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

Abstract

Abstract Background There has been a significant paucity of literature reporting on the burden, risk factors, neurosurgical outcomes for expansive intracranial hematomas (EIH) following traumatic brain injury (TBI) in Uganda and related low middle income countries. This research determined the burden, risk factors, neurosurgical outcomes in Uganda EIH patients. Methods A mixed methods study design was conducted among TBI adult patients with intracranial hematoma who underwent surgical evacuation during a period of 18 months. In analysis, univariate, bivariable and multivariable, cox regression analyses, Kaplan Meir survival curves, log rank test were sequentially conducted at p-values of <0.2 and 0.05, at a 95% Confidence interval (CI) in respective order to assess factors associated with EIH, surgical outcomes. Results Of the 324 patients with intracranial hematomas [80.6% male, mean age 37.5 (17.4) years], 192 (59.3%) had EIH resulting in a proportion of 0.59 (95% CI: 0.54 to 0.65). At multivariate model, age group between 39 to 48 PR =1.54 (95% CI 1.20 to 1.97; P = 0.001), age above 48 years PR =1.56 (95% CI 1.23 to 1.98; P <0.001), smoking PR =1.21 (95% CI 1.00 to 1.47; P = 0.048), having severe systemic disease PR =1.36 (95% CI 1.14 to 1.64; P = 0.001), and presence of swirl sign PR =2.26 (95% CI 1.29 to 3.95; P = 0.004) were found to be risk factors for EIH among patients with TBI. The Kaplan Meier 16 months mortality was 53.4%, 95% CI= (28.1 to 85.0). At multivariate Cox regression, the predictors of mortality were young age, MAP above 95 mmHg, low GCS, complication such infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, ASDH, contusion, and EIH Conclusion EIH is common in Uganda with a prevalence of 59.3% and 53.4 % of the Kaplan Meier mortality. Increased age above 39 years, smoking, having severe systemic disease and presence of swirl sign are risk factors. Old age, MAP above 95 mmHg, low GCS, complication such infection, spasticity, wound dehiscence, CSF leaks, having GOS < 3, QoLIBRI < 50, ASDH, and contusion are predictors of mortality.