“Predictors of appropriate management among patients with traumatic head injury seen in regional and district hospitals in Tanzania

Abstract

Background: Traumatic head injury (THI) is one of the leading causes of death and disability. In Developed countries, the designation of clear pathways and trauma centres has improved care and outcomes of THI patients unlike in developed countries the burden is still high and little is known about how well patients are managed. Aim of the study: To determine factors that are associated with appropriate management among patients with THI seen in regional and district hospitals in Tanzania. Materials and methods: This was a prospective cohort study of THI patients seen in regional and district hospitals of Tanzania from October to November 2020 and included 162 hospitals. Patients were enrolled consecutively for over a 24hour period at each site. A structured case report form (CRF) incorporated into online data capture software was used to document patients’ demographics, clinical presentation, management, disposition and 24 hours’ outcome. Appropriateness of management was assessed using the WHO essential trauma care guidelines. Resource availability was determined using the WHO emergency unit assessment tool. Data was analyzed using SPSS and summarized into counts, proportions, medians and interquartile range (IQR), 95% confidence interval (CI) and P-value determined statistical significance. Logistic regression analysis was used to determine predictors of appropriate management in THI patients. Results: A total of 1056 trauma patients were seen in 162 hospitals around Tanzania during the data collection periods. Of these, 218 (20.6%) patients with THI were enrolled in this study. The median age was 29 years [IQR 20-38 years] and 73.4% were males. Road Traffic Crash (RTC) was the most common mechanism of injury, 112(51.4%). Among all THI, 130 (59.6%) received appropriate management. Availability of equipment at the facilities -adjusted odds ratio-(aOR 4.74 (95% CI 1.04- 21.52) was associated with appropriate management, with moderate (aOR 0.013 (95% CI 0.002-0.11) or severe head injury (aOR 0.017 (95% CI 0.002-0.17) were significantly less likely to receive appropriate management. Conclusion: In this study, head injury severity and lack of equipment at the hospital were found to be independent predictors of appropriate management of traumatic head injury patients. There is an exigency to develop, implement and study systems that can sustenance the improvement of THI appropriate management and optimize outcomes of such patients.