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. 2017 Sep:105:257-264.
doi: 10.1016/j.wneu.2017.05.153. Epub 2017 Jun 2.

Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource Poor Setting

Jessica Eaton  1 , Asma Bilal Hanif  2 , Gift Mulima  2 , Chifundo Kajombo  2 , Anthony Charles  3
Affiliations

Outcomes Following Exploratory Burr Holes for Traumatic Brain Injury in a Resource Poor Setting

Jessica Eaton et al. World Neurosurg. 2017 Sep.

Abstract

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The incidence of TBI in low- and middle-income countries (LMICs) is disproportionately high, with an associated increased risk of mortality from TBI relative to high-income countries. Although computed tomography is the diagnostic method of choice, this is often unavailable in LMICs. Exploratory burr holes may provide a suitable choice for diagnosis and treatment of TBI.

Methods: We performed a retrospective review of prospectively collected data at KCH, a tertiary care center in Lilongwe, Malawi. All trauma patients presenting between June 2012 and July 2015 with a deteriorating level of consciousness and localizing signs and who underwent exploratory burr holes were included. Additionally, we included all patients admitted with TBI, requiring higher-level care during 2011. No patients underwent exploratory burr hole during this time. We performed logistic regression to identify predictors of mortality in the total population of TBI patients.

Results: Among the 241 patients who presented to KCH with TBI requiring higher-level care, the total mortality was 16.4%. More than half (163, or 68%) underwent exploratory burr hole with a mortality of 6.8%. Mortality in patients who did not undergo exploratory burr hole was 43.9%. Upon adjusted logistic regression, not undergoing exploratory burr hole significantly increased the odds of mortality (odds ratio = 12.0, P = 0.000, 95% confidence interval = 4.48-31.9).

Conclusion: Exploratory burr holes remain an important diagnostic and therapeutic procedure for TBI in LMICs. Exploratory burr hole technique should be integrated into general surgery education to attenuate TBI-related mortality.

Keywords: Global neurosurgery; Low- and middle-income countries; Trauma; Traumatic brain injury; sub-Saharan Africa.

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Conflict of interest statement

Conflict of interest statement: This work was supported by the Fulbright Program and the National Institutes of Health (NIH) Office of the Director; Fogarty International Center; Office of AIDS Research; National Cancer Center; National Heart, Blood, and Lung Institute; and the NIH Office of Research for Women’s Health through the Fogarty Global Health Fellows Program Consortium composed of the University of North Carolina, John Hopkins, Morehouse and Tulane (R25TW009340). The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Figure 1
Figure 1
Algorithm for placement of exploratory burr holes.
See this image and copyright information in PMC

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