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The Initial Prehospital Management of Traumatic Brain Injuries in Kigali, Rwanda

Published online by Cambridge University Press:  30 June 2020

Ashley Rosenberg Open the ORCID record for Ashley Rosenberg [Opens in a new window] ,
Leoncie Mukeshimana ,
Alphosine Uwamahoro ,
Myles Dworkin ,
Vizir Nsengimana ,
Eugenie Kankindi ,
Mediatrice Niyonsaba ,
Jean Marie Uwitonze ,
Ignace Kabagema  and
Theophile Dushime
...Show all authors
Ashley Rosenberg*
Affiliation:
Division of Acute Care Surgery, Department of Surgery Virginia Commonwealth University School of Medicine, Richmond, VirginiaUSA
Leoncie Mukeshimana
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Alphosine Uwamahoro
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Myles Dworkin
Affiliation:
Thomas Jefferson University School of Medicine, Philadelphia, PennsylvaniaUSA
Vizir Nsengimana
Affiliation:
Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
Eugenie Kankindi
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Mediatrice Niyonsaba
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Jean Marie Uwitonze
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Ignace Kabagema
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Theophile Dushime
Affiliation:
Service d’Aide Médicale d’Urgence-Rwanda Ministry of Health, Kigali, Rwanda
Sudha Jayaraman
Affiliation:
Division of Acute Care Surgery, Department of Surgery Virginia Commonwealth University School of Medicine, Richmond, VirginiaUSA Program for Global Surgery, Department of Surgery Virginia Commonwealth University, VCU Health, Richmond, VirginiaUSA
*
Correspondence: Ashley Rosenberg, MD, General Surgery Resident, VCU Department of Surgery, 1200 East Broad Street, PO Box 980135, Richmond, Virginia23298USA, E-mail: Ashley.Rosenberg@vcuhealth.org
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Abstract

Introduction:

Traumatic 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/Problem:

What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda?

Methods:

A 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.

Results:

Patients 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.

Conclusion:

Currently, 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.

Keywords

ambulancedeveloping countriesRwandatraffic accidenttraumatic brain injury
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 533 - 537
Copyright
© World Association for Disaster and Emergency Medicine 2020

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Footnotes

Note: Rosenberg and Mukeshimana are co-first authors.

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