Factors associated with unfavorable Glasgow outcome score among traumatic brain Injury patients post decompressive craniectomy in Mulago National Referral Hospital, A cross sectional study

Abstract

Background Decompressive craniectomy (DC) is a procedure performed in patients with Traumatic Brain injury (TBI) to relieve ICP. Patients who have undergone DC are reported to have improved survival but with poor functional outcomes. In Mulago, there is limited information on the burden of TBI patients undergoing DC and the factors associated with a poor functional outcome based on Glasgow outcome scores (GOS). Objective To determine proportion of TBI patients undergoing DC at Mulago National Referral Hospital (MNRH), their GOS, and factors associated with a poor GOS. Methods A cross sectional study was performed for a period of 4 weeks at the Neurosurgical outpatient’s Clinic on TBI patient records to determine the proportion of TBI patients that underwent decompressive craniectomy. Theater books and patient files were also reviewed to identify patients who had TBI and decompressive craniectomy. Pre-structured questionnaires were used to collect data. Patients who had DC were invited to the outpatient’s department to assess their GOS and complete the questionnaire. A total of 180 patients were included in the study with 34 of them had DC. Data was exported to STATA version 17.0 for statistical analysis. Bivariate and multivariate logistic regression was used to assess for association. Results Majority of patients who underwent DC had a Median age (IQR) 29.5 (23.5 – 38.0) years with majority of them with primary and secondary education. Motor accidents (55%) and assault (22.8%) are the commonest causes of TBI. Proportion of patients that underwent DC was 1.3% (95% CI 0.7%-6.7%). Most of patients underwent DC had severe head injury and most of them ≤ 50 years and male. Radiological findings were contusions and acute subdural hematomas. Commonest DC was frontal temporal parietal DC. Majority of patients had DC between 2-4 days from injury. Most of patients had a favorable GOS (55.8%) and 41.2% died. Patients with unfavorable outcome had lower GOS. Severity of TBI was significant factor in determining GOS of patients in our setting while pupillary light reaction and time from injury to surgery were found not to be significant. Conclusion The findings showed that 1.3% of the patients with TBI are managed by DC with 41.2% of the patients having unfavorable GOS, while 55.8% have a favorable GOS. A low admission GCS is associated with unfavorable GOS, while abnormal pupils and time to surgery were not statistically significant in determining GOS.