Functional Outcomes of Tbi Patients Undergoing Craniotomy for Extra-axial Hematoma: A 2-year Experience at Kilimanjaro Christian Medical Centre-tanzania

Functional Outcomes of Tbi Patients Undergoing Craniotomy for Extra-axial Hematoma: A 2-year Experience at Kilimanjaro Christian Medical Centre-tanzania | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Functional Outcomes of Tbi Patients Undergoing Craniotomy for Extra-axial Hematoma: A 2-year Experience at Kilimanjaro Christian Medical Centre-tanzania Elizabeth Ubald Wampembe, Sengua Koipapi, Lele Mutombo Fabrice, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7075281/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Introduction : Traumatic brain injury (TBI) remains a major global health issue, particularly among young adults, with high rates of morbidity and mortality. Delays in surgical intervention can worsen secondary brain injuries. When performed promptly and appropriately, surgery significantly reduces mortality and morbidity. This study evaluated factors associated with unfavourable outcomes in patients with extra-axial hematomas at Kilimanjaro Christian Medical Centre (KCMC). Objective : To assess factors associated with unfavourable outcomes in TBI patients with extra-axial hematomas treated surgically at KCMC. Methodology : A retrospective study was conducted at a hospital using data from the KCMC TBI registry and general surgery operating theatre records. A total of 295 patients who received surgical treatment for extra-axial hematomas were included in the analysis. Clinical, radiological, and intraoperative information was examined using SPSS version 29. Results : The study included 295 participants, 92.9% of whom were male, with 89.5% aged 18–49 years. Mild TBI was the most common (50.8%), followed by severe (25.1%) and moderate (24.1%) TBI. Motor traffic accidents (MTAs) were the leading cause (72.9%). The mean Glasgow Coma Scale (GCS) on arrival was 11.4. Most patients (63.7%) had systolic blood pressure between 90–149 mmHg. Acute epidural hematomas (60.3%) were the most frequent, followed by subdural hematomas and intracerebral haemorrhages (36.6%). Additional injuries were present on CT scans in 67.5% of cases. At 3 months post-surgery, mortality was 18.3%, and unfavourable outcomes were noted in 28.5%. Factors significantly associated with poor outcomes included age ≥ 50 years (p < 0.002), early hospital arrival (p < 0.007), polytrauma, elevated systolic BP (p < 0.000), herniation syndromes, midline shift, and other CT abnormalities (p < 0.001. Conclusion : Craniotomy showed a positive impact on outcomes, but delays and secondary factors remain critical. Early referral, prompt triage, and adequate resuscitation are essential to improve outcomes. The findings highlight the need for tailored treatment approaches and strategies to minimize delays in TBI care. TBI Trephination craniotomy decompressive craniectomy Extra-axial hematoma Glasgow outcome scale Low resource settings Figures Figure 1 Figure 2 Figure 3 Introduction Traumatic brain injury (TBI) is a non-degenerative, non-congenital brain injury caused by external force, leading to possible cognitive, physical, and intellectual impairment, psychosocial dysfunction, or altered consciousness. Annually,( 1 ) TBIs affect about 69 million people worldwide, with road traffic accidents as a common cause, particularly in low- and middle-income countries. ( 2 ). In the U.S., over 69,000 people die in traffic accidents each year. ( 3 ), In Tanzania, TBIs affect 86% of middle-aged men ( 4 ). Addressing this global issue requires enhanced awareness, prevention, and comprehensive neurosurgical intervention( 5 , 6 ). The initial step in evaluating traumatic brain injury (TBI) is assessing injury severity, crucial for clinical decisions, communication, and preventing secondary injury ( 6 – 8 ).The Glasgow Coma Score (GCS), ranging from 3–15, is widely used for rapid neurotrauma assessment, with scores of 3–8 indicating severe TBI (Brain Trauma Foundation). The Injury Severity Score (AIS) suggests that an AIS ≥ 5 defines severe TBI. Combining GCS and AIS has been shown to predict 2-week mortality in TBI patients ( 9 , 10 ). Computed tomography (CT) is crucial in evaluating head trauma, detecting conditions like epidural and subdural hematomas, subarachnoid hemorrhage, and contusions, aiding in prompt clinical decisions and potential neurosurgical intervention (Khairat and Waseem, 2024). TBI is complex, requiring a comprehensive approach to prevent primary and secondary injuries ( 8 ).Extra-axial hematomas, such as in the epidural or subdural spaces, can be life-threatening if untreated. Timely surgical evacuation, especially of epidural hematomas (EDH), is associated with better outcomes.( 11 ) Craniotomy involves surgical removal of a skull region to drain hematomas and control hemorrhages, and is the standard treatment for large extra-axial hematomas. This procedure, typically performed by neurosurgeons, is particularly crucial for hematomas over 30cc. However, in resource-limited settings like Tanzania, where only 36% of patients receive this intervention, craniotomy remains a challenge due to the scarcity of trained neurosurgeons( 12 – 14 ). The lack of specific studies in Tanzania on TBI surgical procedures hinders efforts to improve patient outcomes ( 15 , 16 ). The purpose of this study was to highlight the factors associated with unfavorable outcomes of patients with traumatic brain injury who underwent craniotomy operations for extra-axial hematoma in a tertiary referral hospital in Tanzania and to establish the correlation between the clinical and radiographic characteristics and unfavorable outcomes of the patients. Methods Study Design and Setting This was a retrospective study conducted at Kilimanjaro Christian Medical Centre (KCMC), a zonal referral hospital in Northern Tanzania serving about 15 million people. It is one of two centers in the region capable of performing craniotomies. Although a neurosurgeon is available, most procedures were performed by general surgeons or surgical trainees. Study Population The study included all patients who underwent craniotomy for traumatic extra-axial hematomas at KCMC between March 2022 and February 2024. Inclusion Criteria Patients with traumatic extra-axial hematomas confirmed by CT scan who underwent craniotomy during the study period. Exclusion Criteria Incomplete records (clinical data, CT findings, operative notes, or ward progress). Patients who had other surgeries or underwent craniotomy for non-traumatic causes. Sample Size A total of 295 patients were included using convenience sampling. Variables Outcome : Glasgow Outcome Score (GOS) at 3 months post-op; scores 1–3 were classified as unfavorable. Independent Variables : Age, sex, time from injury and admission to surgery, pupillary response, comorbidities, pre-op GCS, polytrauma, hematoma type, midline shift, hematoma volume, and herniation signs on CT. Data Collection Data were obtained from the theatre registry and electronic hospital records. A structured checklist was used to extract key information, which was compiled in Excel and stored on a secure, encrypted drive for analysis. The outcome was determined using the Glasgow Outcome Score.( 17 ). A score of 1–3 was considered an unfavorable outcome, while a score of 4–5 was considered a favorable outcome. This GOS classification is shown in Table 1. Table 1: Glasgow Outcome score and the outcomes of Traumatic brain injury. The volumes of hematomas were measured using the ABC/2 method.( 18 ) Data management and analysis The data from the registry were filtered, reviewed, and checked for validity before being transferred to a statistical package for analysis purposes. The cleaned data were imported into SPSS version 29 for analysis. Mean and standard deviation (SD) were used to summarize the numerical data, whereas frequency and proportions were employed to summarize categorical variables using tables and figures. The relationship between variables was tested using the Chi-square test at a 95% confidence interval, and a p-value < 0.05 indicated a statistically significant association. Ethical consideration Ethical approval was sought from the Kilimanjaro Christian Medical University College Research Ethics Committee. Permission was sought and granted from the Department of General Surgery. Informed consent was sought from clients or their relatives(for patients whose GCS was low to give informed consent ) for the study, and no names of clients were used in the analysis and reporting of research findings. Access to this information was only for research purposes. Privacy and confidentiality were ensured using password encryption. Results Clinical and demographic characteristics A total of 295 participants were included in this study, with 274 (92.9%) being males. The mean age of the participants was 36.5 years (SD ± 15.2). The mean Glasgow Coma Scale (GCS) score on arrival at the Emergency Medical Department (EMD) was 11.4 (SD ± 3.5. Thirty-six participants (12.2%) had known medical conditions. The leading mechanism of injury was motor-traffic accidents, accounting for 215 cases (72.9). The average duration of injury time was 24.3 hours (SD ± 23.0). Most patients had mild TBI (50.8%), followed by severe (25.1%) and moderate (24.1%) TBI. At presentation to the emergency department, the majority had systolic blood pressures between 90–149 mmHg (63.7%). Additionally, 25.4% of patients exhibited pupillary dilation, and 16.9% had polytrauma, i.e., long bone fractures and chest injury. Mean hospital waiting time for surgery 13.8hrs ± 10.3hours. The most prevalent pre- op GCS category was 13–15 with 151 participants (51.2%). (Tables 2 and 3 ) Table 2 Demographic characteristics of the participants Frequency (N) Percentage (%) Age 18–29 200 67.8 30–49 64 21.7 ≥ 50 31 10.5 Sex Female 21 7.1 Male 274 92.9 GCS at arrival 3–8 74 25.1 9–12 71 24.1 13–15 150 50.8 Mechanism of injury Assault 44 14.9 Fall 28 9.5 MTA 215 72.9 Unknown 8 2.7 Commodities Yes 36 12.2 No 259 87.8 Table 3 Clinical factors of participants Frequency (N) Percentage (%) Time interval from injury to presentation at ED 0–12 39 13.5 13–24 135 46.7 25+ 115 39.8 Severity of TBI Severe 74 25.1 Moderate 71 24.1 Mild 150 50.8 Systolic blood pressure ≤ 90 35 11.8 90–149 216 73.2 150≥ 44 15 Presence of Pupillary dilation Yes 75 25.4 None 220 74.6 Polytrauma Yes 50 16.9 No 245 83.1 Time from admission to surgery 0–6 92 31.2 7–15 101 34.2 16+ 102 34.6 Pre GCS score 3–8 87 29.5 9–12 57 19.3 13–15 151 51.2 Radiological findings for patients who underwent craniotomy surgery for acute extra-axial hematomas One hundred seventy-eight participants (60.3%) had AEDH, followed by ASDH (n = 108, 36.6%), and ICH (n = 9, 3.1%) (Table 4 ). The proportion of patients with hematoma volume equal to or more than 30cm 3 was 106 (35.9%), whereas the majority of patients had hematomas below 30cm 3 . Two hundred seventy-five patients (93.2%) had midline shift > 0.5cm, and 78 patients (26.4%) had herniation syndromes, and the participants with head CT scans showing other abnormalities were 196 (67.5%), Table 4 . The most common additional finding was skull fractures (n = 71, 24.1%), followed by intracerebral hemorrhage in 44 patients (14.9%). (Fig. 1 ) Table 4 Radiographic findings on brain CTs Frequency (N) Percentage (%) Hematoma type AEDH 178 60.3 ASDH 108 36.6 ICH 9 3.1 Hematoma Volume ≤ 29 189 64.1 ≥ 30 106 35.9 Size Of Midline Shifts ≤ 0.49 20 6.8 ≥ 0.5 275 93.2 Herniation syndromes No 217 73.6 Yes 78 26.4 Other Head CT Scan Findings No 96 32.5 Yes 199 67.5 Outcome of participants post-surgery. At 3 months post operatively, overall mortality was 54(18.3%), on further analysis severe TBI patients had mortality rate of 29% (26 patients) of all death with mild and moderate TBI contributing to 13,2% and 25%(20 and 8 patients respectively), severe disability and moderate disability was observed in 6 (2.0%) and 24 (8.1%) of participants respectively, and those with unfavorable outcome were 84 (28.5%) (Figs. 2 and 3 ) Factors associated with unfavorable outcomes Factors linked to poor outcomes after adjusting for possible confounding were aged > 50 years, male gender, shorter time from injury to presentation at ED, polytraumatic injuries, and higher admission systolic blood pressure (Table 5 ). The absence of pupillary dilation, moderate and mild post-resuscitation GCS, and shorter time from admission to surgery were associated with favorable outcomes post-adjustment. Mechanisms of injury and comorbidities did not show significant associations with outcomes. (Table 6 ). Larger midline shifts and the presence of a herniation syndrome significantly increased the risk of unfavorable outcomes, 0.001 and 0.000, respectively. Hematoma volume had no significant effect on outcomes. Other head CT findings significantly increased the risk of unfavorable outcomes both before and after adjustment for other factors. (p value = 0.000) Table 5 Clinical factors associated with outcome, crude odds ratios, and adjusted odds ratios with chi-square p value UNFAVOURABLE N(%) FAVOURABLE N(%) COR AOR P-VALUE AGE 18–29 25( 30 ) 118( 30 ) 30–49 41(49) 88(37) 1.288 (0.645–2.573) 0.272(0.272–0.272) 0.474 ≥ 50 18( 21 ) 30( 13 ) 2.232 (1.073–4.643) 0.594(1.051–3.939) 0.002 SEX Female 2 ( 2 ) 19(( 9 ) Male 82(98) 192(91) 4.057 (0.924–17.820) 13.057(2.947–89.820) 0.054 TIME FROM INJURY TO ED 0–12 15( 18 ) 30( 14 ) 0.323(0.143–0.730) 0.43(1.184–6.509) 0.007 13–24 53(63) 82(39) 0.250(0.133–0.470) 1.303(0.91–4.138) 0.321 25+ 16( 19 ) 99(47) SYSTOLIC BP ≤ 99 17( 14 ) 51 ( 24 ) 100–149 48(57) 140(66) 3.500(1.777–6.894) 18.515(0.508-227.282) 0.743 ≥ 150 24( 29 ) 20( 10 ) 5.100(2.148–12.108) 13.227(1.923–189.49) 0.000 PUPILLARY DILATION None 46(55) 174 (82) 3.270(1.834–5.829) 1.023(1.128–7.197) 0.000 Yes 38(45) 37(( 18 ) PRE-OPERATIVE GCS 3–8 56(67) 31( 15 ) 9–12 10( 12 ) 47( 22 ) 0.278(0.145–0.533) 0.480(0.312–0.928) 0.013 13–15 18 ( 21 ) 133(63) 0.225(0.119–0.426) 1.280(2.942–4.569) 0.005 POLYTRAUMA No 59(70) 186(88) 2.273(1.167–4.427) 1.122(2-670-18.214) 0.016 Yes 25( 30 ) 25( 12 ) TIME FROM ADMISSION TO SURGERY 0–6 46(55 46( 22 ) 0.133(0.064–0.276) 0.210(0.043–0.918) 0.000 7–15 26 ( 31 ) 75 ( 36 ) 0.385(0.182–0.814) 0.249(0.062–0.942) 0.012 15+ 12( 14 ) 90(42) MECHANISM OF INJURY Assault 6( 7 ) 38( 18 ) 0.861(0.482–1.543) 1.892(.873–4.102) 0.106 Fall 14( 17 ) 14( 7 ) 1.242(0.673–2.274) 1.313(.600–2.873 0.496 MTA 64(76) 151(72) 1.393(0.820–2.331) 1.888(.891–4.002) 0.971 Unknown 0(0) 8( 3 ) COMORBIDITIES Yes 13( 15 ) 23( 11 ) None 71(85) 188(89) 0.599(0.270–1.329) 2.269(0.613–8.394) 0.223 Table 6 Radiological factors associated with outcome, crude odds ratios, and adjusted odds ratios with chi-square p value UNFAVOURABLE FAVOURABLE COR AOR P-VALUE Hematoma type AEDH 38(45) 140(66) 2.947(0.754–11.516) 2.109(0.420-10.576) 0.364 ASDH 42(50) 66( 31 ) 1.257(0.319–4.950) 1.182(0.225–6.210) 0.843 ICH 4( 5 ) 5( 3 ) Size of midline shift ≤ 0.49 4( 5 ) 16( 8 ) ≥ 0.0.5 80(95) 195(92) 0.337(0.175–0.650) 2.034(1.097–8.320) 0.001 Herniation syndrome None 26( 31 ) 191(91) Yes 58(69) 20 ( 9 ) 0.047(0.024–0.090) 20.88(10.219–42.688) 0.000 Hematoma volume 30 cc 59(70) 151(72) 1.032(0.968–1.099) 1.143(0.519–2.518) 0.741 Other head CT findings None 12( 14 ) 84(40) Yes 72(86) 127(60) 3.969(2.030–7.759) 4.727(2.035–10.981) 0.000 Key results; The results of this study showed that of 295 participants in this study, 54 participants (18.3%) had died at 3 months postoperatively. Overall, 211 participants (71.5%) had favorable outcomes, while 84 participants (28.5%) had unfavorable outcomes. Discussion The study demographic distribution mirrors other research, with a majority of male patients (92.9%) and an average age of 36.5 years, similar to findings in Tanzania, Nigeria, and China. ( 19 – 22 ). This male predominance, particularly among middle-aged men, is likely due to their roles as primary earners, involvement in manual labor, and higher risk-taking behaviors. Motor-traffic accidents were the most common cause of injury (72.9%), followed by assaults (14.9%) and falls (9.5%). This pattern aligns with studies from LMICs like China, Lebanon, and Ethiopia, where rapid infrastructural development and inadequate road safety contribute to injury rates, contrasting with Europe and the USA, where falls are more prevalent. ( 21 , 23 – 25 ). At three months post-operative, the study reported an 18.3% mortality rate (54/296 patients). Severe disability occurred in 2.0%, moderate disability in 8.1%, mild disability in 17.6%, and good recovery in 53.9% of patients. Overall, 71.5% had favorable outcomes, while 28.5% had unfavorable outcomes. The overall mortality rate in this study is lower compared to studies from Turkey and India, which showed rates of 49.1% and 76% for severe TBI with herniation. ( 26 , 27 ) And on further analysis, the mortality of severe TBI patients was still low in our study at 29%. These findings align more closely with studies from Nigeria and Uganda, where mortality rates were 16.9% and 16.2%, and favorable outcomes were 66% and 71%. The lower mortality in this study may be due to the higher proportion of patients with mild to moderate TBI and the predominance of AEDH cases, which typically have a better prognosis. Age significantly impacted prognosis, with older patients experiencing worse outcomes, consistent with findings by Howard et al. (1989) and D’Amato et al. (2007)( 28 , 29 ), but differing from studies in India and Turkey ( 26 , 30 ). The likely reason is that older patients tend to have more severe injuries and slower recovery. Early surgical intervention from presentation at the emergency department (ED) was associated with better outcomes, aligning with findings from studies in India, China, and Turkey ( 23 , 25 , 29 ). However, a shorter duration from injury to surgery was paradoxically linked to unfavourable outcomes. This may be because patients with severe injuries are more likely to arrive at the hospital early, either directly from the scene or through referring centers, but they typically have a poorer prognosis compared to those with mild or moderate injuries. In contrast, due to limited resources, patients with less severe injuries often experience longer waiting times in the ED before surgery, either while receiving resuscitation or waiting for theatre availability. A study from Nigeria ( 30 ) found no added benefit from faster surgical intervention, highlighting the need for improved hospital referral systems, better resource allocation, and effective triaging. Elevated systolic blood pressure (SBP) above 150 mm Hg was associated with worse outcomes, consistent with studies from Poland, Kenya, and Tanzania ( 4 , 19 , 31 ). Maintaining normotensive SBP through early resuscitation is crucial for better outcomes in TBI cases. Pupillary abnormalities were strongly linked to poor outcomes, similar to findings in India, Ethiopia, Uganda, and Tanzania ( 11 , 27 , 32 , 33 ). In contrast, the absence of pupillary dilation was associated with better outcomes, emphasizing the importance of rapid response. Polytrauma increased the odds of unfavorable outcomes, though not statistically significant in our study, unlike other studies that showed a stronger correlation ( 11 , 23 ). Higher preoperative Glasgow Coma Scale (GCS) scores were associated with better outcomes, consistent with prior reports. ( 16 , 26 , 28 , 32 , 34 ). Comorbidities like hypertension, diabetes, and cardiovascular disease did not independently affect outcomes, aligning with studies from India and Ethiopia (Michael et al., 2023; Tanwar et al., 2024). The mechanisms of trauma—motor vehicle accidents, followed by falls—did not significantly impact outcomes, consistent with findings from Turkey, Kenya, and Tanzania ( 26 , 33 , 35 ). Radiologically, ASDH showed a trend towards unfavorable outcomes, though not statistically significant, similar to findings from Turkey and contrasting with studies from China and Tanzania. ( 24 , 26 , 33 ). Larger hematomas volumes were not significantly associated with unfavorable outcomes, which contrasts with studies from Poland and India.