PREDICTORS OF OUTCOME AMONG PATIENTS WITH TRAUMATIC BRAIN INJURY AT MOI TEACHING AND REFERRAL HOSPITAL: ELDORET, KENYA   Judy C. Rotich

Background of the study Traumatic brain injury (TBI) is the damage to the brain which occurs due to an external physical force that may produce a diminished or altered state of consciousness. (Kulezsa et al., 2015). Neurologic damage from brain trauma injury does not occur at the time of impact but comes about after several hours and days of injury TBI is a critical health and socio-economic problem and is associated with death, especially among young adults, and brings about lifelong disability among the survivors

indicates that in the USA, in their adult population of ages 25-34 years, the leading cause of TBI injury was falls at 28% followed by motor vehicle crashes and assaults at 20% and 11%, respectively. In studies conducted at Kenyatta National Hospital in Kenya, found that the TBI in adult population involved in road traffic accident accounted for 55% followed by those who sustained injury due to assault at 30% and 7% those who sustained the injury from falls from heights (Opondo, 2005)

Problem statement Traumatic brain injury is a common problem particularly in low and middle-income countries. These patients are nursed in the intensive care units where the care is individualized (Bullock et al., 2007). However, the patients arrive in the hospital past the time when secondary brain injury has set in. Despite these, judicious care in the intensive care unit can results in better outcomes. Delay to care is one of the major determinants of the outcome of care in any place worldwide.

The purpose of this study was therefore to determine the patient and clinical factors that are associated with the care outcome and also identify the knowledge gap in the nurse’s practice in the management of the TBI patients.

objectives To determine the predictors associated with the outcome of patients with Traumatic brain injury admitted at MTRH-ICU.  To determine the demographic characteristics of TBI patients in MTRH. To determine the source, cause and diagnostic characteristics of TBI patients in MTRH To determine nurses role in the care of patients with TBI in ICU

justification This study has identified patients at risk for a more focused approach to manage them and also provide knowledge to all the service providers for a more multidisciplinary approach. It will also justify why MTRH needs to open a neurology unit and its ICU and hence the patients with TBI will have a specialized care which will improve outcome and reduce disabilities associated with the injury

Conceptual framework Dependent variables were patients demographics, cause of injury, GCS level and length of stay Intervening variables laboratory investigations( RBS, sodium levels) , and vital signs Dependent variables was the outcome( dead or alive )

Research methodology This was a descriptive retrospective cohort study 109 patients sampled being patients admitted in the ICU with TBI between Jan 2013-dec2015 Using a structured data collection tool clinical and laboratory values were collected The study was approved by MTRH ethical committee and NACOSTI Data collected was keyed in into Microsoft excel and binary logistic regression statistical model of analysis was done. Statistical significance was set at 5%level (p-value) and highly significant when the probability of error is less than 0.1% (p<0.001).

Results A total of 109 patients files of Traumatic Brain Injury (TBI) patients were reviewed , male were 89 and female were 20 of which 60 (55%) died in the unit and 49 (45%) were discharged from the unit to the respective wards alive. Majority of the patients were between 31-40 years at 53% and the leading cause of injury was RTA at 48% with the most diagnosis was subdural hematoma at 38% Average length of stay of this patients was 7 days

The predictors determined were GCS level ,length of stay , feeding pattern and the use of the head injury chart were highly significant in determining outcome with a p value 0.000 The study also revealed that a patient who was not closely monitored using the neurological chart had 23 times higher chance of dying while in ICU and the patients who did not feed were 13 times likely to die than those who fed The RBS levels and sodium levels had a probability of 0.4% and 2% respectively and p=0.987 and p=0.453 respectively which in this study had no strong relationship to determine outcome

Discussion In this study the majority of the patients were male , females were few and again with better outcome . The relationship between age and outcome was determined in this study and the mid age at 31-40 were most affected and hence advance in age does not mean poor outcome but rather the degree and kind of injury sustained The majority of patients sustained RTA this in comparison with other studies were in agreement

KNH, OPONDO 2005 findings were 55% of the patients sustained RTA , 30% assault and 7% from falls from a height KNH,SHISOKA 2011 findings age 21-30yrs 52.7%, 31-40yrs 17.6%, male 81 at 89% and females 10 at 11% cause of injury RTA 42.9%,assault 36.3%, and falls at 15.4% occupancy of neuro patients at 62% in the icu –recommended establishment of a neuro ward MTRH,JUDY 2017 findings age 31-40 yrs. 40%,18-30yrs 25% males were 89 at 835 and females 20 at 17% cause of injury RTA 48%, assault 34% and falls 18%

Conclusion and recommendation Traumatic brain injury (TBI) is a vital health problem that affects citizens globally. TBI is an emergency hence requires timely and correct intervention for good treatment outcome. It is one of the leading causes of disability, death, and economic loss to the society Road safety should be continuously emphasized to drivers, pedestrians and passengers Establishment of the neuro center with an ICU Continuous professional education should be provide especially to nurses on care of TBI patients ,timely evaluation and reporting and improving documentation.

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