Time to Recovery and Its Predictors in Patients with Traumatic Brain Injury Who Underwent Urgent Neurosurgical Intervention at ALERT Trauma Center, Ethiopia

Ermiyas Belay Woldesenbet,1,2 Fitsum Kifle Belachew,2,3 Kebede Embaye Gezae,4 Gebrekiros Gebremichael Meles,4 Fedila Yassin Ali,1 Yared Boru Firissa,5 Victor Meza Kyaruzi6,7 1Department of Public Health, College of Health Science, Wolkite University, Wolkite, Ethiopia; 2Debre Berhan University Asrat Woldyes Health Sciences Campus, Network for Perioperative and Critical Care, Addis Ababa, Ethiopia; 3Division of Global Surgery, University of Cape Town, Cape Town, South Africa; 4Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 5Emergency Medicine and Critical Care Department, ALERT Hospital, Addis Ababa, Ethiopia; 6Research Department, Winners Foundation, Yaounde, Cameroon; 7Department of Surgery, School of Medicine, Muhimbili University of Health Sciences, Dar Es Salaam, TanzaniaCorrespondence: Ermiyas Belay Woldesenbet, Email [email protected]: This study aimed to assess and compare the in-hospital recovery times between two groups: those exposed to early intervention and those with late intervention in a cohort of Traumatic Brain Injury (TBI) patients requiring urgent neurosurgical intervention in ALERT Trauma Center in Addis Ababa, Ethiopia.Methods: The study was conducted over seven consecutive months, from March 14, 2020, to October 13, 2020. Patients were consecutively recruited from the emergency department until the final sample size was fulfilled. The recovery time between the early and late surgery groups was compared using the Log rank test. The Cox proportional hazard model was used to analyze the event data, with the assumption of proportional hazards being checked. The measure of effect was reported using the adjusted hazard ratio, and a stepwise approach was used to build the final model.Results: A total of 117 TBI patients undergoing urgent neurosurgical intervention were observed and the median survival time for the early surgery group was 4.1 days, and for the late surgery group, it was 6.4 days, with no statistically significant difference (CHR: 0.73; 95% CI; 0.47– 1.11). On the other hand, severe TBI grade emerged as a significant independent predictor, indicating an 86% lower rate of recovery compared to mild TBI cases. Additionally, higher diastolic blood pressure within the range of 50 to 100 was associated with a 24% increased rate of recovery.Conclusion: This study identified factors influencing recovery outcomes and predictors of prolonged recovery, specifically severe TBI grade and lower diastolic blood pressure. The results emphasize the importance of timely intervention and provide specific considerations for optimizing patient outcomes in TBI cases and guiding further research in the area.Keywords: Glasgow outcome score, severe, TBI, neurosurger

Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

Background Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies.</p