( 30 , 36 ). Larger midline shifts and the presence of herniation syndromes significantly increased the risk of unfavorable outcomes, consistent with studies from China, India, Poland, and Tanzania. ( 24 , 30 , 31 , 33 ). Additional CT findings also increased the risk of unfavorable outcomes, emphasizing the need for early surgical intervention. In summary, our study identifies key factors influencing TBI outcomes, including age, injury duration, SBP, pupillary abnormalities, GCS scores, and radiological findings. These insights underscore the need for tailored patient management and further research to better understand these associations. Conclusion Surgery was associated with good functional outcomes despite high mortality and morbidity, and is highly recommended in trauma patients with extra-axial hematoma. Though updates on referral systems, triage guidelines, treatment protocols, and documentation are needed. Declarations Ethics Approval and Consent to Participate This study was approved by the ethical committee of the university, and all procedures were conducted per the ethical standards of the institution and the Declaration of Helsinki. Written informed consent was obtained from all participants and their relatives before their inclusion in the study. Consent for publication Written informed consent for publication of the study findings was obtained from all participants. Competing interests There are no competing interests. Author contributions E.U.Wampembe: data collection & analysis, manuscript writing, patient clerkship, and surgery. B.R. data cleaning and analysis D.M-manuscript writing L.M.F: literature search and manuscript review K.A.V: critical review S.K. C: Critical review and final approval of the manuscript. *H.R. - Critical review and final approval of the manuscript Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution E.U.Wampembe: data collection & analysis, manuscript writing, patient clerkship, and surgery. B.R-data cleaning and analysisD.M-manuscript writingL.M.F: literature search and manuscript review K.A.V: critical reviewS.K. C: Critical review and final approval of the manuscript.*H.R - Critical review and final approval of the manuscript Data Availability "The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request." References Coronado V, McGuire L, Faul M, Sugerman D, Pearson W. Brain Injury Medicine, 2nd Edition: Principles and Practice. In. 2012. pp. 72–83. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. 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Koipapi S, Mmbaga BT, Chilonga K, Msuya D, Rabiel H, Nkoronko M et al. World Neurosurgery: X Outcomes of traumatic brain injury patients with acute epidural and subdural hematoma who underwent burr hole surgery : A two-year study at Kilimanjaro Christian Medical Centre, Tanzania. World Neurosurg X [Internet]. 2024;21(December 2023):100257. Available from: https://doi.org/10.1016/j.wnsx.2023.100257 Ayogu O, Onobun D, Igbokwe K, Ugwuanyi C, Mordi C, Ibeneme S. Factors affecting the outcome of traumatic brain injured patients with acute epidural haematoma in National Hospital, Abuja. J West Afr Coll Surg. 2021;11(1):1. Shisoka JM, Omondi LA, Kimani ST. Determinants Of The Outcome On Traumatic Brain Injury Patients. Kenyatta Natl Hosp. 2019;32(1):34–47. Article O. Association of Outcome of Traumatic Extradural Hematoma with Glasgow Coma Scale and hematoma size. 2010;133–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 14 Sep, 2025 Reviews received at journal 05 Sep, 2025 Reviewers agreed at journal 05 Sep, 2025 Reviewers invited by journal 28 Aug, 2025 Editor assigned by journal 13 Aug, 2025 Editor invited by journal 22 Jul, 2025 Submission checks completed at journal 20 Jul, 2025 First submitted to journal 20 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7075281","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":507024426,"identity":"654bb1e4-b1e1-47d1-babc-d15a19eb4c4a","order_by":0,"name":"Elizabeth Ubald Wampembe","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"Ubald","lastName":"Wampembe","suffix":""},{"id":507024427,"identity":"96439a16-ec8d-4627-8d4a-1c7d7d3fc819","order_by":1,"name":"Sengua Koipapi","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Sengua","middleName":"","lastName":"Koipapi","suffix":""},{"id":507024428,"identity":"f956e578-971d-4e18-97a0-3b190e7e8c53","order_by":2,"name":"Lele Mutombo Fabrice","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Lele","middleName":"Mutombo","lastName":"Fabrice","suffix":""},{"id":507024429,"identity":"7b2b3c8c-54fa-4bb6-b177-91efbece343a","order_by":3,"name":"Kerry Alexandra Vaughan","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Kerry","middleName":"Alexandra","lastName":"Vaughan","suffix":""},{"id":507024430,"identity":"e42bcf8f-499e-4750-89d0-705fd7a71300","order_by":4,"name":"Bahati Robert","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Bahati","middleName":"","lastName":"Robert","suffix":""},{"id":507024431,"identity":"0e0ec57e-60a3-4577-b955-60894bcb15ea","order_by":5,"name":"Dennis Machaku","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Dennis","middleName":"","lastName":"Machaku","suffix":""},{"id":507024432,"identity":"78be5c9f-d57d-49ed-b49c-c5acb8f0febf","order_by":6,"name":"Salum Kondo Chilonga","email":"","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":false,"prefix":"","firstName":"Salum","middleName":"Kondo","lastName":"Chilonga","suffix":""},{"id":507024433,"identity":"ad768172-b34f-4a16-a639-631deb0cf09a","order_by":7,"name":"Happiness Rabiel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYBACAyidwMbA3PiAgeEASVoYmw1I08LAwNgmQZQWc/azxx7z7rHL42NvbKvmqbkjx8/A/PDRDTxaLHvy0o15niUXs/EcbLvNc+yZsWQDm7FxDj6HHcgxk+Y5wJzYJpEI1MJ2OHHDAR42abxazr8BaalPbJN/2FbM848YLTfAthwG2sLYxszbRpSWd+mGcw4cB/olsVlybt9hY8lmQn45n3vswZsD1Xny7YcPfnjz7bAcP3vzw8f4tDAw8LAx8UCZEAYzXuUQLYw/oEw4YxSMglEwCkYBMgAAj+FPyaFOsXQAAAAASUVORK5CYII=","orcid":"","institution":"Kilimanjaro Christian Medical University College","correspondingAuthor":true,"prefix":"","firstName":"Happiness","middleName":"","lastName":"Rabiel","suffix":""}],"badges":[],"createdAt":"2025-07-08 13:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7075281/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7075281/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90794601,"identity":"69c472cd-ab66-48e2-b01e-53b7f9eb2f04","added_by":"auto","created_at":"2025-09-08 08:45:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74803,"visible":true,"origin":"","legend":"\u003cp\u003eHead CT scan findings in addition to extra-axial hematomas\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7075281/v1/e2b743509001b0db579f59be.png"},{"id":90794603,"identity":"2fb480a9-c52b-494a-91f4-be84f5fc2e05","added_by":"auto","created_at":"2025-09-08 08:45:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32234,"visible":true,"origin":"","legend":"\u003cp\u003eGOS score 3 months post craniotomy\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7075281/v1/0e95f686f11204c803f22788.png"},{"id":90795155,"identity":"2a2f99d7-b3dd-4781-b011-ea0bcbf775e6","added_by":"auto","created_at":"2025-09-08 08:53:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":30059,"visible":true,"origin":"","legend":"\u003cp\u003eOutcome of craniotomy surgery based on GOS\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7075281/v1/dbbc4bcc21471b05dbd0e502.png"},{"id":90796024,"identity":"b4d5c77e-38fa-41aa-aa03-571ec5a5ad0b","added_by":"auto","created_at":"2025-09-08 09:01:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1607209,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7075281/v1/d19062c7-8567-410b-9271-2abd67437404.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFunctional Outcomes of Tbi Patients Undergoing Craniotomy for Extra-axial Hematoma: A 2-year Experience at Kilimanjaro Christian Medical Centre-tanzania\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic brain injury (TBI) is a non-degenerative, non-congenital brain injury caused by external force, leading to possible cognitive, physical, and intellectual impairment, psychosocial dysfunction, or altered consciousness. Annually,(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) TBIs affect about 69\u0026nbsp;million people worldwide, with road traffic accidents as a common cause, particularly in low- and middle-income countries. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In the U.S., over 69,000 people die in traffic accidents each year. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), In Tanzania, TBIs affect 86% of middle-aged men (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Addressing this global issue requires enhanced awareness, prevention, and comprehensive neurosurgical intervention(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe initial step in evaluating traumatic brain injury (TBI) is assessing injury severity, crucial for clinical decisions, communication, and preventing secondary injury (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).The Glasgow Coma Score (GCS), ranging from 3–15, is widely used for rapid neurotrauma assessment, with scores of 3–8 indicating severe TBI (Brain Trauma Foundation). The Injury Severity Score (AIS) suggests that an AIS ≥ 5 defines severe TBI. Combining GCS and AIS has been shown to predict 2-week mortality in TBI patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eComputed tomography (CT) is crucial in evaluating head trauma, detecting conditions like epidural and subdural hematomas, subarachnoid hemorrhage, and contusions, aiding in prompt clinical decisions and potential neurosurgical intervention (Khairat and Waseem, 2024). TBI is complex, requiring a comprehensive approach to prevent primary and secondary injuries (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).Extra-axial hematomas, such as in the epidural or subdural spaces, can be life-threatening if untreated. Timely surgical evacuation, especially of epidural hematomas (EDH), is associated with better outcomes.(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eCraniotomy involves surgical removal of a skull region to drain hematomas and control hemorrhages, and is the standard treatment for large extra-axial hematomas. This procedure, typically performed by neurosurgeons, is particularly crucial for hematomas over 30cc. However, in resource-limited settings like Tanzania, where only 36% of patients receive this intervention, craniotomy remains a challenge due to the scarcity of trained neurosurgeons(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The lack of specific studies in Tanzania on TBI surgical procedures hinders efforts to improve patient outcomes (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe purpose of this study was to highlight the factors associated with unfavorable outcomes of patients with traumatic brain injury who underwent craniotomy operations for extra-axial hematoma in a tertiary referral hospital in Tanzania and to establish the correlation between the clinical and radiographic characteristics and unfavorable outcomes of the patients.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective study conducted at Kilimanjaro Christian Medical Centre (KCMC), a zonal referral hospital in Northern Tanzania serving about 15\u0026nbsp;million people. It is one of two centers in the region capable of performing craniotomies. Although a neurosurgeon is available, most procedures were performed by general surgeons or surgical trainees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included all patients who underwent craniotomy for traumatic extra-axial hematomas at KCMC between March 2022 and February 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePatients with traumatic extra-axial hematomas confirmed by CT scan who underwent craniotomy during the study period.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eIncomplete records (clinical data, CT findings, operative notes, or ward progress).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003ePatients who had other surgeries or underwent craniotomy for non-traumatic causes.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 295 patients were included using convenience sampling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e: Glasgow Outcome Score (GOS) at 3 months post-op; scores 1\u0026ndash;3 were classified as unfavorable.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eIndependent Variables\u003c/strong\u003e: Age, sex, time from injury and admission to surgery, pupillary response, comorbidities, pre-op GCS, polytrauma, hematoma type, midline shift, hematoma volume, and herniation signs on CT.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were obtained from the theatre registry and electronic hospital records. A structured checklist was used to extract key information, which was compiled in Excel and stored on a secure, encrypted drive for analysis.\u003c/p\u003e\n\u003cp\u003eThe outcome was determined using the Glasgow Outcome Score.(\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e). A score of 1\u0026ndash;3 was considered an unfavorable outcome, while a score of 4\u0026ndash;5 was considered a favorable outcome. This GOS classification is shown in Table\u0026nbsp;1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;1: Glasgow Outcome score and the outcomes of Traumatic brain injury.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg 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XuPZSQBy6vsFYzsh7VBOK8GHlD4g9aEnIikPSy/ybx547igg0E5f9EGQ1weqiH2zfOaVU7CyAV1ttdWyf7Y51ji3GvMj4L6Z8CstPnLmCtJsjjTm6+iZy5gPMrXbNybIdj29ja5xaG8MnGzZbJhTPpKFIXc0lv16OXEfCAQCgUAgMA6BuOkmAp2Sbws4Yu1YnRW2WX0snxZ7cX5NwZUbhQXcgtYRaUWspee/Kb37EvyiA2LAOsydxNG6j+KQ8pKmvas2I/BlUXbczD0BIZdHPKLuONpzK4GlzWLuVyDa2wAgIOUXWZZccsnxitV+ljpt4y+r/qpqzddbYQgMH3p+tNrvXX8FVl54+Kivv9pQrxfp9XOPXCNYM4ts1dO0d4+EVVWVjEl7aZq9139uWTaM/LxtRF0/+tGP5k0J15OultmsnvbeIc9rrbVWtuz6OU5zlBuKzWbZ2LaXt9l7OHAngWVjvJ8n5MZlPuunYH7bOPrJQxvDxjyNz3DZdtttE3Lrw1bfDXSHgMPd6Rb9oP8+oubuVurlQkQ/IshkqAAAEABJREFUmTfGpbxvvDIimE9k2kauMT6eA4FAIBAIBAKBnkKgU/JtMbZQIpysic0qtrAJ9TjE08LIF7QjEsQdZMSIEYkl2JVrCXJaylKuDxhZM5EMFkbH3CW+8eof36iTQQupD8OQMYTbcbw8NhXqQ+i10bvOAvcQxMPvDiN4zdJrPzcdi/4KK6zQLEmywPt4FYH2W958bJXbNHGTl3x5HY/3t8XZJsCHeX6aryvtb9KlHnuFhLGEklU/Ncjq2UrhNo1kDXFFqFvJI82TTz6Z/7ElZJXbA3cmwbMxIo98oqXtjaDN5Mzml5uLzabNH9/1qmp9U1dvG8t2Mx99rmC+p3Aao48C4sxPGtEXXy+nvXvuH36lhIuYUx2Yt5e2lfc26SzX/N+5nCH0NsElr5+q1B+6hgtKeV+/6lP9Oe4DgUAgEAgEAoHeQqBT8s1ivOGGG+bfA0Zg+Xu20hgLrN8jRn74hbeXh6+so3O/6WwBR175W1rY63kssPxbWZxZ9+px9Xtkh2tK/Z1NwPe///38c2eOlcVxYUF+fXTp1yK8axb82guyr99Ijjz8tdtbxBF/llC/kILENCvTO7+q4acT9Rlp8Usq7R2NS99e8HvL7cX19nuWS6cVfk6S/3d79bGI2uS0F9/43uarow1bY/r6MxLFcmtj4B/f8fNy9fj27r/xjW8kmxq/z07+2ktHLvW3xJM1Lhh8mZ2s1AOCaZNG/hHikqeVKz/u9mSsMT+i70NkFna/JsIa3tFHzo3523s2Blx5xBs/lmMEv95H9zaSrMtcUmzEpO8s+N19rjI+UiXD5k1neTqKt/kwn2x6ubRoe0lvzvrY0qaKZZyOKXFxDQQGOwLR/kAgEBh8CHRKvh3F8uvkW8ndgw+2Rb5YlhBGfpaeq6rKv5ENBhY51mqWMq4j3FakEYdAI7V8NJEZH4ZZPMUJV199dbKQOz5WvmDhZM1EdFi4pGsWkBz/SI8jclY5aVy13ZW7h3dIo58jdAzut76RDIuytomXVhuRN3X7VQd5LPD8guXRdumkZ/lF0Flb/aSajzwRQXHaDyNX6UodSBNLvFMFH1VqM4ykk0Ye+d17515wr60s+uXjTu/7OrBcar9x8Y+yIFKl/droHmmzeYGz9nkPA/fl6l4Qh4Sx3sLSO32vY+ydIK3ynTJI410J6iJ78GWZL+9d5Svlye+dwDLKpUK9rKg+LDTu0gvaqizjjth6ZxOI6DmZcUKknHpwUsL6zfLtt7BLO9Vfv6/nUS4Z5ivuI+d6XLmHkbYoxztzzS8EOckhkza95VREGnU53dEH6QXvPatPvHcleCb7PnTmPgYn3yZwmeJiUtKVK+KNTCsPuS1yK149+mMuey6BXoEbS7U0QonTpvLsXntKnHtyVjbR5b2rzS63MvNUm70TzEM/ATnXXHMlrjLayChQ6lBmaV9V/b8OkzdCIBAIBAKBQCDQ0wh0Sr5VyE0CuUIQLaysXXxrLWSC9xZYBL1OBv0smw+xHIGzmCFErMwIC0shf1HxCL16hKr68B/F8c8/W0ill0YdyJF/vMYvMkjbNnz4ZOG1sCLJp512WpKfdZ0VUvtYaz9MmZJ+XXTRRYkVfJdddkmCOv1Kin8MRD6kjNWs5EFGEE7EjMUPKVGHfD4mQ4SQf32WB0FjMfRxmQXeEbv+I9ril1122eRjUuQMgdFPdWu7TQu8WcX5vatHQMxsXM4555zEXUI5/RVYjPXN5gY5Y8XnRmOstJXVlxUaIUbExdnoaK+fg5SmBLjol3i4X3vttfn33pUtPaKmPJZxecge6zY3Ay4f0pSADMPHqUp5p344slZ7x+LqX0pE5jxLq92Iod/HtrmRxnioB/H2SzxIsX9MxzzwCzijR49OPlZEFJUjIPHGCQlGiMmWX2HhskQ2kXvpbAD1pQT18WFGruWVph5sYpXjdIUc+mhXPHnzwSfCz83CO33hB+27Ar+DTladQvhlIXPRJpdlnryX+l21ye/p27wgrtLqi/kqLTlWvoBwK9uH2Z5tmv2DRyzPcFM/+SfL8ktTD/4BJj7g6vFev42bvEixcrTbmNvEwUec8uonEPIK5oO5Tt48l+CkyVhtsskmyZw3d32AXfrL/YUesHGx0S754hoIBAKBQCAQCPQ0Ai2Rb5VakCySCBJywB3Fgou4WOyRRqSTe4j0JXhmaUKqkN1igfvmN7+ZLMw+YixpXS3CSKyF0ULKwqUOvttIHvIjXXuB77hy/WKDstSHFCHdiDu/73peBMOvG9hc+IUKZJdlX15kkqtJPT1ipl2ImJ9ZQ5DUwbUFLogCgl7ysK4hFH7n2IbFT6J5Rsql0R5WcoQMRkiDzQPLtj5oF5cCBE49AssnK5+fWZNfOf0VbHbghLA5wSAXiDDyydKI7BRrKWuqfiG2iLeNmv6UIA8C7KcUyYp+2szArKSHg3JgpF5pYVm3dBYsWKiNud9d904+gZVYeX4lxDcExly84FQFseO+od3IqY0lVw5ySV6kQzqRNT+ZJ51+eV+CeLKrferiuqWdhbiaS96zGpf+u6pPG7hJcUkq5ZWrMp04IPNkj9tUiTMH/Uuj5Zkc+5cbzT+/6EF24aYMebVdHuOk7hLEs0o7xTF3nDYh1H5CUZy+lToQZP2CJflWprkqjfr9DKS+0h/ylnzlyk2EPHA7q6oqyQcDesFmi/++sTVuxsGmipzZAHku5ZQreeTy5RdVqqoqr/OVvOmvuaZ/2q7P6jTH6DY4kb2coat/In0gEAgEAoFAINACAi2T71IWQmPhQqoQWtY/lmsfMFoYS7r6FTH1URaXD3nktdg1+7k8Lh3qsAAiYkiLPAiTI/x6uc3ukQ1uHwgKgi+vnz9EHCz0zfKw0FvsS/ukZ0Vs1r6SH8nUB4RbHdqnjEYMPCOJ0tQD0lXK0mZkq8Trc2lLedfs2rgxKOX19RWRY1lkdS3thIeNEDJU2uM7gBLf3pU82dzIwwrZmA5OrLxIbYnj440cy9MYkGUbQO+b1b/RRhulEi8Ngqos2GqLOtTFb5gcSyP4oLjES4OIV9X/kz2bKN8oiKsHG7P6c3v33LWq6v/LU6fgdKSeh4Xae4HrlrnjXmhWv/zmar2M9u5hR85tMksasoxIK18wX53elPhyRY5tKsuzq/ksT2PQZm2vqiqpzxhLXw/G3AlK/Z0NbWNZnmFvrKtqfPy0l7HAx9s2U8qzyVW2TZp4ZUQIBAKBQGCwIRDtHTwIdJl8D56uRUsDgUAgEAgEAoFAIBAIBAKBgYVAkO+BNR7Rmh5BIAoJBAKBQCAQCAQCgUBgYCIQ5Htgjku0KhAIBAKBQGCwIhDtDgQCgUCgAwSCfHcATkQFAoFAIBAIBAKBQCAQCAQCPYlAb5PvnmxrlBUIBAKBQCAQCAQCgUAgEAgMagSakm+/C+w3giOclQKDwCBkYDDLQLQ95DdkIGQgZCBkYGDJQFPy7fd4H3jggRQhMAgZCBkIGQgZCBkIGQgZmEAZCC4VXLKJDDQl336L2D9sEmG7FBgEBiEDIQMhAyEDIQMhAyEDIQM9JQNNyfegdqSJxg9UBKJdgUAgEAgEAoFAIBAIDHsEgnwPexEIAAKBQCAQGA4IRB8DgUAgEBgYCAT5HhjjEK0IBAKBQCAQCAQCgUAgEBiqCNT6FeS7BkbcBgKBQCAQCAQCgUAgEAgEAr2JQJDv3kQ3yg4EAoFmCMS7QCAQCAQCgUBg2CIQ5HvYDn10PBAIBAKBQCAQGI4IRJ8Dgf5FIMh3/+IftQcCgUAgEAgEAoFAIBAIDCMEgnwPo8Fu1tV4FwgEAoFAIBAIBAKBQCDQdwgE+e47rKOmQCAQCAQCgbYIxFMgEAgEAsMOgSDfw27Io8OBQCAQCAQCgUAgEAgEAin1DwZBvvsH96g1EAgEAoFAIBAIBAKBQGAYIhDkexgOenQ5EGiGQLwLBAKBQCAQCAQCgd5HIMh372McNQQCgUAgEAgEAoFAxwhEbCAwbBAI8j1shjo6GggEAoFAIBAIBAKBQCDQ3wgE+e7vEWhWf7wLBAKBQCAQCAQCgUAgEBiSCAT5HpLDGp0KBAKBQGDCEYicgUAgEAgEAr2HQJfJ93vvvZeE3mtSlDwYEHj//ffT22+/3W545513spx88MEHfdId9dx3331p0003Tbvuumuf1BmVBAKBQCAQCAQCgUCPIzDkC2yJfCNazz33XBo9enTaYost0g477DDkgYkOdozAtddem9Zcc80022yzpcknnzwtssgiabXVVhsX1lhjjbTtttumM844Iz3//PMdF9YDsbfffns66qij0nHHHZfeeOONHigxiggEAoFAIBAIBAKBQKDnEWiJfLMqvvjii4llEblx3/NNiRIHEwJLL710OvPMM9PGG2+cm73TTjulCy+8MIdTTz01E++nnnoqbbjhhmn//fdPTz/9dE7XW38WXnjhdMghh/RW8f1XbtQcCAQCgUAgEAgEAkMKgZbI98QTT5zmmmuuTKRmmWWWIQVAdGbCERgxYkRaaKGFcgHTTjttmmiiiXKYccYZ08orr5yOPPLItOqqq6ajjz46W8DDXSlDFX8CgUAgEBg0CERDA4FAoOcRaIl8l2onmWSSNN9885XHuAYCHSIw88wzZwu4k5Njjjkmvfbaa+PSe4eMv/vuu0nwPC5y7I3nejzXp7Gvx/vfe/kF9+MliBeBQCAQCAQCgUAgEAgMIAS6RL4HULv7oSlR5YQgMPfcc6evfvWr6eabb0533HFHLuL1119PZ511Vv4wcsUVV0xf/OIX01577TXON/ytt95Ko0aNSuuuu262oC+zzDL5/u677875y5977703bb755mn11VdPK620Utp+++1LVFwDgUAgEAgEAoFAIBAYkAgE+R6QwzJ0GsU1ZfbZZ88duvXWW/MvoJx33nnp3HPPzf7iF110Udp6663TSSedlN1UJPTx5J577pm+8IUvpIsvvjgddthh6a677sq+4+KFO++8M+efY4450imnnJJOP/30NMMMM4iKEAgMTQSiV4FAIBAIBAJDAoEg30NiGAduJ/iBI+Ba+Nhjj6UXXnghnXPOOWmVVVZJ88wzT5p00kkTyzaC7oPJV199dZx7ype+9KXsQ/7xj388TT/99Onhhx9WTA7HHntsevDBB9N2222X4/iZb7PNNjku/gQCgUAgEAgEAoFAzyIQpfUcAkG+ew7LKKkJAn7vu/w6zuc///n0yiuvpOuvvz59+9vfTr4hKB/z+unCl19+OXElQcZvueWWtMQSS6Qbbrgh7bzzzvlain/88cfTjTfemOadd9401VRTlddpmmmmGXcfN4FAIBAIBAKBQCAQCAxEBIJ8D8RRGUJtQry5iPg1lPLLKNNNN112O/FBZWNYbLHFEp/wSy65JG222WbphBNOSGuvvXbyU4IFlieeeCL53fny3PfXqDEQCAQCgUAgEAgEAoEJQyDI94ThFrlaRIB/Nys1Swj4bOoAABAASURBVLdfP2Hp9kHlZZddlv91zHoxN910U2L9vvLKKxMXEv9Qj58rZAH3D/mUtFNPPXWacsops9uJ9OV9XAOBQCAQGBYIRCcDgUBgUCPQZfL95JNPDuoOR+P7DoELLrgg7bPPPmnRRRdNW265Zf6XMFnAPR9//PFp7733To888kgm4ddcc006/PDDU1VV6eqrr06s29JprX+xEmF3z1Lut+YXWGCBNGbMmHTiiSd63SZI66cH27yMh0AgEAgEAoFAIBAIBAYAAl0i39wH7rnnnvTAAw9kq+MAaH80oR8ReP7559Opp56aW4AII8aCnxT0CyYs1zPNNFMmyIsvvngm1sj3Jptskrzfb7/9kl8rYdX2U4E//OEPE6v2bLPNlj+6XHPNNdMee+yRf5Lw6aefTqzlBxxwQPLhJuLuQ8zdd989+4SzsG+wwQa5LZdeemk64ogjMqnPL+JPIBAIBAKBQCAQCAQCAwSBlsn3/vvvn7baaqu07LLLZhKFKD311FMDpBvRjL5G4KqrrkrrrbdeevPNN7NMnH322WmFFVbIYccdd0xTTDFF/lUT6RZccME2zfMTgv/4xz+yawl5Wn/99dOFF16Yll566eS/ddZZJ/mpwemmmy7/NOGhhx6alInMq0N5I0eOTKNHj05bbLFFuu6669IVV1yRDj744ISwI/Ubb7xxmmyyyRQXIRDoRQSi6EAgEAgEAoFAoGsItEy+/eLE5ZdfnurB8X/XqovUQwUB/zDO+eef30Yeimz4KcGDDjoo/8M39V8jqffdL5X4/W55Tj755Ey8/SyhNKzju+22W7Z077vvvmnWWWfNJNs/zLPkkktKksOcc86ZDjzwwNwGFnE/Nzhq1Kj8gWb88kmGKP4EAoFAIBAIDGUEom+DEoGWyfeg7F00OhAIBAKBQCAQCAQCgUAgEBhACAT5HkCDEU3pFgKRORAIBAKBQCAQCAQCgQGPQJDvAT9E0cBAIBAIBAKBgY9AtDAQCAQCgdYQCPLdGk6RKhAIBAKBQCAQCAQCgUAgEOg2Ar1CvrvdqiggEAgEAoFAIBAIBAKBQCAQGIIIBPkegoMaXQoEhjkC0f1AIBAIBAKBQGDAIhDke8AOTTQsEAgEAoFAIBAIBAYfAtHiQKBjBIJ8d4xPxAYCgUAgEAgEAoFAIBAIBAI9hkCQ7x6DMgpqhkC8CwQCgUAgEAgEAoFAIBD4fwSCfP8/FnEXCAQCgUAgMLQQiN4EAoFAIDDgEAjyPeCGJBoUCAQCgUAgEAgEAoFAIDD4EWjegyDfzXGJt4FAIBAIBAKBQCAQCAQCgUCPIxDku8chjQIDgUCgGQLxLhAIBAKBQCAQCARSCvIdUhAIBAKBQCAQCAQCQx2B6F8gMGAQCPI9YIYiGhIIBAKBQCAQCAQCgUAgMNQRCPI91Ee4Wf/iXSAQCAQCgUAgEAgEAoFAvyAQ5LtfYI9KA4FAIBAYvghEzwOBQCAQGM4IBPkezqMffQ8EAoFAIBAIBAKBQGB4IdDvvQ3y3e9DEA0IBAKBQCAQCAQCgUAgEBguCAT5Hi4jHf0MBJohEO8CgUAgEAgEAoFAoE8RCPLdp3BHZYFAIBAIBAKBQCBQEIhrIDAcEQjyPRxHPfocCAQCgUAgEAgEAoFAINAvCLREvj/44IP0zDPPpFtuuSXdcMMN6Y477kgvv/xyvzR46FY6eHr2zjvvpLvvvjv95z//yeHee+9Nb7/99ngdePrpp3N8Sec6XqJ40WsIXHjhhWnOOedMf/7zn3utjih4eCLw+OOPp7nnnjt997vfTW+88cbwBKGFXr/33nvp/vvvTzvvvHOaaaaZ0u23395urieffDLtueeeabnllsv6td2EfRQxZsyYtO+++6Zll102zTLLLGmHHXZIzz33XB/V3rvVvPDCC+mggw5KX/7yl9NZZ53VI5VdddVVGa8eKawXCsHjzNvf/OY36eMf/3i6/vrre6GWKLJVBDol3wbsv//9b/rpT3+a1ltvvbTqqqumlVdeOe21116ZkLdaUaQbOghYbC+44IL0i1/8In3xi19Mq6++evrXv/6V3n///TadvOeee9IRRxyR1lxzzbTTTjulU045pU18PIyPAGzh9uabb44f2cGbl156KW906klGjhyZNtlkk7TAAgvUX/frvQWqqw2wiXvooYcSXdTVvJG+Cwh0IelUU02VNt5447TaaqulSSaZpAs5h1dSRolnn302/fOf/0yvvPJKh52/7777MjlHkDpM2AeRyOlmm22W6JC///3vaauttkrHHntsuvjii/ug9t6v4uGHH04CXdtTtcHJfOip8nqinLfeeivdddddyXpifWZEZQR76qmneqL4KKMbCHRKvimMs88+O33uc59LxxxzTLaiLbPMMnki/va3v+1G1ZF1sCIwzTTTpB/96Efpd7/7Xdp8882zlWbHHXdMDz74YJsufelLX0q//vWv86Zt++23T3bcbRLEw3gIPPLII3mT8vrrr48X19ELi+Jll13WJsl8882Xdtttt7T44ou3ed9fDxT+AQcc0OXq9Qt56XLGyNBrCNABu+yyS1p//fXTpJNO2mv1DPaCp5hiivT5z38+LbbYYp12Zemll05LLbVUp+n6IsGVV16ZhE9/+tNphhlmSD/72c/SX//61/SVr3ylL6rv9To+85nPpK997Ws9Vo8NFs+AgWTo0Dlr8j/+8Y/02muvpYknnjjpN3mcbLLJRA+4MJwa1Cn55mLwyU9+Mm299dbZyrnCCitkq/eiiy46oI9YhtMg9kdfWbtmnXXW9IUvfCHNNtts6bbbbkvf//73EwtsvT1TTjllks5iXVVVPSrumyDARaSr1hiK/+ijj27q+tOkin57ZSOgrV1pAKv33/72tyFz3N2VvkfaoYPAYNugXHrppRl8hM3NRz7ykbTSSitlXe45QlsEGAfWXXfdNPnkk7eN6Mend999N5133nnjuZcY06qKtbgfhyZX3Sn5tuvdcMMN864p5xj7Z955583+fgjY2Mf4fxgjQNmwgn/nO99J1113XeKz+Oqrr3aKiGMwPoU33nhjJu7PP/98divgduGdwJdcQazAd955Z/KOz6SjNO+dytjZP/roo0n+m266KbEcixN8l8A3veSr+ys+8cQTiTuVOIFVlluDsn3T4F2pX1n6hBR7ry2evS+BbyeiaBMiTT1oI0UorX5zodDWm2++Obfbe30888wz8+nA888/n7+vKPXbAOuX9sr3wAMPJO2Uz/Ew1x7+e/qk3scee0xUEucou/Sb76n4EuAnoXSsNt7D0jvB+4KFvNrhfXvB2Gmzchx16rd3rC5//OMf00knnZQtMOId+cJbvP7ol/fqL/UYv+OPPz6dc845yfsSX+pvbF/BWLwy9ImMeW4W9EmZQsHCsaxngUzIp1xjqzx9geett96aXQRKPun0RX3G6sUXX8xjqG9kQzyZqeMjvfclqE+56oGdIE5f+AN7ry3Kh5e5oD3SlFCOlsXpA5nVRlhLI95cKTIszr164SlNCTbSxl9d5MhcKnHabgz1xztlqq8EbfSe24U03pNf7wT59c97bVWX910J+kQuzCPtVyeclGF+aB/8zbnSBmMuTpoStFE52gJjYw2nEu8KJzItDRy03/sSjJH6tAVe+masSny5kgXlqwe2ZKLEtXfVFjIHJxjqk/pKevf19osnf+JhZGxKXjhwa5FHfGMgT3QYHNWrjfpMP0lb2i+NtihPH9RT4kt93qvL2JjL4uuh6CvlC8owf9wLcCz9KNiT59J242o8pdMeY1QvX3mlLcqDi7Gup6nfa6N0JcCiXob+mgf6VB9b93/5y1+yC5byYGX8BW3VJ3lL/d6RVfWQJenlKwHusNEn+dRZT6M+/TJvzVnB+MLZvXL085JLLkmHHHJIXmPIm3hxJeib9PKqq2Bd4kscfOGsHSUurt1HoFPy3awKAyvYCTeLj3fDC4Hpppsu+387kjzxxBPTCSec0OFHWCb1H/7wh+zCJK3vCbitWEDEHXrooWmVVVZJW2yxRQbSwkO5LbvssmmttdZKyKUFTN5vfvOb+UMg/uTibQQoZcpm7733Tsibuhyb/uQnPxlnBeD3xqfxs5/9bNpoo42SRZMyosC5V22wwQZp1KhRuX6KkmWZVfr3v/992nLLLdOBBx7YxoeTpUj58h5++OH5SFPZ++yzT/aHN1+0S1uOO+64jBE/Sv2m1PSRknNC8NBDD6XTTz89UZ4UNfLJaoy8wmbTTTdNZ5xxRvaxt0jCwzGi/H/605/yJsWiqB1rr732uH7w02ed0a6f//zniYLXQaQBVt/73vdS8cmGBxeRU089NR188MEZI21vJC7yC/oHkyOPPDKRAXm+9a1vJYsla7c2whe51cZrrrkmb7b4kfp+RN/kh7t+W4AschYwR/c+9JbPuKnvprEbrf333z+76KjLGBpr7RCv/9yenNhZRL1rDNxZuE7Aw8ZRvEXex3G+ZSBf8FeXcXLKc+655yZ9/PGPf5zIm7qNK/IoziaUi9Vpp52WZeCHP/xh0g8y5BsJeJIl733MVhY8izAZtUkhH7vuumv+zkbZNlZka6mllkpw22abbdLyyy+f67e4ljK0nwUOjrAgq9ttt12em8ZYvEVU/Fe/+tVEZrXF9xjm27bbbps3R9IZMx/YGXM4kA/f+pQ4MuljS3PBOzIrPSy5olxxxRVeJwSMu4J5WtwUle0eRsrXH/31Pmdq8Q9cyM7JJ5+cXeC0nyscHWJsyTq3OCcn5roxXWONNRLf3CLHZEP7yKxytAPWCElpBszMpTJ2yjQPjY00yoCRPpHjX/7yl9kdR3niSyD/SI6y6KnlllsuHXXUUeM20iVd/WoeXHvttTmd+rnx6Ys+SSf+oosuypt29WmDslk8xZM99ZlnZIsM0kn0jfjGYAwYAe6+++6E5HE5Ne+QPXXB1YeK+kvXwZwc0yX6Z9551jflmKNOy7k+NNZlXjktJTPSIfY+EqezvDO3zBv5jBl3Cf1ARI0xLOBNhswnOpKekV6ANVdHa4OyyIP7xo2TtAIZXmeddfJ3MnCEhfqNtbkEP/K23377ZcOGPAId5fTXCa92WavUZV2DHz2qT+aAfugjDOk6885Y0jPKIpfGTh71aYfxJFPGDEZI9x577JG/vTMO+m/uwRmO9AGM6ArfZuiD9YScq6MEWDHc0Dsrrrhi2n333ZN84q2v9CA9IqhPn8RF6BkEJoh8G0wkpZCjnmlKlDKYEZhzzjnzNwEUEIWH6FHWjX2i0CkbhBNhotgQGYs1xUGJUTTzzDPPuKyf+MQnEpK05JJLjnuHbCJXFDji45sEigT5oTQtAFVVJaRJHRYcysgzCwR/P4prxhlnTMr1HcNEE02UPCMmZJvSQx4oNxUjVYcddliiSL2jSL2nxPRZf9WLnOmbkyH+1pQs9xsLPMKgbMrX4qEMBGj66adPe4/dLIwcOTL7h2rvqAD1AAAQAElEQVQvYkMJKg+u0sNo5plnThYDCpuPocXYO32yyPgA1jExd7ExY8ZoYg5Iu/ZNPfXUCU4FY36ACy+8cKLwLRA2Qb/61a+yr6oFDUFw2oWYIHe5sIY/8mifDQVCSFnrv2TaYfw86582WuQQQrjxh4WHhQZZsOlBaOaff/6ECPmVCB/tymfzRf9YAPnIWjC0b6655koWCx/+qhMecLcgOWb1rjHAwwJZf0+mLEZ+3cF7MgF7cmBhskDD15iQGwstedK3hRZaKC/KiAh/e2m0QZxFW5uQFWQICdRnGzr1kAPtJPvG4dvf/nbewKp/9tlnTxZ4pMGmCPmzIE43dtNLHi3myrARkx/GZEmcPiI+6pRGHi4Q5gxS59ce1AdX5I01Tjpx5qSTLONqHBALceaevl599dUecyDnZBIm5AmpEPHRj3402ZT7OFN7bI7MA5sw/TA3fRTsFye0Q55Wg/lOhskqebAhQV70zy+xmO9kDEmGvzmLmJgDxhFZJM8IpY0i+SJPNozmmXboM7nUD5sUOJIpfUGspIGvcYS1jY28xkpa8SXQD2SD/jDnF1100bwRIPMlTeNV+xFM+JpT5hZ9SI/ZKJJLG3H6TxwMjUEph+WafGq7/iGp0047bYke72qu2pibB8a55PPrGHSJvs0/dl4i8TBAnulzY6EwesxmWbtsWsRLSybE14PNHNJIV2mXeWK+/OAHP0jKoEsWWWSRnIX82Hzqt/brp5Mim2s6hG6GqTlHxhBV8kW36A8dod3ylQ18Lrj2R3k+mLT5NXawYMSh2+gv9WgbA0ktW/4I1ZrhHdmjL6wJ+o/8WkdsCj3DCXfSH/WoAzEml/LbMMCYjJFZ84OuNN/p4qqq8q/mwEp7yYf5pW3IMd1p42iew4rcwNB6YhzUUQJdYp7Ky5BqY2LzJN68EE+PmP9wpjPERegZBLpMvikQSplQU9w904wBW0o0rAsIIGgWYLtzixiS1JidUmRxs9OmpBAOCsI9q4YJToFRLvW83FsolPLOvXyeLbSsIn6Nh/XWoqsOpJTblPKkpYxYOFkAlI9wIqEIB8WoLKSP4rSAIcwWS/HaS+lakNTlnrKXh4K2yCEkFgYK9xvf+Eb+EI2ClMZiRHmqz0KmHIsJzLS3owVY35FsREzZiACckAdlNws2Mcqux6mT9Y8Fl5JG3sWrG0GxGMLK/K6qKv+y0YgRI5I+6b8+WCjkaQzIhkXPpsuY6iOLZmO6+jNdAmN9Mx76ZVyVRYbqaev3o0ePzm5wfnmptM/i4djY2EprE4VsWPik8a5ZsPDX31dVlWxO4OC9viC/yH1VVcmiSJbIDv0HN1ZB5egH8vGpT30qIVYIrcXagsZahcCSG8TCRgn+8NRf44lEkzfxNhsjx27EjJmr8rUHwTNOyDvSZT45KdB3CzxSq43kRF6kwMbSoo9w2siQC5jAjAxqt42M8smCK4KA8FuAYcESiQSI04cFF1zQbZtgA06+kVmkQKQ++nBPXcYakfFsfhhvZWuDewRJvfK1EvTVZgtx0SaExqZJ35FyZSCqxgBBQU4QWGMhH/kzD4ynzVJVVQk2SJpNFeKNiMOhtN/YmEOw1V7zm8whbWSEHNNHyIugDSWQJWNj7SQ/CK7+6kdJU7+a3//+97/z6YE5q04bOPfG24aNMYP8sJbKa66SDTh4thmBN9yrqkpLLLFEDuK6Guh2OsCJD3kkQ2RRmQgcfa/eOeaYI+s+myFxNlf621gffUbuEHP6WrwyYUlObTq8E2zOzGX9d0qk7/SLZ7jYPMHCuJpDxsRmmZwpEy42tPLSt436RfthjfgaH7KqXvjRh+aF9pJV8iJOMA42JWTGc5E9OpsMGm/rgqt82mo+6rM55YTAvNRW+lM/1Q03VzjbkNABdIU2fuxjH0sItblDB0lrDpvr2mM+aEtngUxb58xlsgg/YyifMhjIrGvarN90krgIPYNAl8m3AaG8CATh6JlmRClDBQGKAMmlrDbaaKPsb1bvGyVjQiMilJzw9a9/PbtwUNAUZz19K/eUYlVVyZVSVT5SQjGn//1XVVU+qkeWyK9FRJSFGVHwayHyqp8SshiLl87C4IhdWwUWFQqdspSGgvSMuHsWLNJVVSXK2LM61M0NQBkCZawMhM1VusaA+LGwsVBcfvnlyeJQFtrGtK08Wxzhrb8sQBZ4Lh2UKyWrDAs1Em2ToZ2Cei0i+iBNYxAHI4uYBU+bKXeLTGPa8oyksvRQ/lw2LK6Nfoklbf1qgUBUyZq2CSyOFiSLZUmrP8hQee7Otao+/ECpXh55a1am90JVVXmToL0WaAudtgobbrhh/uUBm04LHVcNBHS55ZZLe+21V4ID61tKqc1/FvWqqlJVVXkBtuhavJVhcdY+slcyIaXSaA9iUt67WrxdBfGu5MEVWYAvPe+khiWcZVVce6GqqkROyRhXBenMJ5sZ5MGzTQaLrXkHB8FpC2JKDpBZ6VoJrJHmso2MjbBNM2tpPa9ySz/10aYI5nxpke+bbropu5CZi9qCMNIfZMmcRcDNFYRWvOC0xKYe6RVvfKcbewpR6q2qD+e9fpd35Wp8yr32lPtmV2NhbM1FcqFuQV/NHSd8ZMZ81h9kjwFDvTYbyqRTyR3i5ERHf22kjZH4rgRuJLCk60o+uqsQz+KyVuKkdW8MqqpyO16wOUJCWV1tROheY4oMOk3AN2xubTBtnhRgnOlacgMPgeXf2CKm4hhEGFS8Fy/YeNFHVVWN+zjd5tCpiY2UOalvVfX/bVUm2SBjrPTKteGwudcWdVhnBM/1oN9ljKuqyrrAs/fpf/95JocerQEMPdaTehoyYz6SN+MsrVBVVZuf+ayq/2+3+M5CGR/pqurDvGTOs9M9m0jGLKd12tVoOZcuwoQj0CXy7fiKpYB1w8BMeLWRc6gigBxYWLlMsLiw9lKe9f5ScEiaCU2Z1ENR5PX0XbmnvBFmeRBw1xKKzFJ4gvcWLISBJQUxQDIsziwl4gVHgxaCejvLvXhtZsFBOC0WCKC+W5jKgiGdgCSWvOWKeFokxTcGZFe5FgiLG0JrIW5M1+ozpY5g6Lcx4NZiAfFcMFGWBYeLTGljuXJNEN8scCewiJEBRBoRQrSapfVO37gCIPYWVOmRHnGdBe2zeSjtKleuRJ3l7Y94JNj4lXaWK79n8qbfLKU2dsgeKzO3FAtyR+21UDOCWEhhiExYpOt5EANpqurDBbYe1949yyNfYoSF5Zdl0VxunFON+ZFs8sWCZwNuc2UzUMiK9Nps3AsG5Wo8yxyVrrOw7LLLJnPDfCB3CIMNCB3QXl5Ehv4p8xtuyLQNaGlHuSJqyjE39Ke8L1enaGSYvrHJkLY3AosmA0Cpt1zLZghBIkdOgrjI2DDZnGqL8YAN1wsbOps8bjo2DeK7Eown+dLnej6E1xhXVevyVfLLZ2OD9LF022zQQzZ83vFzZ3mmo0uecmXdLliUKxcYmzhp9N0YlbhyRaLVK43xR9DpRcYiGy7vS3CaYbND9m1cuNHQ4dYKpNnGy1wpRpaSb0KuyrNW2oQwBNXLsNmqqipvuuvve+ve5uz888/PPzF56623Jhs87loTIje91cbBXm7L5NvxG4VJwbGIDPaOR/t7DwFEgw8epWoxZLkptVn8qqrKiyaSWt67sux2trhL11FA/Chd10ZLH6JJ6VLOyIhyLMIUC4JhAUOaEVxxAuXMwqRtjQpR36RBbvhGUuA777xz/lf/LJYsl2UBp5yrqsofCFKw8gnKRFD463puDCym/G5ZYLjyIJ360JiuK8/IhIWaBZ2F0mJXJz3ayt0AFo3llkW98b1FyGYKllwcLFCsVfwFG9OWZ+4J/EYdM/P5ZD0vcR1dtc9C2qx9CGNHefsjTntZpvl4NtaPkCNvsGJNZZ20gUC4WJoQ0sY89WdE2+aQ5ZV1zOLISFJPo3yyyZpYf9/RvbmDDCBy2u2kijwzvnSUD7G2RiDA/Gtt4Fhh1S+f0whxSJLnerDp0P76u47uETNzmV+qTSFXJ/KEwLWXT930DktoVVXZt9hcpRvqeZA2Vnh6hGwjgPV49/QF/YF8IudIk/clsODKW54n5Ep2uEmYj/X8ThBtPIwta6z5a84h36zhvs+Q3oZM32xsuY1wW4KV/onvSrDZ4SJDJ9XzcXWg1xkg6u9bvedG46SR3mD80H6nbtwz9NGmVJpSHhlTH39o8l/ek1eY2ySYS+aBeVXiXY0pfUsOPAs2i4wb6qZr5fdeMH7WJN8lwY9hiZHBZs3GGFn3W+hFvuWZ0GCtcUqlfY2yZM0wd5wSTGj5XckHN+3hMmT+2wyZ/wNRv3alXwMpbUvk22RjJfOhCOEoHbCg2EWX57gOPwQoIMqpseeUn6+1kU/Kv8SzBjsGZeWwELAUs6QgdT6WEW8xo4AtOBS7vO6ldd9RQCQtEhZlC1DJL49FjC80cuBZkN6igbDbMLCCIDLiBBY7Cm/33XfPv/rBwqVM1iTKXRrtp5ApJxtUQf/4/IoXEAPt8nEWSxs/YJYdygyJoOikqwf+ffotrUW+qj48LlV/SVe/985ihHywUHluFtTl9Er9FmuklzWwpEVM4G/zZKFGiCxaNhb1sSzpXbWDZaSqPvwgSPkWTIuT+MbAIm7zgkTYrFlM1aMcaRsXH+8EHxPZgJATRN/mgR7SPhug0j75yVMz0qScEow1q5JFGx7ag/Aqs6Tp7tXizLrNHcviro3aR0b8aggygQBa/I0Nv2PfKxhDG796/fVNmkUaZsiDDRmyTj4RwYIj2WQ4MZZIer2sju65HtkEIBVcA7hLSV8nJp6bBfPbBs+vYaifL3hJBwdWfnKnj2SVzCJZ3pFz89wG2PE+nErexivya9xspMmsecXloJ5H2ayU8hpfRJUOkN7ct2Fh4XPiQLZgbkPE2smiyX/Zmod8mfPkDOY2lYitsugHY0H+S92ebVjEq3tCgvbZdJsbLK7GFdkmA8g02aV/YWdcbBTMOWNddDJ89A/Z1Bd+z+RgQuSb9RcXILNw1ifzhXyZ7+TEu64G8l/WAvpxqaWWSogmfWxDrw7ud6Vcuh2u5g+5LDpGuxB4uNDx8hkDOoIcGju6md6GaSmPjHNhQTL5+tPl0osnLzaFjCTWCP2ky8kA2TLO5qu03Q10MPcg5frAsl4ePWaek9v6+67ckwXy00oe89K6BCfz11pKhmDYSv5I0zkCnZJvCsYxjaNxR8k+NikBSWrvuLzzqiPFYEbA4k7xOPpjmRAoqHqfLIqUHQJeVVWOYsmxm0ZE+RBapClLSpRyt+AIFI3F0nGjOErYokExWdRZPvk3KhRBRVxYPjwjk/xBKXUfYWobBWqj6NcgWFmkK8GiYWNp4XfcX967knELL8uSo1uLAMXvYzc+gtKwmrOMs57w10WCLN42H5QmhadP2mvh4OKiDZStPrNy2qwoSx+VZc45JkZUWNZZRJFfwcIpTn0WEuQVWeamqKngxgAAEABJREFUgACIM2/hCy9WGqRM+SUYE8fV6jOfy3tXmxEfrxkXV21DQJAi/tzSNAsIpEWU1ZS+oOx9FFXSGhcLNVccV+SZHFkgEVPkGalGfhypkyek0hGoRdUCYFFgwdUu48Viru/aB4uy4bFxsXiTg0YCW9rjimCxshlbGBs7i4w6Ldrkm5XQ6Q159LEna5gNkXFCcmwcYYPkIHDkUR+UL1i8lE9uWIOV7R7ZRKKq6sO5wbUDAWAtVrcTRrKhjBKcfthEskDD1lE5kiqebLEGag/8EAdkgnzqW1VViYuRviAPNn76oT/GTP+chugL7LVZe2GJeDqCN3byql+dNhI2K0irZ8Ec5ydK5s2/qvqwf+KMlV9O0Dd9hI135oG65CGv5jcMWRvlaxbUSQ60xS+vICw+QINDSc9/2yZMmeYjizt9ol51+U4B8TJPrWV0lnmNZInXZ2OEuCL3Ng/mDMsgPYbwknn1Gk9yaD6RS5jBUV/g61495ib5d4/MGAekHe7K9c4Yk1tky8YAQVx77bXzx8/mEdlnGdZPZWkD+YODurj9iUPOGQXIA7k09uazOS6+MSCs8mubvHyxfaTotMCml4sYvaJM5XHHYw03f5VFnswL5NzG3Xz1vrOALJsXNg7kQXok3DrBrUh/vRP4tMMaCSZDxoOeMDfgYAxtAJ0EaIc5Ip5cwB5uMLN5o3/IN/3ohAbe1gi6lezAwIfbTlS4ncBYO21y5JNefdol2OiZQ+YIXSAPfGACR5ta+CL35IJusZky7nS1vpofNgCwlobuMy7k2BxluECMtc0c0Xbv6Cb6iB62ISEz5FXZNv3y6L+xVZf3dKYxskZqk/4pT1/gSW7Mb8ZX88P4iIvQfQQ6Jd8UMwJCQVGYdvklsFwgSd1vRpQw2BAwYSkIZNSCY1EzeRv7gWQiQBRliUP8kHJEEbG18LKCUmQlDWJoMUaMyB1iYuJTAhZBCxTlKD+CSnlYjEt+Fh5toiRdKULk12Jb0tSv0lNuFHv9vXsuGpQ8MqI+itlCTwmLp+BYqORlGbIoIQSIAwIoL0KHcLHOyI9wIpOsi/U5hFxbLBBMR/5Iv82GzYFFkxLlh4uoIq/qRRA8Iw2srMiYRdaCaeFmvYAVxa29JSD42mATUN6Vq/Isnq6IFFKnrYhVSVO/WjC1i64ohBXZ0caSDrFElmyoLKrG1CLu3hgaWwuffiMPFg/yRX6QfmPJRUV53tXbZ3Gst88JBuwtZE4v5GkWxOkjIgsnbULg5SPfFmrEDbky9giSxcv4GhvH0BZcLjQWLqTL2MG/jrf2G3sLmnLIgA2KjZ92WfiNBcJMXljZxDfirW0soBZd88DcqY8fQmhuGXt4u1q8zVH1IAzkSBts4hApc0ffvbPhQv7Vb7OKAMLZBhKpt1lGsJBD6Y2d9EiO8ktgUdYf41relStSpUzuIsogN+ZosSDC3PxApGBb8jVezVm4wh6RMk/pDIS4pDU3YIwkIijmjzEmW9Ig1fBhydYWJFLbWN7FCzYc3ukPOVEHWSuEkI5jhYWXdRKRJDuwQqqRLYScTGuDsTNHfCvCB9sGhlsBAwEMyD9jg020sSXHxtTVXNReulPbxKuTDiF/xtMcgZ94MkoH0JfKQLqQOpiIbwzagrwZV+1FTrXVlYwwwNGjZIcOtEGxybCZsblAJm1obVhgrE+NdTR7pjv1i9yUeH3zE3nNNgo2AsoWb9zoZlbz+hpifphL9Jw0dI2+2+AznpB180XfyDBZx23Inf7RX8bIM9Kqv/po/Ol8Ot3Hq6W9rja65odxLWNiPUB06XC6j7sccq5tTt2klQb2cCBn1g4yQW7pAPKtTmus/DYSxtV4MjyJ1x7uIa7kxzywlpAZcgAP42MdMo5Iv40CHGEhrzFGyG3w6Cr9hgNdZo7SC/oZofsIdEq+KUpC216o7/q635zWSohU/Y8AkmfBqssFS3NjyxyjI02sE/U4yt8CIT/FaVddVW0tZBSjnTciTikhbizTCB4lhhDKL1g0KZt6HUg+RSaeAtLmenz9XnssyvV39XtlITpIngVYf6rqw/YitpQVa4yfe7PIWZwFCowlgZVCeRSfhUC/EAHlel+CZ4s4pUkRwk9fYa2PyKjNCJLKuiOfNDYm2sZi58iWItXvEiwEVfVhe+URELL6YuddPbDCqIflByEwBvX4+r2FgXKXXp0WRSSqnsbCaOGySWCtF2fhUb5jdeWz9MIFcRGvL0gVYq6P3pUgrfpKfotUiVM+gkt2yrtmVwQB5ize2oa0IxLwc0/WEAl9KkGbLejl2ZUhwrUeqqot3hZM8iANGUD8S5uMcb2exviSzmYGgXDK4R5BKXGuLHxw0Xf1aBfZFicgkt6XQKZYp8uzK8xsILRHPd5pN6KgDHIHK+8F6Sze4krQLvO6PDdeYVwwtJFCOksac0R9dEJHc9YcKWVoh42QcS/luGoX2SUj5hUiZ76IK8HJEl2jDKTWmmfulXhXc45c0jlIKXn3vgTzEqFRhg20sRZno0NfeF+COUqXlGdX+qTk9yyYf8owB2yoYW4eGJ8i69ZfrgrwkoeeqMfDFb7ei7fRNO+RZmU3BuTK6Z20JSgboZZWfQinttA3dLLxEgczc6Pkc0VcxbUSkFPzraQ1N42FDVJ5V79qK72uHnrecz1e/vpcIOd0jDTGSL4SbGCMWXl2Nc9gBT+4e0febLbgRy+VOaFMgTFEuhLkpWPJVXnnSn5c66G03zpqA8Vyb9zIORlVvnEvslry2oA2jplNelVVybpEt8GpzIWSz5WRwRi5L8FG0ZpNB6nfe/0go9oQoWcQ6JR890w1UUogMDQRcMyHdLMWsP5apBALi55AWbK+IUVDE4Fh2avodC8jwILo6Lxxw9XL1UbxgUAgEAj0CQJBvvsE5qhkqCLA2o5sO5plEWT95V/rKN2xoON5x+NV1dYKOlTxiH71LAKOmbmFOCJWsqN1R+Luh2rgj8s1g1tKo5W6lT470ucWJK0PEbl9cL/xHCEQGBoIRC8GOwJBvgf7CEb7+xUBlm1Hnvz3HF1yL+Fzx6XAkayj97B69+sQDerK+X3yaeY2xC2BvydyOqg71UnjnRhxX+gkWbvRPmxD3uHFlx5+CHm7GSIiEAgEAoE+RiDIdx8DHtX1LAIDoTTkGjli7fbRJr9Qfp4s4QOhfdGGwYsAf1r+nORK4AcactXxePIT5qsOL4Gvdt2XuOPcERsIBAKBQO8jEOS79zGOGgKBQCAQCASGJgLRq0AgEAgEuoxAkO8uQxYZAoFAIBAIBAKBQCAQCAQCgQlDoOfI94TVH7kCgUAgEAgEAoFAIBAIBAKBYYNAkO9hM9TR0UBgaCMQvQsEAoFAIBAIBAYDAkG+B8MoRRsDgUAgEAgEAoFAYCAjEG0LBFpGIMh3y1BFwkAgEAgEAoFAIBAIBAKBQKB7CAT57h5+kbsZAvEuEAgEAoFAIBAIBAKBQKApAkG+m8ISLwOBQCAQCAQGKwLR7kAgEAgEBjICQb4H8uhE2wKBQCAQCAQCgUAgEAgEBhMCnbY1yHenEEWCQCAQCAQCgUAgEAgEAoFAoGcQCPLdMzhGKYFAINAMgXgXCAQCgUAgEAgEAm0QCPLdBo54CAQCgUAgEAgEAoGhgkD0IxAYiAgE+R6IoxJtCgQCgUAgEAgEAoFAIBAYkggE+R6Sw9qsU/EuEAgEAoFAIBAIBAKBQKC/EQjy3d8jEPUHAoFAIDAcEIg+BgKBQCAQCGQEgnxnGOJPIBAIBAKBQCAQCAQCgcBQRWAg9SvI90AajWhLIBAIBAKBQCAQCAQCgcCQRiDI95Ae3uhcfyLw1FNPpcceeyy9++67PdKMt99+Oynz+eef77A89T3xxBM5bUn4/vvvp9deey09/vjj6c033yyv0zvvvJMeffTR9NJLL417FzfdQ8A4PfPMM+nFF1/sXkE9kNu4G9sxY8akBx54ILfpgw8+6IGSOy4CBs8++2zqTFYbS4GZOUMuxWnrW2+9lcizfng3UIM2P/LII3kuaXdX2vnmm28mY/Tiiy92mE25MFWPse0wcUQGAoHAgEWgZfJtgT7rrLPSiSeemM4999y8sFMEA7Zn0bA+QcCCc8stt6TTTjstnXDCCenCCy9MFob77ruvx0hnn3SkSSUIlD41C3/6059yX2+77bb0+uuvN8md0hZbbJHWWmutjEfTBF14iXT/7W9/S1//+tfT/vvv32HOhx9+OK233npp6623zunee++9dNddd6U99tgjfe1rX0vXXnttfu8PQrbaaqsl87qvFvMHH3wwnXrqqVleGrEtuN5xxx0JIdHGwRSefPLJ9Mc//jGtvfba6Xe/+12/N/3GG29MxxxzTNp3333T5z//+SwTt99+e6+2ywbv+OOPT9/5znfSQQcd1HJd1pNjjz02feMb38gbBRmfe+65dNJJJ6UVVlgh/f73v/dqwAY6b7nllstybc51paHG6XOf+1ynMvPGG29kTNXz4osvdqWKgZU2WhMIDHMEWiLfCMZvfvObdPbZZ6c//OEPmVT84he/SK+88sowhy+6j0QdcMAB2cJbVVUmefvtt1/acMMN06uvvjroAdKHww8/PP3whz9Ml1xySZpooolyQLJOOeWUtNFGG6Wdd9453XnnnQl5qHd4m222SXvttVeaaaaZ6q8n+P4Tn/hE+s9//tNpfvVpUyHfMkwxxRTphRdeyMFzCbPOOmv65S9/mVZaaaVUVVV5nWyo7r777nHPPXlTVVV6+eWX02677Za23HLLvJlnrYctq+fJJ5+cNt9887TVVlslhKYn6+7tsqqqypuGe++9t9eq+ve//51PMDqrgDyai5/85CcTGT7iiCMSknfDDTd0lrVb8VVVZVkaPXp0l8tZddVV05577pnIpcwTTzxxQmRthD0PpGCjUG/PbLPNlg488MA8l8hyPa6z+7nnnjsdeeSRyUa4npY1/Kabbhr3arLJJkvf/va3cz0f+chHxr2Pm0AgEBhcCHRKvln1WKFY0n7961+n008/PVs0kHDvB1d3B1xrB3WDEKW9xpJLC+aPf/zjTLiRpnXXXTexylg0B3MHkVgE0GKnH9/97nfTD37wgxx+8pOfpEMOOSTp64knnphJOKuUdCUsN9YKZjGdaqqpyqsJvs4yyyxpmWWWaSn/1FNPnQnAV77ylZwegZlzzjnTIosskp/rf6aZZpq0xhprpAUWWCATphLHysiCWZ578jpy5Mi0ySabZII9YsSItMoqq+Rn2G633XbJZm7ZZZdNSLhND+t8T9bfm2UZp8UXXzz1FjHiguEE5P777++0GzZqt956a7JpgzNL9KWXXpq+9a1vdZq3OwkQ5y984QtdLqKqqrTwwgtnAkouFTD99NPnd72FpzomJFx55ZXpvPPOa5N12mmnTd/85jfTggsumDfobSI7eZh55pnTOuusk/taktKfDF71sZ5kkkkS+VLP5JNPXl2XkSAAABAASURBVJLGNRAIBAYZAp2S70knnTR96UtfSo7EpptuumyRYCWzyCDmg6y/0dweROCMM85IfDtZ1siJoi3ySJ/FobzzfrAGxFWftL/eH/cf/ehHs+XWhgPR4dbRV64b2tMbgbX0qquuShdffHHqzb7A1aakqqrkvqqq5D+Wvdlnnz1b45HFq6++Oh111FGpcWMj7XAMTiRGjRqVrcGd9f+yyy5LxrOkY41FjNsS2RIb11YR4ArDjac354e2cBU7+uij24yh9xECgUBg8CPQEvl2nFa66njYUdiSSy6ZFl100fI6rsMQARY1x8EWCC4K9YV+rbXWSoW0Fmik5brBh5NFx7M4PuJOVLwXRo8enVj4xJ1//vnZ51N6/uXecVn45z//mS2jf/nLXxLLUFkIuYk4plWPDwzlv+CCC7KbQ8nLavXnP/85+x3L6/2EhimnnDJb6mxA4FCstMjizTffnF0qtKmUzx2B5ZLLin5qS4lzRa7Ew+Gcc85JTz/9tNfjBacOo8aSMP3gRlDwktCHaUgrDDx3FHwUxxpa3GbU7+icu8dFF12UMVIOnLVJ+Ne//pU3Xcpl/fNOW40BzPn9K6cuD9J2New19lQFQde+gqsynKrAjm81uXnooYfGbRT0h2zcc889+WM/7eNHzs+9sT3G5Yorrkgw/Otf/5o/PFW+wKXuv//9byI/PnBzrz6YcN+RpgRjbQzE+/aBmx49WeLL1VjKDy/fzSi3xGm3NsIOhvogHayVL51ykT59k048