• Cyrus Elahi, Rocha Thiago Augusto Hernandes TAH 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center. , da Silva Núbia Cristina NC 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center. , Francis M Sakita, Ansbert Sweetbert Ndebea, Anthony Fuller, Michael M Haglund, Blandina T Mmbaga, Nickenig Vissoci João Ricardo JR 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center. , and Catherine A Staton.
• 1Division of Neurosurgery and Neurology, Department of Neurosurgery, Duke University Medical Center.
• Neurosurg Focus. 2019 Nov 1; 47 (5): E6.

ObjectiveThe purpose of this study was to determine if patients with traumatic brain injury (TBI) in low- and middle-income countries who receive surgery have better outcomes than patients with TBI who do not receive surgery, and whether this differs with severity of injury.MethodsThe authors generated a series of Kaplan-Meier plots and performed multiple Cox proportional hazard models to assess the relationship between TBI surgery and TBI severity. The TBI severity was categorized using admission Glasgow Coma Scale scores: mild (14, 15), moderate (9-13), or severe (3-8). The authors investigated outcomes from admission to hospital day 14. The outcome considered was the Glasgow Outcome Scale-Extended, categorized as poor outcome (1-4) and good outcome (5-8). The authors used TBI registry data collected from 2013 to 2017 at a regional referral hospital in Tanzania.ResultsOf the final 2502 patients, 609 (24%) received surgery and 1893 (76%) did not receive surgery. There were significantly fewer road traffic injuries and more violent causes of injury in those receiving surgery. Those receiving surgery were also more likely to receive care in the ICU, to have a poor outcome, to have a moderate or severe TBI, and to stay in the hospital longer. The hazard ratio for patients with TBI who underwent operation versus those who did not was 0.17 (95% CI 0.06-0.49; p < 0.001) in patients with moderate TBI; 0.2 (95% CI 0.06-0.64; p = 0.01) for those with mild TBI, and 0.47 (95% CI 0.24-0.89; p = 0.02) for those with severe TBI.ConclusionsThose who received surgery for their TBI had a lower hazard for poor outcome than those who did not. Surgical intervention was associated with the greatest improvement in outcomes for moderate head injuries, followed by mild and severe injuries. The findings suggest a reprioritization of patients with moderate TBI-a drastic change to the traditional practice within low- and middle-income countries in which the most severely injured patients are prioritized for care.

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