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. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-023-02227-9.
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Larrey Kasereka Kamabu, Godfrey S. Bbosa, Hervé Monka Lekuya et al.. 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. BMC Surgery. (2023). https://doi.org/10.1186/s12893-023-02227-9 Larrey Kasereka Kamabu, Godfrey S. Bbosa, Hervé Monka Lekuya, Eugene J. Cho, Victor Meza Kyaruzi, Arsene Daniel Nyalundja, Daniel Deng, Juliet Nalwanga Sekabunga, Louange Maha Kataka, Doomwin Oscar Deogratius Obiga, Joel Kiryabwire, Martin N. Kaddumukasa, Mark Kaddumukasa, Anthony T. Fuller, Moses Galukande
1https://ror.org/03dmz0111grid.11194.3c0000 0004 0620 0548Department of Surgery, Neurosurgery, College of Medicine, Makerere University, Kampala, Uganda 2grid.442839.0Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo 3https://ror.org/03dmz0111grid.11194.3c0000 0004 0620 0548Department of Surgery, Makerere University College of Health Medicine, Mulago Upper Hill, Kampala, Uganda 4https://ror.org/03dmz0111grid.11194.3c0000 0004 0620 0548Department of Pharmacology & Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda 5https://ror.org/02rhp5f96grid.416252.60000 0000 9634 2734Directorate of Surgical Services, Neurosurgical Unit, Mulago National Referral Hospital, Kampala, Uganda 6https://ror.org/00cv9y106grid.5342.00000 0001 2069 7798Department of Human Structure & Repair/ Neurosurgery, Faculty of Medicine, Ghent University, Ghent, Belgium 7https://ror.org/00py81415grid.26009.3d0000 0004 1936 7961Duke University, Durham, NC USA 8https://ror.org/027pr6c67grid.25867.3e0000 0001 1481 7466Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 9grid.442834.d0000 0004 6011 4325Faculty of Medicine, Université Catholique de Bukavu, Bukavu, South Kivu Democratic Republic of the Congo 10https://ror.org/00py81415grid.26009.3d0000 0004 1936 7961Duke Global Neurosurgery, Neurology and Health System, Duke University, Durham, NC USA 11https://ror.org/03dmz0111grid.11194.3c0000 0004 0620 0548Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda 