• Ashley Rosenberg, Leoncie Mukeshimana, Alphosine Uwamahoro, Myles Dworkin, Vizir Nsengimana, Eugenie Kankindi, Mediatrice Niyonsaba, Jean Marie Uwitonze, Ignace Kabagema, Theophile Dushime, and Sudha Jayaraman.
• Division of Acute Care Surgery, Department of Surgery Virginia Commonwealth University School of Medicine, Richmond, VirginiaUSA.
• Prehosp Disaster Med. 2020 Oct 1; 35 (5): 533-537.

IntroductionTraumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d'Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda.Hypothesis/ProblemWhat is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda?MethodsA retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data.ResultsPatients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU.ConclusionCurrently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.

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