Improving Outcomes of Traumatic Brain Injuries: Kilimanjaro Christian Medical Center
Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism (closed or penetrating head injury), or other type of injury (e.g., focal hemorrhage, subdurhal hematoma or diffuse axonal injury).
TBI is a critical public health problem worldwide and is the most common cause of death and disability for injury patients. According to WHO, injury will be a major cause of death and disability by the year 2020. It is estimated that TBI affects about 10million people worldwide leading to hospitalization or mortality.1 The burden of TBI in many countries varies and is poorly understood. TBI are a major public health problem effecting society effecting children and family's sociologic, employment, economic, and health status. TBI can cause a host of physical, cognitive, emotional and behavioural effects and its outcome can range from complete recovery to permanent disability or death.
In Africa, TBI has its highest prevalence for men of economically productive years, 25-44 years of age.1 Globally, road traffic injuries (RTI) cause over 60% of TBI deaths thus highlighting the significant public health nature of this problem. Rapid economic growth in developing countries and consequent urbanization, which tends to accompany dramatic increases in vehicles that has resulted in catastrophic incidences of TBI in these countries. These same regions have shown the highest rates for TBI related injuries due to violence. In many LMIC, there is a poor reporting system, which makes understanding the true magnitude of the TBI burden poorly understood. Most literature from Africa discusses head injury, not the more precise clinically precise traumatic brain injury, which makes literature from Africa difficult to use for comparisons. Most studies are also hospital based, with undefined catchment areas, and are subject to care seeking limitations at both severe and milder ends of the spectrum.
CPG have been developed in high resource, high-income settings in order to standardize care for TBI patients. The institution of CPG and standardization of the management of TBI has been shown to improve patient mortality rates and neurologic outcomes in high-income settings.2 Unfortunately, there are no current resource appropriate CPG for TBI in LMIC that have been shown to improve outcomes.
To improve outcomes for Traumatic Brain Injury patients through an evidence based, multidisciplinary quality improvement project
1. Collect prospective TBI patient care data in order to identify current treatment and potential quality improvement areas
2. Perform a systematic review of international LMIC acute TBI management
3. Develop a multi-disciplinary team to utilize current TBI care data and a the systematic review of international TBI CPG to create a resource appropriate acute TBI diagnostic and stabilization treatment protocol
4. Evaluate the impact of the CPG implementation
* Established a Traumatic Brain Injury (TBI) Clinical Registry
* Completed a quality systematic review of all acute TBI management clinical practice guidelines in high and low resource settings: submitted pending acceptance
* Establish a resource appropriate Clinical Practice Guideline to improve acute care of TBI patients
* Submitted grants seeking funding for CPG implementation and evaluation
This project has already improved outcomes for TBI patients at KCMC by improving quality of care delivered at the KCMC Casualty Department.