Early management of traumatic brain injury in a Tertiary hospital in Central Kenya: A clinical audit
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Date
2016
Authors
Mwita, Clifford Chacha
Muthoka, Johnstone
Maina, Stephen
Mulingwa, Phillip
Gwer, Samson
Journal Title
Journal ISSN
Volume Title
Publisher
Medknow Publications
Abstract
Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is mostly
attributed to road traffic accidents in resource‑poor areas. However, access to neurosurgical care is poor in these
settings and patients in need of neurosurgical procedures are often managed by general practitioners or surgeons.
Materials and Methods: A retrospective clinical audit of the initial management of patients with TBI in Thika Level
5 Hospital (TL5H), a Tertiary Hospital in Central Kenya. Seventeen audit criteria divided into five clinical domains
were identified and patient case notes reviewed for compliance with each criterion. Data were analyzed separately for
those below 13 years owing to differences in response to brain trauma in those below this age. Results: Overall, there
was poor compliance with audit criteria in both groups. Among those below 13 years of age, only 3 out of 17 criteria
achieved compliance and 4 out of 17 criteria achieved compliance for those above 13 years of age. Assessment for the
need for a cervical radiograph (7.1% and 8.8% compliance) and administration of oxygen (21.4% and 20.6% compliance)
had the worst performance in both groups. Conclusion: Poor compliance to audit criteria indicates the low quality
of care for patients with TBI in TL5H. Quality improvement strategies with follow‑up audits are needed to improve
care. There is a need to develop and enforce evidence‑based protocols and guidelines for use in the management of
patients with TBI in sub‑Saharan Africa
Description
Research Article
Keywords
Clinical audit, Head injury, Traumatic brain injury
Citation
Journal of Neurosciences in Rural Practice, January - March 2016, Vol 7 Issue 1