The prevalence and patterns of fatal traumatic head injuries at an urban public hospital; a retrospective postmortem examination study at Mulago National Referral Hospital.
Abstract
ABSTRACT
BACKGROUND
Traumatic brain injury (TBI) is a significant public health concern globally, with a substantial burden in low- and middle-income countries like Uganda. Despite its severity, TBI remains understudied in Uganda, with limited data on its prevalence and patterns. This knowledge gap hinders effective resource allocation, program development, and accurate disease burden estimation. Uganda's Mulago National Referral Hospital admits a substantial number of trauma patients, including youths with severe TBI. Understanding the prevalence and patterns of fatal TBI is crucial for improving patient outcomes, allocating resources effectively, and designing preventive measures. This study aims to address the scarcity of data on fatal TBI in Ugandan public hospitals, providing valuable insights to inform targeted interventions and optimize resource allocation.
METHODOLOGY
This retrospective study, conducted at Mulago National Referral Hospital in Kampala, Uganda, examined postmortem examination records of patients who died from traumatic head injuries between January and December 2023. A waiver of consent was obtained to access these records. A mixed stratified and quota sampling method was used to select a final sample of 252 individuals from a total population of 645. Data collection involved reviewing postmortem examination registry and reports using data retrieval sheets, with quality control measures in place to ensure accuracy and reliability. Data analysis involved descriptive statistical analyses and association statistical tests to determine the prevalence and patterns of fatal traumatic head injuries. Ethical considerations included anonymization of records, secure data storage, and acknowledgement of previous research. The study's limitations included its retrospective nature, limited time frame, and selection of a sample population, which may have impacted generalizability.
RESULTS
This study examined the patterns and prevalence of fatal traumatic head injuries at Mulago National Referral Hospital in 2023. A total of 645 autopsies were performed, with 775 cases (33.2%) identified as traumatic deaths, and 645 cases (27.6%) presenting with traumatic head injuries. The majority of cases were male (85.6%), with a mean age of 33.1±1.3 years. Skull fractures were present in 645 cases (27.6%), with calvarium fractures being the most common (p-value < 0.001, Fisher's exact test = 14.52, chi-squared test = 23.11, df = 3). Hematomas were observed in 222 cases (88.1%), and brain parenchymal injuries in 106 cases (16.4%). Clinical signs and symptoms of head trauma were present in 61 cases (24.2%). The study found significant associations between skull fractures and hematomas (p-value < 0.001, Fisher's exact test = 21.13, chi-squared test = 30.12, df = 1), brain parenchymal injuries (p-value = 0.002, Fisher's exact test = 9.52, chi-squared test = 12.15, df = 1), and increased intracranial pressure features (p-value < 0.001, Fisher's exact test = 18.25, chi-squared test = 25.23, df = 2). The findings of this study provide valuable insights into the patterns and prevalence of fatal traumatic head injuries in Uganda, and highlight the need for improved prevention and management strategies to reduce the burden of traumatic brain injuries.
CONCLUSION
In conclusion, this study demonstrated that traumatic head injuries are a leading cause of mortality among autopsied cases at Mulago National Referral Hospital in 2023, with young adult males being disproportionately affected. The findings underscore the importance of targeted preventive measures, improved data collection practices, and regional collaboration among healthcare professionals to address this critical public health issue in Uganda. The study's results have significant implications for public health policy and clinical practice, highlighting the urgent need for coordinated efforts to mitigate the incidence and consequences of traumatic head injuries in the region. These findings provide valuable insights into the patterns and impacts of fatal traumatic head injuries in Uganda, emphasizing the need for evidence-based interventions to reduce the burden of traumatic brain injuries.