Association between traumatic brain injury (TBI) patterns and mortality: a retrospective case-control study

Area of Science:

• Trauma Surgery
• Public Health
• Emergency Medicine

Background:

• Low and medium-income countries (LMICs) face a disproportionately high burden of traumatic brain injury (TBI), nearly three times that of high-income countries (HICs).
• Weak pre-hospital emergency medical service (EMS) systems in LMICs like Kenya exacerbate TBI outcomes.
• Local data on TBI patterns and mortality is crucial for developing targeted pre-hospital interventions.

Purpose of the Study:

• To determine the influence of traumatic brain injury (TBI) patterns on patient mortality in Kenya.
• To identify specific trauma mechanisms and healthcare facility characteristics associated with TBI mortality.
• To inform the design of evidence-based EMS interventions for TBI in LMICs.

Main Methods:

• A case-control study involving 316 TBI patients.
• Data abstracted from medical records in three tertiary trauma care facilities in Kenya (January 2017 - March 2019).
• Logistic regression analysis to assess the influence of trauma patterns on TBI mortality, controlling for confounders.

Main Results:

• Road traffic injuries (RTIs) were the predominant trauma mechanism (58%), with blunt trauma accounting for 71%.
• Patients with RTIs had a 2.83 times higher risk of mortality compared to non-RTI patients (OR 2.83, 95% CI 1.62-4.93, p=0.001).
• Transfer to a public hospital was associated with a 2.18 times higher risk of death compared to a private hospital (OR 2.18, 95% CI 1.21-3.94, p<0.009).

Conclusions:

• Trauma mechanism (RTI vs. non-RTI) and the type of tertiary facility (public vs. private) are significant determinants of TBI mortality.
• Strengthening local EMS trauma response systems, particularly for RTIs, is essential.
• Adequately resourced public facilities are critical for providing quality, life-saving interventions and reducing the TBI mortality burden.