Factors that influence outcome of traumatic brain injury patients at Kenyatta National Hospital

Abstract

Background: Traumatic brain injury (TBI) is among the leading causes of admissions in hospitals globally. It is associated with significant morbidity and mortality.TBI is a neurosurgical emergency and timely intervention is critical to favorable outcome. Patients admitted at Critical Care Unit with TBI patients which accounts for 62% and an average of six admissions in 24 hours at Accident &Emergency department. Objectives: To determine the patients’ factors, clinical care and systems factors affecting outcome of traumatic brain injury patients at Kenyatta National Hospital. Methods: A descriptive cross-sectional design was used for this study. Purposive sampling method was adopted and a check list was used for data collection. Sample size was 91TBI subjects .Data was analyzed using Statistical Package on Social Science (SPSS) software. Results: The patient factors and institutional protocols influenced outcome of traumatic brain injury patients’ management. Patient factors were;> 40 years had poor outcome (p=0.042), casual laborers were at risk of TBI (p=0.043), Polytrauma had significance to poor outcome (p=0.042) and time lapse from trauma to hospitalization (p=0.051).The clinical care factors influenced good outcome which included; diagnosis and medication (p=0.001), Nursing care (p=0.055) and clinical setting A&E (p=0.051), CCU (p=0.032).Protocols factors, patients admitted to surgical wards had poor outcome (p=0.051). Conclusion: Prevention of TBI is the standard, where it fails early hospitalization and intensive care is paramount for good outcome. Recommendation: Neuro intensive care unit, Neuro emergency ward set up and training of Neuro teams for critical care and management of traumatic brain injury patients at KNH.