 2012;29(1):19–31. (PMID: 219881983253310) Adatia K, Newcombe VFJ, Menon DK. Contusion Progression following traumatic brain injury: a review of clinical and radiological predictors, and influence on outcome. Neurocrit Care. 2021;34(1):312–24. (PMID: 32462411) Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American stroke association. Stroke. 2015;46(7):2032–60. (PMID: 26022637) Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7(5):391–9. (PMID: 18396107) Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355–65. (PMID: 23713578) Qureshi AI, Palesch YY, Barsan WG, Hanley DF, Hsu CY, Martin RL, et al. Intensive blood-pressure lowering in patients with acute cerebral hemorrhage. N Engl J Med. 2016;375(11):1033–43. (PMID: 272762345345109) Hanley DF, Thompson RE, Muschelli J, Rosenblum M, McBee N, Lane K, et al. Safety and efficacy of minimally invasive surgery plus alteplase in intracerebral haemorrhage evacuation (MISTIE): a randomised, controlled, open-label, phase 2 trial. Lancet Neurol. 2016;15(12):1228–37. (PMID: 277515545154627) Sundstrøm T, Wester K. Surgical management of traumatic intracranial haematomas. In: Sundstrom T, Grände P-O, Juul N, Kock-Jensen C, Romner B, Wester K, editors. Management of severe traumatic brain injury: evidence, tricks, and pitfalls. Berlin, Heidelberg: Springer Berlin Heidelberg; 2012. p. 91–9. Jayaraman S, Mabweijano J, Mijumbi C, Stanich M, Dobbins S, Wolfe L, et al. The care of injured patients admitted to Mulago national referral hospital in Kampala, Uganda. Emerg Med (Los Angel). 2015;5(270):2. Ssebakumba MK, Lule H, Olweny F, Mabweijano J, Kiryabwire J. Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago national referral hospital Uganda. Egypt J Neurosurg. 2020;35:1–12. Kuo BJ, Vaca SD, Vissoci JRN, Staton CA, Xu L, Muhumuza M, et al. A prospective neurosurgical registry evaluating the clinical care of traumatic brain injury patients presenting to Mulago national referral hospital in Uganda. PLoS ONE. 2017;12(10): e0182285. (PMID: 290882175663334) Vaca SD, Kuo BJ, Nickenig Vissoci JR, Staton CA, Xu LW, Muhumuza M, et al. Temporal delays along the neurosurgical care continuum for traumatic brain injury patients at a tertiary care hospital in Kampala. Uganda Neurosurgery. 2019;84(1):95–103. (PMID: 29490070) Alahmadi H, Vachhrajani S, Cusimano MD. The natural history of brain contusion: an analysis of radiological and clinical progression. J Neurosurg. 2010;112(5):1139–45. (PMID: 19575576) Hudak AM, Caesar RR, Frol AB, Krueger K, Harper CR, Temkin NR, et al. Functional outcome scales in traumatic brain injury: a comparison of the glasgow outcome scale (Extended) and the functional status examination. J Neurotrauma. 2005;22(11):1319–26. (PMID: 16305320) O’Donohoe RB, Lee HQ, Tan T, Hendel S, Hunn M, Mathews J, et al. The impact of preinjury antiplatelet and anticoagulant use on elderly patients with moderate or severe traumatic brain injury following traumatic acute subdural hematoma. World Neurosurg. 2022;166:e521–7. (PMID: 35843581) Wilson L, Marsden-Loftus I, Koskinen S, Bakx W, Bullinger M, Formisano R, et al. Interpreting quality of life after brain injury scores: cross-walk with the short form-36. J Neurotrauma. 2017;34(1):59–65. (PMID: 27297289) Zia N, Mehmood A, Namaganda RH, Ssenyonjo H, Kobusingye O, Hyder AA. Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry. Trauma Surg Acute Care Open. 2019;4(1): e000259. (PMID: 308997936407550) LaGrone L, Riggle K, Joshipura M, Quansah R, Reynolds T, Sherr K, et al. Uptake of the world health organization’s trauma care guidelines: a systematic review. Bull World Health Organ. 2016;94(8):585–98. (PMID: 275166364969985) Burchell SR, Tang J, Zhang JH. Hematoma expansion following intracerebral hemorrhage: mechanisms targeting the coagulation cascade and platelet activation. Curr Drug Targets. 2017;18(12):1329–44. (PMID: 283786936894484) Carnevale JA, Segar DJ, Powers AY, Shah M, Doberstein C, Drapcho B, et al. Blossoming contusions: identifying factors contributing to the expansion of traumatic intracerebral hemorrhage. J Neurosurg. 2018;129(5):1305–16. (PMID: 29303442) Servadei F, Nanni A, Nasi MT, Zappi D, Vergoni G, Giuliani G, et al. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery. 1995;37(5):899–906 discussion. (PMID: 8559338) Nasi D, Di Somma L, Gladi M, Moriconi E, Scerrati M, Iacoangeli M, et al. New or blossoming hemorrhagic contusions after decompressive craniectomy in traumatic brain injury: analysis of risk factors. Front Neurol. 2019;9:1186. (PMID: 306971866340989) Xi G, Keep RF, Hoff JT. Mechanisms of brain injury after intracerebral haemorrhage. Lancet Neurol. 2006;5(1):53–63. (PMID: 16361023) Juratli TA, Zang B, Litz RJ, Sitoci K-H, Aschenbrenner U, Gottschlich B, et al. Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study. J Neurotrauma. 2014;31(17):1521–7. (PMID: 24738836) Allison RZ, Nakagawa K, Hayashi M, Donovan DJ, Koenig MA. Derivation of a predictive score for hemorrhagic progression of cerebral contusions in moderate and severe traumatic brain injury. Neurocrit Care. 2017;26(1):80–6. (PMID: 274732095233574) Cepeda S, Gómez PA, Castaño-Leon AM, Munarriz PM, Paredes I, Lagares A. Contrecoup traumatic intracerebral hemorrhage: a geometric study of the impact site and association with hemorrhagic progression. J Neurotrauma. 2016;33(11):1034–46. (PMID: 26391755) Rehman L, Afzal A, Aziz HF, Akbar S, Abbas A, Rizvi R. Radiological parameters to predict hemorrhagic progression of traumatic contusional brain injury. J Neurosci Rural Pract. 2019;10(2):212–7. (PMID: 310010076454978) Kim H, Jin ST, Kim YW, Kim SR, Park IS, Jo KW. Risk factors for early hemorrhagic progression after traumatic brain injury: a focus on lipid profile. J Neurotrauma. 2015;32(13):950–5. (PMID: 25557755) Kubota K, Yamaguchi T, Abe Y, Fujiwara T, Hatazawa J, Matsuzawa T. Effects of smoking on regional cerebral blood flow in neurologically normal subjects. Stroke. 1983;14(5):720–4. (PMID: 6658956) Maruishi M, Shima T, Okada Y, Nishida M, Yamane K. Involvement of fluctuating high blood pressure in the enlargement of spontaneous intracerebral hematoma. Neurol Med Chir (Tokyo). 2001;41(6):300–4 discussion 4-5. (PMID: 11458742) Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke. 2004;35(6):1364–7. (PMID: 15118169) Pires PW, Dams Ramos CM, Matin N, Dorrance AM. The effects of hypertension on the cerebral circulation. Am J Physiol Heart Circ Physiol. 2013;304(12):H1598–614. (PMID: 235851394280158) Yu Z, Zheng J, He M, Guo R, Ma L, You C, et al. Accuracy of swirl sign for predicting hematoma enlargement in intracerebral hemorrhage: a meta-analysis. J Neurol Sci. 2019;399:155–60. (PMID: 30818076) Selariu E, Zia E, Brizzi M, Abul-Kasim K. Swirl sign in intracerebral haemorrhage: definition, prevalence, reliability and prognostic value. BMC Neurol. 2012;12:109. (PMID: 230134183517489) Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, et al. Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73(8):961–8. (PMID: 273233145584601) Subramanian SK, Roszler MH, Gaudy B, Michael DB. Significance of computed tomography mixed density in traumatic extra-axial hemorrhage. Neurol Res. 2002;24(2):125–8. (PMID: 11877894) Connor D, Huynh TJ, Demchuk AM, Dowlatshahi D, Gladstone DJ, Subramaniapillai S, et al. Swirls and spots: relationship between qualitative and quantitative hematoma heterogeneity, hematoma expansion, and the spot sign. Neurovasc Imaging. 2015;1:1–8. Morotti A, Boulouis G, Romero JM, Brouwers HB, Jessel MJ, Vashkevich A, et al. Blood pressure reduction and noncontrast CT markers of intracerebral hemorrhage expansion. Neurology. 2017;89(6):548–54. (PMID: 287015015562954) Huang Y, Zhang Q, Yang M. A reliable grading system for prediction of hematoma expansion in intracerebral hemorrhage in the basal ganglia. Biosci Trends. 2018;12(2):193–200. (PMID: 29760358) Amare AT, Tesfaye TD, Ali AS, Woelile TA, Birlie TA, Kebede WM, et al. Survival status and predictors of mortality among traumatic brain injury patients in an Ethiopian hospital: a retrospective cohort study. Afr J Emerg Med. 2021;11(4):396–403. (PMID: 347037308524110) Matovu P, Kirya M, Galukande M, Kiryabwire J, Mukisa J, Ocen W, et al. Hyperglycemia in severe traumatic brain injury patients and its association with thirty-day mortality: a prospective observational cohort study in Uganda. PeerJ. 2021;9: e10589. (PMID: 335204427812933) Cheng P, Yin P, Ning P, Wang L, Cheng X, Liu Y, et al. Trends in traumatic brain injury mortality in China, 2006–2013: a population-based longitudinal study. PLoS Med. 2017;14(7): e1002332. (PMID: 287005915507407) |
| معلومات مُعتمدة: | D43 NS118560 United States NS NINDS NIH HHS |
| فهرسة مساهمة: | Keywords: And predictors of mortality; Burden; Neurosurgical outcomes; Risk factors; Traumatic expansive intracranial hematomas |
| تواريخ الأحداث: | Date Created: 20231025 Date Completed: 20231027 Latest Revision: 20240124 |
| رمز التحديث: | 20240124 |
| مُعرف محوري في PubMed: | PMC10601114 |
| DOI: | 10.1186/s12893-023-02227-9 |
| PMID: | 37880635 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1471-2482 |
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| DOI: | 10.1186/s12893-023-02227-9 |