Outcomes at Discharge of Pediatric Traumatic Brain Injury (pTBI) in Western Uganda: a Prospective Cohort Study

Background: This study aimed to describe pediatric TBI patients presenting to one regional referral hospital in Uganda and identify factors contributing to unfavorable outcomes.

Methods: This prospective, observational cohort study was conducted at Mbarara Regional Referral Hospital (MRRH). Favorable outcomes were defined as any patient who was either discharged from the hospital or had a Glasgow Outcome Score (GOS) greater or equal to four. Unfavorable outcomes were defined as any patient dying or having a GOS of three or fewer. Logistic regression was used to determine the factors significantly associated with unfavorable outcomes.

Results: A total of 560 pediatric TBI patients were included in this study, with males making up 65.5% (n=367) of all patients. The main etiology was Road Traffic Accidents (RTA) (n=372, 66.4%), with the majority being injured as pedestrians (n=271, 48.4%). Unfavorable outcomes were associated with bilaterally abnormal pupils (OR 22.39, 2.98-168.11 CI, p-value 0.003), incontinence (OR 19.01, 5.37-67.33 CI, p-value <0.001), need for ICU care (OR 12.17, 5.47-27.08 CI, p-value <0.001), and a severe Glasgow Coma Scale (GCS) on admission (OR 11.25, 4.01-31.58 CI, p-value <0.001).

Conclusion: Demographic characteristics reflected trends worldwide and highlighted that RTA, specifically involving pediatric patients as pedestrians, is a major driver of pTBI cases. TBI severity on presentation correlated with unfavorable outcomes, reinforcing the need for rapid triage protocols and access to the necessary human and physical resources to manage pTBI appropriately.