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

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

World Neurosurg. 2017 Jun 02;:

Authors: Eaton J, Hanif AB, Mulima G, Kajombo C, Anthony Charles

Abstract
BACKGROUND: TBI is a leading cause of death and disability worldwide. The incidence of TBI in LMICs is disproportionately high, with an associated increased risk of mortality from TBI relative to high-income countries. While CT 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 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: 241 patients presented to KCH with TBI requiring higher-level care, with a total mortality of 16.4%. 163 (68%) underwent exploratory burr hole with a mortality of 6.8%. Mortality in patients that did not undergo exploratory burr hole was 43.9%. Upon adjusted logistic regression, not undergoing exploratory burr hole significantly increased the odds of mortality (OR=12.0, p=0.000, 95% CI=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.

PMID: 28583456 [PubMed - as supplied by publisher]

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