/3lx9aAeG2MuJvpB/qX1XjptU5Y0ThfE+6ZAnGBDDdMzzzwzkVflGH8yJ75ZMDe1n1zDAHFsTMeHn1yK1x591L6Szvg4TSVvxri8r1+1zZyRX9CuggFXMO8E+qier9yTUfqGXEhHfqSFSUnjaozJhjTaa3PtPeLtxEs/lCNev/UfhmQVttKaA+JL0DfvtbPMcem9c8qk3+TM8/XXX59+9KMf5e9FyLoy6EvzHLb6LV09KNdYSqt/+lDi4XbNNdck46NuGJb2lDRxDQT6BYFhWmmn5LuOCwXBz83Cwdo33VhLeD0+7ocXAj6CWnPNNZNFfNNNN00+sioK39EoK2ZBxCK+/fbbJ4s60nHwwQfnj78sGBYGllZl7LrrrtlntuRTHlJTFgrPfCOvu+66/EGnhYQLyE033ZQtREigelihLUKspvyKfWSG1PhYkWXXom8h4i5TFtZSZ1evjpltRJwEISraiFhwreB7bdFUJqK/yy67ZEItDdcOBFOcgJjtuOOOGSPkg080PBAz8SUgX7/61a/yh1c+6txwww2Tj6ERC8Qb2dQvJLrkaXZFsKWV32KN/BgzGwmbCs/KRFKNLf/2ww47rM34aJtNB/cG6X3syddc+xybN6u31XfzzDNP+uxnP5v96REb+WDJdxnZVT4Ssu222ybjiwwh0ptttlkiF3zutQOJ0XbvlCEoB0bKIQvHHXdcdh0iZzZ35JHLy0477ZQ/oETAyBOs1EFmlYMMaQOZhL022BSV9koj2NzABT4w0y7PCLG0ZFEbyYeNgMDNT1+0RRnwnX/++d1mWTc23uUXtT/e1ePcC95rr+80zAt1m4vari3aDlPk0fzRV3PP+MIQUa9VM+4WFtwQfQdErvWRvIxL8L8b3w35AJNsS6O/hx56aJuN3N57751gbq35X7bxLjZi5onxKWRVIv1DWn/729+2+z3SQ2M3auYV8qyvyKq1zLgrQ4CDeUnHINXmhnlmXNXx8Y9/PNkUSltwJX/cz2BmfRSnfJh5px55vRfMYXMbXsi0NusPXSpe2iWWWMLtuLFWntOMMjY58n9/1G8e+GEE4wrHn/70p4mcS0Jm6Rs6CgbKoG/ERQgEAoG+R6Bl8s264JcWKEaT1kS2SPV9k6PGgYKABYgViN+zhYq/rl8qsEBYtEo7kRvKHln//ve/n5AiC69FyuL7qU99KlmYEQu+nk5Vij+je/6jiDlXD0THz44htsrYfffds3UOeUICvvzlLyf+zRY0Ps4WNbI633zzZR9tixEioTxE0iIsDUJQ2tvV64wzzpj4WcsHB/dLL710mmGGGfJP+XkvmDeO/hEqi7kF3oIqLqWULJYWTvggQ34xQx59KWlcbSIs6MgkQojM/fznP8+nBcZk2WWXzT6nFnDp2wtIxBe/+MUE15KW7zc3M/ivvPLK+VdT+IQbZ/2UVh4kXbnc0YzRBhtskN1HnJIhRr4R0VdpuhMQcOOKHGkj4kjvlPFXF7KI7PHR94se0iM7xpi8IOuIMdwRXe3ZZ5990sc+9rH88bj35PPyyy9PPvbT7uWXX16ybD3nqqEeZfFJZqFkAZWA1ZP86L/vA2wEbUhHjBghOgd177DDDvlDOemk4d/O6uoXUbgvycMCyzpsHiBPSPeLL76YP/RFmsgz/3iFupJ/c8dzPXAJ5Ndt40IWfZMhrffqgId5CkNyhrTZNH7ve9/LckMGzDk4ky3WduRNmfV6yr1TKfMYsSbXytOfEu86ZsyY5ONPc9O4WEe4F9EB6pDGnIEvfeG5WSB3fKNtsKuqyv7VypRW/xZaaKH8TcZiiy3mVZtAfliRzVHfcSC7G2+8cbK2+YhVYvjbjJhj9IR4/TGGLOHmAOz5ottwwxVW9AuZR36VI2iDj5ltzo2dtnlP7rSVrBmHkSNH5l9zqW84yLH5R458O6Ieecw9/uHaqSyBjBhHeph80cP0rA3diSeeKEn+oQTfn+gz/aLeHBF/AoFAoF8QmKjVWuecc878pTwlbLF1JEl5tJo/0g1NBCygfsqMxcaiYBHzc3YWVwuWXjt+ZeliDUd+HF8jflVV5V/Qsdgi3UgJ8sl6baGUFymwICMonv00ncVMHmWyPLHUcg9Aunz0xKfVgmbxm2OOOfLChlAhB8g5a582+HjJrwxon2fldzdot3KRHr8wUi9PG1jmkDxkCrFEAkoapIe/vPwWf2UJ9Y2MtPqF9CKFSA4LLiv26NGjMwGebuyJFJIsbUfBwg73ztJqN8wRCQSBVV+7lG3zAkNy4Bn+yJWNunze9WRggUZOyZbxr6oqkaV//OMfCW7644pcGGubAYRk9dVXz7+/TE5YHREpJArxQ5gQqaqqxlnQ9UNeG6illloqb6QQr7nmmiv/ig9Z06+///3viYwhVnzXkUNESz7xgjlBrulNJz0wJJ9kV3tYo8mwtOaQ+sg7kqZsJw+NMiDthAQnJORy3nnnzXhps03xZz7zmeREyGZPPBmqqiqRR21CBI1zY50IOgJtjtYxQBLracma/PpGdsh3VVXZd71sQNVp81jP1+zextBplnG3GSML0hkT82vFFVfM88C7xgBXbbBR484jSFPcTpxOcelB8OmRqqryB45O7mxApW0WYFYf85LGvFGfkwZz3nvtVYdNH/xhg8yL6yhUVZXIt1Opejrjpkz6tcgXrOFhAwdrc8JJmFMDcmcjRUfVy0kpngKBQKCvEGiZfJcGsYJxPaFQ7KzL+7gOXwQshsgWKyDrFlLJquweKqyEyAdrI0u1wCKDICHqxYrDcoPEIQhIEdJhYfnqV7+qmBwQZUfyyhAsiEiKXwKxkOVETf6wllt0bB7lK8HiiKTpQ5NsLb3SVpsBiVmNXZsFH6GyaLHasVQhbn5BpaTVLxsQGxkbGgtniWvvqs+f/vSnEwxYh9tL1xPvWfYQMfPeBsb4ILGIWU+U36wMpAexQeyqqkr86BGuMn6slAgqsldVVbMi8jvjUlVV4h5DHhESeUs5rsYCIe/KpgHxRBiR7lxRkz82nE5c1FECd4T1118/kW3ku0m2Hn+F9NoIkHVyU68APp7rbhyeOwv6Ru6Q2Y7SstpyDaMbnCCwvhvbjvJ0FIc4IpNOPRBZBN7VpkkdzfJWVZV8i+KUTT5jwO2KLJf0ZIOVXvnlXXeu2qNOukeflWXDajPovicC3abdRbZczVHWb+OKhDsZ0xabdfewJ389UX+UEQgEAl1HoMvkWxV21QhLT1ljlDmQQrSlNQRYUVhaSmqWQUe1fFXJCF/REldVVXYt4UNaD9IidNKxNLFoORa2UDvOtpCWeGkQB8fj9TLKfaNFSPrGwApa0pcr/3PtbUzb6jN/XtZT9SOB7eVDULgZ7LXXXtlv2rE/v0/kXR5WXT7ijpFtSmxovO8ssFwjUyzhnaXtTjySaXxtCmy0uHZ4xxrcnXLby8ua7+SDJZkVWroRI0YkLjdl7OpXGEjTLJCbqqqSTUqJtwmq53dPFrgQlDSdXc2BztKIr6oqcU9RRz3YkDazmMrTG8FGl5XUtV5+kZ2ukk6bmCK/9fIa71mY9dXvjduomMPGtTFdV565UbDg21A7BbHZ74xQ8o1GPn18qH4b/rp+QeKRVRbwrrSlo7TWSqdajFbcfrSBlbqjPF2Nq6oq0bd12XLPnYpVnRsVg4dNP/JPz7LGd7WeSB8IBAI9g8AEkW+L3HRjj7Ypv55pRpQyGBFgzeMiUm+7403H2BabYg1G0GzUWKnrad1zF/DRkXuBFRURsKD6iIuPovclIOiO6uukXxxreUcWRFYfFk1lstbJI1hsHVWzdnnuamD95YLlI6af/exniYWvvTIsfuYOSxgSjoywfnMXQd75aiKyNgiIwYixRLO9survkR+WNVbb+vveuLeIc/tgNbRx8LGaMe+NuuCBtHEjKG4ZSLQP4MhevU44wqD+rn7vyJ/ll+sHeVQOYlJktKRl+UWQynNnV6cO3FiMQXtpyR7Z9LFvYxp9QYYb3vfKY1VVicuSbwhYSuuVFDydaNbfd3avb06rfOfRUVq/2qL/LK9OgLqz2S312OzyyXb6wudcOzoiteSDpdspHL3CV9uGuJTnal3jzsIf33M9+K6g/tzqPYx8D0DH2HjTYSNHjmw1e6fptJl8s+jXE3OlcRpAxulTG1guYazi8PfRL71TzxP3gUAg0DcIdEq+kRM+io7mECgLmK/BWSZN5L5pZtQyUBFgyXKEi1xoowWO1Yi8cKHwjssA9w5WRYueXxdBcJBxizLLjHQCy6SjeOQOEbfAel+CD48QbRYci66PpXxQyZokjfrJqYWH7HonWHj4OfJX1gaElxxblPyKgQVSusagvNI3ZZZ4dbBQ+9ATqfab1MhoiTdPpHEt7ZBeWpY19fnoTryAENmE2FRYSJEjVlX1Wzw9S4e8I6TFcolIwIHFjz+o+tUnn/a6eievfriK905wL0jrWaiqKv+DO0ihuc8C7b2A4DgyNwbGdNFFF/V6XEBCuRyxipe6x0XWbtTJalra4yoaZo7RfU/iw0Yy4AOxshHRT8SIbPm5NLLG4ucYXf4SbIZKf2Fnk8hPng+z0xSkWfl8e8kEEkLmkDhuLNoHY+2q9wNOgnh1ccXxiyk2YMZJHhsy8bDTRxghOyyzLI4IvvH2DQI3ELKgrcpTl7z1e/V5711VfTg2fK3NMW403jcG6cmJsmCqH9KQU3LC6qlt3kuMRqiyAAAQAElEQVQHA1ZgH2l6R0alr+f13BhslJFYssoNRLtg4Cot+STPTrO89wwf42Nc9I3Mi5Pes7Zrt2dt0QbvXL0roaqq/A9P2TDoj/lnfpT4xqsy6B64aQP51g79h4V7H7CSEe5ExsdGXZtZkekaZVZV5ZJPr2xanHwpo2CmHu3Oif73hxzTQfSOKwL+v6h8KX3T75KXsUBZ2qpt3Hs8SyNTycOVzebUr82YK1yztMmponXaaQY9ZZOobN83OFlTlmdlRQgE2iIQT72NQKfkm/Jh7eKfizyxOrIyUSaUbm83MMof2AiwErEmIy6ILHKJZDgOthhqPWuwn/ciM/yZ/YQWH21Hv37hQ5oSkG0nKtw3EJvyvlyRbiSBL7hfAfChGCKobMfZFkmEHhlzzI8UlLwsb6zOXBnINPLI/9Q71qOSrlwRSRZqvtjeSauPAn9hv4LgF0e0yUaCNVU6pMJ7/bPQI/fKEock+CULeMGEJdCvk+gH/0z4+BALhogNEqNPjtXl58eJcLGas+IJ3H2QURZodfsFFBsLi7V2WLyRYf2wAVCHxVnQF2l9BFp+cxjBVjdLvrLKIq9+dcAadizT3tUDIsUCRw4s7vW4cs8CKB62SJeP/DxrC+Lu5/ZsKLiFOKqvuwXA2keq2kqGkEXWPb/ogayUOlhi+c1rv3EnG9x6xCPyPh4lZ4gwsmWDaEz8qgkipi2IEuIFY5tFFkNjCjcf/oqzgWJ9JQ/GzUYA1kikcZLe5tKYk1dlsM4ac3X7dRDEShsRIZsAaZAmm0ry62RGP7RdWTYPNidkpJncIoQ2KOSG/max1Tf59VNbyIbxVRdfZOXYeCCQiDistId/vU1OXQaUUwIsuSLZFCHfsDCu5iR3KPIAA313Gsblg2uV/jjdIXvqIJcwt75os/r1w4fQ8CfXNlCwReZL/YisuWzDbnNV3je7kg9znbGAHGmvjRPrN7y4U9kIOc3xbRMZQWzNUW5WPiJXrjROf8gYWTVmxtq/zCoeflw73JeAAKvPh6mN6yY5oEPNF7pLXngjyU5pGDiMkXlp7sJTuXQOvSAdKzadaR7Z7MGEzDI0SKtsJ2rykF0bT7Iur/gIgUAg0LcIdEq++SOa+BYZX4rbdVvoEKBCNvq2yVHbQEHAL+BQ9pS4e0RK25BmZMKi5lnwM2KsLwJCZbGxSCN54uvB0TgiUCddJZ5lXJz8ylEe+ZSnqqqEZLH+WLCQUiSo5NUeeUpe5AZp4opQ0tSvFixkk7VSPmTPwi8gQayISARCYYNR8spXVVWCAYJkg+IddxzWNBsTlk4EzIKtXYL26BtyidgjCMgckoQ0VVWVkFM//YaAsbZZyBGAgqN6YOR4G0FHOJCoqqryz+rZQFucLe7CyJEjEwycCnjWB1hKZ/OErCBN3pdABxhPobwrV3KgzYhKe1ZI+Y2TNho7biXGCa7GjD8wLJCfOq7qYJWGgTGUxvh7RmrEl8C1Qd/0CYFCfLStxHPvMXbKMbbK8gxn7UMqkXdtgKdytM8mB67aIZ32IcI2VQggUoZQw8A7/r6snMZa+dqrPvUqX3591zbvjSVs1Ac/8mETogxtN+7mjY0PuWxGnshAVVVJWbAht+RNfv0yP9VPdpBt4w2f+nyDn/YwupAfQf5mQRu0U9+4PpEXc9AzeVe/jSXSZz4gtn6hxyYAGUR21U2effRK9oxd6Yd2SsfXn45pbEtVVamQzGbtK+/MBZsEfUdE9XHnnXdO6oOVd9La0JFLMmFu+4CRHCDC4m1UPBs/66C+kYUyhsqtqg+t49KXoN/K09fyztVY25AZ19IG78mothprukD9ZMLpn7ExV9QrLd1iswVzcfLRgfSKeH0wJ+ktOJBjOkZchEAgEOh7BCbqrEoE28Sm3LiZOHJGHlg1Ossb8UMbAYuIgPixtLB6kZOVVlopWRiqqu0CxHKD5BU5shA0Q4iVyGKE+DaLV7YNoA8WEWCLngVFWmXXA1n1vgR1yqutFk55S1zjVd/qZdXvEQHlWCDNkXpeC17ppzzqURaCaP5YPL1HbGxuS15tsclFvhEaOCALjtURMum4DLBwSacMxEQ6cYK6vS9BO8QjReWdK7cLwX0J+qMMvy5iPOGLSHlXgsWexQ9BaTY+SCKLMkJXVW3Hv5ThaJ8Fv9Rbv8KV/CCZVdU8Pyx9jKp9+ufIvYx/qQNBYrFUtjQ2QCWuXBkT9FkackSOxSHEnr0vwdiprzy71tNrj3eO88mcZ9iVcVOuMTW20sHIWHrPJQXp8l7gCuN0qLE+aY0NIi892fOuMWi/MpRVDyUdebUBUwZZtPmBhXjtdRJQz2cD4b349oIxsVEzr4yfvhpjJyQlrz6Jh5H6bGCk8YGr8avX6V4/6Az3JaiDjJV2cFFiFSdv5V1HV1ZrJNj8IcPGgKyTFbiUvOqFofYaq/o8lcbYGh9rozExD0sbXZttTJ3qwVL+erD5l6cE89v6CpPll18+wYhuQLzpjJKOrvW+lGUeFLmFsXlf4oxxyWvMbYjq/S3p4hoIBAJ9g0Cn5LtvmhG1BAKBwEBFAOH2yzNcFxzTc+lBLqqqOTnuz36wIrOYuvZnO6Lu3kOALz3rLvcLLpDI+MixJzi9V2OUHAgEAoFAzyIweMh3z/Y7SgsEAoEWEeC3zo2CtZC1jaWuPatri0X2SjIfMdog8BnmO8yXuFcqikL7FQEfTXL18e0BAs5CHVbcfh2SqDwQCAS6iECQ7y4CFskDgeGGAFcdPrF8XPmUcqNxBD7QcODXzIXDrzwgZH59pCfbGGUNDAT4WPs2gk82X3UuSgOjZdGKQCAQCARaQyDId2s4RapAYNgiwLebj6hf8+B/PlCtjH4xxsd79TBsB20Id5y/uM2VwG98CHc1uhYI1BGI+yGEQJDvITSY0ZVAIBAIBAKBQCAQCAQCgYGNQJDvgT0+0bpmCMS7QCAQCAQCgUAgEAgEBikCQb4H6cBFswOBQCAQCAT6B4GoNRAIBAKB7iAQ5Ls76EXeQCAQCAQCgUAgEAgEAoFAoAsIdJN8d6GmSBoIBAKBQCAQCAQCgUAgEAgMcwSCfA9zAYjuBwKDGoFofCAQCAQCgUAgMMgQCPI9yAYsmhsIBAKBQCAQCAQCAwOBaEUgMCEIBPmeENQiTyAQCAQCgUAgEAgEAoFAIDABCAT5ngDQIkszBOJdIBAIBAKBQCAQCAQCgUBnCAT57gyhiA8EAoFAIBAY+AhECwOBQCAQGCQIBPkeJAMVzQwEAoFAIBAIBAKBQCAQGJgIdKVVQb67glakDQQCgUAgEAgEAoFAIBAIBLqBQJDvboAXWQOBQKAZAvEuEAgEAoFAIBAIBNpDIMh3e8jE+0AgEAgEAoFAIBAYfAhEiwOBAY5AkO8BPkDRvEAgEAgEAoFAIBAIBAKBoYNAkO+hM5bNehLvAoFAIBAIBAKBQCAQCAQGEAJBvgfQYERTuo/AW2+9lV5//fX0/vvvd7+wfi7hgw8+SG+++WZ64403knvN0a/XXnstv/PcE+Gdd95Jr7zySnr33Xc7LE7dL7/8cm5TSahd2vjqq6+WV/mqzBdffDG55heD+A9c9M91MHXj7bffznOhP9v9zjvvJDLTW20gk+YHGezK2MCmUT7fe++9ZG51taz26iX75Ma1pNFe79qrQ7vMRW3TL/Or5G3lKr0yXnrppVaSD5k05MvY1bEerJ0jh2TAOtaVPsCAbFkDu5Kvt9NqDx2gX71d12Aqf4LI9/PPP58uvfTSrNgHU2ejrb2LwAsvvJBuvvnmdM4556SzzjorWUA6q/Giiy7KaaW/+uqrO0vebrwJftttt6Xtt98+bbzxxun+++9vN+1giKB8//nPf6Yf/vCHadttt02w1e6nn346fec730k77LBDp2RZ+s7Co48+mo455pi0+OKLJ/V1lH7MmDE53QEHHDCOVP/3v/9NP/rRj9Iaa6yRLPol/6hRo9JMM82Uzj333PKq16/33XffOFkiT8LFF1+cnnvuuQmu++GHH07HHntsWnrppVN35HOCGzABGRGQe++9N+25557pm9/8ZrruuusmoJSeyfKPf/wjy0xnsjUhtSFbl1xySfr+97+f9thjjy4Vcfrpp2f5JB8yWtP+9re/pWWXXTYdcsghXnUrPPHEE+nQQw9NK6ywQjrzzDPHlfXQQw+lr3/962nvvfce967cPP744+nII4/M832RRRZJ66yzTvr3v/9doju9It6333572n333dMnP/nJTtMPhQQIHb108MEHp+WXXz6vPYO9X3fddVf64he/mOWg1b7QcaeeempaZpll0vHHH99qtj5JZ32Zf/750w033NAn9Y1XyQB90WXyTbH/5S9/Sd/+9rfTM888M0C7Fc3qDwRYcyjCn//852mttdZKf/zjHztsxi233JK+9a1vpXXXXTdZDB977LEO03cUSQlTQHfffXdCKDtK29Nxd9xxR3rkkUd6tFhEluXrmmuuyZbDUvjUU0+dNt1007T22muniSbq8vQtxYy7ms8IPbJg8R4X0eRmhhlmSLvttltaeeWV08QTT5xTsLTAm2Ujv/jfn0UXXTT9+te/TgsvvPD/3nx4sSkSPnzq2b+sfTYDO++8c1prrbXS73//+4Q8k8sJrUleRLa32jyh7eoon7lgs2YzInSUtjtxJ598cqfZP/3pT2eZmWeeeTpN29UEZJfcIpyIeFfyf+5zn8vyucACC+RsNu8jRoxI//nPf/Jzd/9oj9AoN+aQzepqq602XhU/+9nPkvl0+OGHJ4Eh44wzzhgvXXsvzF+YqNNcaC9dV9/bMNxzzz1