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Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource Poor Setting.
Eaton, Jessica; Hanif, Asma Bilal; Mulima, Gift; Kajombo, Chifundo; Charles, Anthony.
Affiliation
  • Eaton J; UNC-Project Malawi, Lilongwe, Malawi.
  • Hanif AB; Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi.
  • Mulima G; Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi.
  • Kajombo C; Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi.
  • Charles A; UNC-Project Malawi, Lilongwe, Malawi; Department of Surgery, Kamuzu Central Hospitals, Lilongwe, Malawi; Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA. Electronic address: anthchar@med.unc.edu.
World Neurosurg ; 105: 257-264, 2017 Sep.
Article in En | MEDLINE | ID: mdl-28583456
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The incidence of TBI in low- and middle-income countries (LMICs) is disproportionately high, with an associated increased risk of mortality from TBI relative to high-income countries. Although computed tomography is the diagnostic method of choice, this is often unavailable in LMICs. Exploratory burr holes may provide a suitable choice for diagnosis and treatment of TBI. METHODS: We performed a retrospective review of prospectively collected data at KCH, a tertiary care center in Lilongwe, Malawi. All trauma patients presenting between June 2012 and July 2015 with a deteriorating level of consciousness and localizing signs and who underwent exploratory burr holes were included. Additionally, we included all patients admitted with TBI, requiring higher-level care during 2011. No patients underwent exploratory burr hole during this time. We performed logistic regression to identify predictors of mortality in the total population of TBI patients. RESULTS: Among the 241 patients who presented to KCH with TBI requiring higher-level care, the total mortality was 16.4%. More than half (163, or 68%) underwent exploratory burr hole with a mortality of 6.8%. Mortality in patients who did not undergo exploratory burr hole was 43.9%. Upon adjusted logistic regression, not undergoing exploratory burr hole significantly increased the odds of mortality (odds ratio = 12.0, P = 0.000, 95% confidence interval = 4.48-31.9). CONCLUSION: Exploratory burr holes remain an important diagnostic and therapeutic procedure for TBI in LMICs. Exploratory burr hole technique should be integrated into general surgery education to attenuate TBI-related mortality.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Trephining / Brain Injuries, Traumatic Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Adult / Child / Female / Humans / Male / Middle aged Language: En Journal: World Neurosurg Journal subject: NEUROCIRURGIA Year: 2017 Document type: Article Affiliation country: Malawi Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Trephining / Brain Injuries, Traumatic Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Adolescent / Adult / Child / Female / Humans / Male / Middle aged Language: En Journal: World Neurosurg Journal subject: NEUROCIRURGIA Year: 2017 Document type: Article Affiliation country: Malawi Country of publication: United States