dzdYn6Z0kMFQ88MADyXrSJ5X2ciUf+9jHsnGFkaXVqugpOvmmm25qNUufpfvyl7+c9tprrzTHHHP0WZ09XVF9A91TZXd59WZdPOyww8ZZ4nqqIVHO4Edg1llnTcstt1z6whe+kDvzi1/8Irsz5Icmf1h5KE5Wmq233jpv6Joka+nVlFNOmb7yla+khRZaqKX0PZUI6WTdY7XqqTKVY5FeZZVVEkw9l/CRj3wkE0s4d5F8lyLaXOecc86EIMGvTUSTh2mmmSZttNFGaamllhpH/BdbbLH0qU99arzUyNZPfvKTNPfcc7eJ+9Of/pS6s8lqU1jDw2c/+9lsLfr85z+fY7bccst8CjL77LPn5wn5M++886YlllgiTTHFFBOSvV/yIJFLLrlkQjB7qwEMLz/96U87LZ4ckJlPfOITnabtaoLpppsuz/nGOdJKOSxx5HPOsfIvvTLMN/c9Ecg9K2RjWdNOO23Wc1/60pfaRCG3FnjtMsedJF144YVJG9sk7OCBPmhvPnaQrdOos88+O9nUdpqwHxJMOumkeYNPJ/VD9b1SJd3vNMepSasV0HEs/62m78t0ZHKzzTZLNhV9WW9P1YXz/vWvf+2p4saV0yXyzRq366675mOzcSXETSBQQ8ACYMG18HM7OeWUUxKLTC1Jvr31ylE0NgAAEABJREFU1luzQnecP+OMMyYKJ0cMsj833nhjMjGb9XGQdaVXmwuf66+/Pp1wwgm9Wg/5m2yyyXIdSEy+iT89igBrI5cK1vUeLXgYF8Y1yIkF+QUDKyYiblPgub8CK7pNAYt899sQJQQCgwsBfve/+93v0lNPPdXjDW+ZfDtC22+//bLlq6+tiz3e6yiw1xHgq8wydfTRR6cnn3yyTX0+DOG6xG+5TUTtgdA7Qjv//PPTBRdckJB1R2u1JPmWBY4/KesMF41mi4R8/Oj4HyuPG4E2KMDVsapvGNw76nVfiIVj7csvvzwp3/u6e4kjav6V3C6uvPLKnKYc97LosxaVfKy9CKg6OwrcJPixyqctjpHr6c1D7+3GkSBxFm3Hrvzn9Q/JZUkr9ek//Pjin3feefloHb7yNgbtVD9fWLjU42Giz3feeWf99Xj32mPM4QYbfbjqqqvSD37wg/ydCN9p/TMOriV4Vph65PVePu9s5IzfmDFjPHY5yA8D5XHnsWmChyuXg3qBMOafKB4OTjUK1vV03pd28s1lnBCvv+TksssuyyeExoYVkxzDV5oSYAWjUg4Spv4ST76vvfbapN/GjIwrq5k7iVMY8XD717/+lYoslrJctU17yIp0MKn3X1vk5cLFD1q7Cgbyw46LGJcy8qUM7SNj4huD+aM8ZYkzx2AwevTo5J3+ua/XIV17Qf4HH3wwwcD4NLZfPn0ko/AmM+QNNuIEmGuXvhlD75oF8qh/JcBNOtiYI94bL+9aDfQCmeOqJo8x1T66Ap7kTrn0gHhtLbKkv+RMHnGdBeUVHGBsXsmjbNioh67wDj6eBe/IBGycctNtdI766RXpG4OxlKa0z1V678q8KHnIpTrURaciNtpa4qXnPqiN9Jk+GPcS70rP00XKMI7K8L4ejLE5SOepz9yoxzfew4d+UKbrTTfdlN2AjIHyvYOJOUL+lEtH1nWDe2nJvP7DTn/rddX7Rz7NH/0paaQnI2ShvHMlf/qjfcbz2Wef9XqCgjqMUSnLPGwsiJyU+si5+ouLV5F/ay/ZkRe+yhOKDjNu8DLOdLB0+g83GMHcWMNSmbCTRqBT1GcczGnpyIN6lA9retBYyNuIh3h9ULc2wZP+UrbyxOmXvtNJ0gnaQB6100ntqFGjMvlWhvTmhjK6G1oi3wCkcCeffPK05pprdrfOYZ9/OADAauPDIpPM5Kj3mQI3Eb/61a/WX4+7Nxl+85vfZD9wfnwmnCPugw46qM2vfCB4yC+/SBPUBycmz7iCxt6YbKeddlryMZXJi/RvtdVWycQ3OSkgH2vxoabsucL40IlC13b1ciuxyP/qV7/Kvngm/NiiE0XsuM9EtkDql4nJh/rQQw/NHzAiyfw3t91220ygUgf/6euOO+6Y1E1RKAPRKFkscPq6+eabZ59Qi4I4C5xF0gLu3gdjPnIxb7VHn7XdIqZsvqWUSsmvDAE+6nfUDQMfriIG4ljAnGJ873vfSyeddJJXTYM61WOs+PNbJOBsvLlwiC9YUcp8yB2xK1P/FErpUurf/e53k0XIO8qV7lGu564EShkGyD/3JuP5hz/8IY+ldxaYUh6l7oMl+MGD7Ppw0/uSxpX8/PKXv8x+pjCFGZm1EJHFvfbaK/vlU9hOC7nAfOMb30g77bRTQuqUIZC/o446KpdjEf7xj3+cfdUtxuRLO9ddd938/YS+a5s0G220UZsPSRFCY8cPW/2slWRFHfWgP8q0qLknS9JaaIybj2l9z6PPZErbfGOgbOWQdVZZx/2eybyFy3vP9UAelaG8QjZtghlxyAbczY3f/va3acMNN0wwgl+9jPq9BRFG8pMPsmHOG6eSjkzDHM7mrMWSjB144IE5iXZ6rwztQqhyRJM/Njy+HyCfdAiiIBmdYszXW2+9PG7etRLoNXK4ySab5I945dEe84Au0z9jDlPkyLP5x4BBj5A5Y3/iiSfmTaz8HQU4aL8x5j9MB5l7ykZg9GufffbJRZhzZNEYcBfUVzLvFMl3JggJuSVnOUPtj7g///nP+cNXBpW///3v+aO/8vG7ukpy/TPeo0ePTuTNdyHaiAhJox2wNq7qo7f5yJv/4gXtNxfMUbJufZBOXAlk0pw0/nSiOhmESnzj1Ziap8qCtdNM40TvkV06df3110/mF3yMA33kSs6VZ7zIlrpgifD7/snHoEWu1UOPGkNp4WBc9t13X0Uka4eNrfmtj/nl2D/KggO5U98uu+ySrE3Sj43u0v9kQB/MJWWp21gZx1KQzbmPguEnjXURfnAgs9YlbYCxe/lcxZMr+JuL1jQyZn0l1/oPG/Nzgw02yGu8NZxbio/D9xqrN7XPemFjYq3WvuOOOy4JdK41yAkquVKfuUxHyktvaotgbtMvcKZrjKd8Nq/WVx+kq9e3QcbDPLMekEmyb63SV/Kv3dpf+qX87oaWyDcBN2ksxgh4dyuN/EMfAYuzSUXpsACUiW1CIsiIGMt4IxKEnSK16Fg0KAUTjhuLSYE0ymMC8Ysz2Sg4isAiyy9ZfAmUFkVi8dluu+3yx1/agIwiptrhQxAK3YJDKfh1C7/+QYnKb9J6v80222SLm0mtfErGx4f8OBFFbZ1++umTNpqsJrJ8FIg5ZLLL1yywKihj0UUXTRYBfaGULUYlPTcKv4IwYsSINr90wrrCJ5kiRKwtEtohn0WdcuEKRFlrj/5aRCgXaUqw6FDw8If9FVdckbQZNjPPPHNaffXV2xDHkq9+dWzOv3euueYa96EonWEj5sMb44PYw4pPrAVG2caXb7WyHLXPN998iZKlHL3jz22hW3XVVT12KVCevgeghI0L30PygoQjRBZc8qRQhIW8IpzaaBy0zQZCvGCs9t9//0w2jK3Fhd+8RQIp5O+LtFhALFzGRbnws6jDnuwpCynUb+XYBPI7RoBZ9cyPz3zmM5loGRsyvPfee+dNA8JJrpVBRsgMQq0MfdPuIgPSCEiexWrNNddMZNkc+PjHP55sGh566KE022yzJfJlriJD5Ah5Ng7IODJk/JBW+aqqyr8uZGGFsTrqwbcccFFeeU/21GMcLOwWYG1CZC22FsWStvFqc2YToI36p8/ymw8lrfFEBGFX5rs22MhKY+MwcuTI/J0CufauvUBm6B4ucXyKyaC0+k5vwEf93rUSYOTUmG6kg+ShO4zr1772tfwdBRkhd/poQwR/rnnkw1w0h8gZWZa/o2C8ERNkWNvhgmAom4zU85qDSLBf2Sjv6QxjbcxXWmmlBM/yPU9J46oPDCnaRB/zo6f7bTTIEX1P3ukbxJO8mteIOn2DUCKcyrKhkt7mzHxXjvHddqzxwlpifUC6pYGHfpAFbZW/BDpR3dqsHnJD5kp84xVxZGCEMx2pXjI0ySST5A8F/XITPPXRuJsP0tEd5rN+K9/mmHwpR7tsuBFX5E+d5jVDA6KpbTCnK9UtHtZ8pK1Fnksgh/Kqk9zLzyJLv5Q0rVy10XyjY5FpZbkyPNE7ykDKrRXmpDZKo53WA3oSLvSjtU/6Eqxf8pRna4HvgWaZZZZk/L2nF33kbKNCLxgjfVI/2YYNvSwd3WfO0H1kijzAkg6xbtgYaac8vqGwbtFR6lE2HWe9IGN0ND1uPpEx81c7GNK0zZpkk6QPZBH+voMi//pgzpuXcPdeHd0NnZJvC4gjQZPPBO1uhZF/+CCAhFi4yU9ZVFkhEcJll102UWyNaLCssNhZLCzS0lBIW2yxRaqqKpkgFliKAEG3+FkcpTPJl1tuuTZFsqBoh7LsZpXFKq9NNpTyCjIh09KaYBSo9wgEskZZyIuEmazSNwvaRvFbxLSJsqI4+LWXSd0sn4XKzlp/kGwLNOWDOJT0SKy2iC/vXC1qMGMx0E5160dVVRljuOiztFVVJYuZdnmuByTKQk8pIWYUGpJHwVOClF49fbN7CtdibLFqFl9/Bx/1WWiRUmRDvHEybhZNffYOhhYNytRzV4Iy9L+qqvzzckgVZWrBNr5IWKnbwk4xIyjqQGCRY33yLFhI4eGXXMgCmUBKYGpBlIesVFWVfypSHNJlgTV+Nm/mAJJvzHwcqRzEAh7iyDYlr53qNhbGhRwvuOCCSf3yag9CgMCw6isfrmTXL76IL8HCZVzktwhXVZXUbVFnkVYPuZEemYKPkx31kkcLmrhWw0c/+tHUuGbARZ+MifaVOmw6lWv+uDYLyCOS40M02OincTVeJb12TjXVVPljU0S7qqqkLjIlDflEHuDguaOgLDj4ZRIb6kKYtQHhQhqU3VEZ9Tjzzly0Ua6/b++efMADGUNYyZmPiekt8tFevvIeASR3SAf94j1LKxKpLZ7rAZ5wrb9r5V5Z6pGWvJBVV2NrrHEIOkofuBeQOXUZExt1aZFy8i+eDJNzOBsnc58eYunUdic2dLW8yiG3+In6SzCfkTa6GG5kuE4MS7pyVbc5QY+6N3/gV8onywghXYUkKg/xVy/iaF0zH40Lw43+Kod80tfG0hxHEM0/+ZWtHnKNSGoLLBFjcZ5LoFPoBmXR8ea/qzJLmlauyClcEGf5jYmxU692kDdk1oaA7HuvLdI0lt8oK1VVtfkwvaqqZK7BzlyU39Xz1FNPnfTFekc+6VInctLbWGkXOdBPdZN76w9szXekXV7tHDl2M22OysMyrR7z0zwjazDSV9zAGouLkBm6Tn1wda98et9pgrFTTm+GiTornLCw2ukUy4TgKEE+ixCgTCLPEQKBRgQcY5q8lKpJgMhRTCZQY1rPiJBjQhO7qiqvckCSKGGyxvJI7pTXuLjnxLU/jgzJsGMpwemNiWuyWhRqSce7tbiyGpF/1nDEf7xEDS8QMIqUdUp9gt05JatOO+qGLPkfrbEowsWi0xjf2TNFarNiUbA7Z1FEUuFuYXOMKx4ORxxxRHa56axM8RYreFvwPPdGoFwd31q8fNiiDjJi0WJx8NxXwdjY1FHIFHd79fIl5QLASmJ8BZsHmBvn9vJ5b0HjzkD2yCZZYUVShoAgkxMkVfpWArwQdmPdUXpyjMCopwRypz6ktKO8AyHO0TAyQGbaaw/8WR/JlNMGlq5yQtBeno7ekwWbUmPmBEla88t8opM891awISIjTt7KeDk2N170Y1fqJU8w4XOOYHUlb0+ltXlxksgaX/rDOoxYIlFIMgLLquxUs6SBvT7T9+6d8HSm950k+PUP1lJWdrzFZr69vjB0sABzs1KvzRbi5gSuvTzIODmwMbBRYEU1n+l7ZQjcHhhQ9BGhQ/5s2Lo63xhuuF1wv6EjEOX22tXRezoOhk7jtE9g2dZGugk514/21ueOyu5uHJ3rhAlGNkLdKc+8MRb6V4INHjlCvMlid8rvibydkm87OWTIsYOFXbCYq5wpn5+NnYLnCIFAIwJ2+KwDyAklxTLo2SLamNazSYHAIieUsXclUNCUFqWHgEtb4tq7VlWVv1Og0Fkf6oHibC+f9yyK5J71xO7b8ZX3nQWkl1XE4l+JljIAABAASURBVF+vz30joVQWaz/l7X5CgrZRyBY1x6csoNwikHlYWkgcu9vYUD52+q3UY8Fm/euI7LRSTmdpWIa5oHCpYJXhusEaYqw7y9uT8RR2q+WxlDQb33J021455B6uFmBpyAOySDbqwRiKbyXYDCBVraRlOeLjXa/LPbegVvL3ZxqbjM7qR9D0zzE9VxoEzClbZ/k6indSQka5OZBPpww2uh3l6ak4m1CWSGNUD9zCulqHjQTd2VXi3tV6OkqP+CB79b6U+5KP6w1DQXlfrqzd1oVW+IaTRgSVHDAg2MDgLh3ltVETWNvpb/oe0S/tanY1j+FKT4pnhaVrS5vLlZuE9Yyed4JETqVvNSDdSL0NNCswC3yreRvTaat+lraVq9NGmwRttFY05uvtZ/oentpgDe1ufYwRjGelf+Xq+xLzoLvldzd/p+Tbgoi41ANfGhXbibFG6KTnCIFAIwIUE8KHCNpts3A6lmxMV54dGVtwLLTylPeujltZPFjA7cxNUJtDce0FExmZswuup+HXxgJef9d4T/myAmi3BRhpakzT+EyxaZfNBktHPR5Za2Z1ouxL2axq9Tyt3FPIFKaPdLhN2OmzkPmgySYFIURAWFhhS8G1Ui7MHBGyirSSfkLTIPesU/rAN5PiRxKr6v9PPia07K7kY/2SHmb8i903C8aKQYLrUmO8zWXju/oziw7CDVfHqgiiY/S6rKubZb2er6N7R/vapJyO0jlVcWpJ9uvpyAkra/3dQLxHOugP49Ne++DJh50bC7cBcuR4u730rbxHGG2G1I2UGasiK63kn9A0dB1LpBPmuqFBO5zQdLVc48xaT3/W8vbZLXIFO24ajZtF+rKqPnRTIMf0br1hdLVNj3nDLaMzvY9oIbtcCH2747sglk86uF5uuWcY4o6w4oorJt9h0KPWjXLakZr8x5UBiaYfzT+nLtqNKHN7KVnMeXrB2sCAxO2Mhb/Eu6q/PaJvw+CEwLpiTWI8sU7K19Vg40WWbPgb88JMn2BsDPjYN6bpzWfjBU9uOd2ds9y76An9qLeZHFkvyWH9fX/cd0q++VU5eqkHi4bGWkQI00DYRWhPhP5HgNJhyTWJtYbCZSVinbVgsNgU8ieNgGwhXtKTLcejFhzkxoSUhuuDxcMxIkLPCmKC2sGz9lIoJpQr3y8KT17KF6G126VMKX3toFRZR5QtqFteV8HRnEmqHPH6RWG6Vw8LjHtp1YNoO/p3rMdKxtrsQypkB5liyaHwEG156sH88WEOXGx2la0t6lR26Y886hS89ywgatwJ5LERttmhQOVjvdcX6bUbzspXhjZrb1V9SHI9SyfOGDqC9SFKWazFqU+8UO699yx4J3hXv7qvqip5rx6LjTq8F8gI66uFCx7877wvwVEkyz7/5PKuvWtph7pKGti4FyfU7z0LFjQf2PiICqbwks9VvPa6dzRKTn0caZHmkkfRc7EyZsouQZy8Agu1hddGCLHSX+9ZArkDOaWQnoXVIqQMfRCk8yyUe21zT95Y3JxEst57r50CrFn+lMH6Z/Hx/QR5VJ9NLncfeZQtnatyXYXyrly9K0E79b29hbqUU67yKcezq2eh3Jerd43BR3fa7+SVDEurf650iHsbdBsj79ThvXFTlrEh7+7F16/uCwbyea4HFnTuXVxY6B/jX49vdt9eecoX6nlK2tIucdyYtNlH1OTMeJnL5AURk6ajIK96BO4edIGxN7/kcwKJyNOf0iKf0mgD2ZFPOsEzfdIeQSztl0eQx1VQnqt6WbXpFSeK9Ln69Q1pRU4ZZmz66R1EWZ99IEd/21A5cXIqxvCnvdpVgjrIobYwctDx3tG51h3toP+0rTGop5wW2mzBnq+98kpa5ZrDylGusqxTCDvijTTiST7W9H2KuSy9j6Dlod/JkLaxyJNV88echYc1Ul3KFuTxbANm7VGfcZfHeigNmddGbROk9961WaDL+VdbN2Fq0609jKi+SdEH7dA2a6c4446YN5bnWxhrng2vdpiTNkjSea63R5sEcSUYNxsL7wWy7WQJnnSxdyWUPPXngo+4ci/eMz1O7+ELZEXb4EjW9AmO2ie9II9Q7kt53gnSwsFcsZ57193QKfnubgWDJn80tNsImDwWRh+tOO7hZ6dQRIrSQVZMLO8s+vzYLJQEmlWCRY6C5nvHissKymph4ju285U5X0D57f79+onJwveWdZeytciY0L6YpkAQHCc12ob0UJIs2cg7FwDKAslXJosZReiehUhbPSvfkaXjQnGUFLJrgrI6muR+ugk59JERCzM/UWSfhUz/KTvx8jcL+mZhtLhZeCgJCpzy1nZ4WqhgaoG08CCJyqIYkHZ4WLCktYhZrFj+bJBhaRHXR+ktfKV88Qil9qkX3vpDOcujDuRXH9wbOz8XBXs+w8aNAkbokCN9YOmBjzYi2vLBpmBlvJEY70tAHm32fVBnIS7vXY2TRQxJ9dwskCPjrn3ifXSjfdrD91K/LRZO8bRJexFHWHJV0B8LJ3ckMsPaZMMED+3RZi5ILLCUulMEvwZgfG0e1EneXEtANMiLvI6NbYz40ou3QRLvdMbiazNpQbP4Ixja5ijYVT9gSRZcLQDG2WbFgmr8LfyOo7kC+kZBnAXD9xbGz5wRZ0NJptXnlMQpEhkwpvqrbTCy0TE/1W3c/FKG+SXeh0k+nrLBtKGwmHlfD8qDsXfkQT8QKVhbDMWxYNqg6hN58U4aC7N89aAu81B/6AeyapOL5CgDHk5RnFKxdMKb3kBOWPx8w0E2pNUG9alXu+gKOkR9Nuv67L4efMcBJ+U36289rflFH9nsI2jmrE0AWSJ7+o3II330BF2oz66wt2lg4TVHWVXJGULiY2pzhLW1Xl/93pwnR8aW/NDHvleBF8Jd0oo3b81z2GgXwmkewRLZI4t0HGJKPxi3kr9cEUO6x7Py6ChERxnkVV/1Cfmke+lV8wHRgyedhehVVZXMfZssuNDRdARZpVPNE6c3dBlZZqTRbrKuTnMUpkV+9Jm8q5s+49qmHu1sFoyD0xJ4mQf6r96SFqE0l8mcvtkk6wNZtG4ZH/OQq6WrcaL/lWPtYYjSPxsBmMhLb9A1Rc/ST+qAM+MPQ5GNNZ1E7v2Agf4j4OTFmOqvMSj6meFAKO2uXxmczCHt0E9tpZf1if6VlnXdem2uI+LmHd0prh70zcbGaZD2OzGgF9ShXdpPhxQ9pD5zrZRBp1jfYUlXq1//1E3+4aANCLl5ijTDwFxSBt1p80D/GH+6jv5XhznA/ccarz9kh9yRQWsdXBkd4ExmzFflmKulbHqC3sAFtMPpF71Ax0jT3TBB5NvCYDLqUHcbEPmHDgLIoYXOT+xZOEya0jvvEL/yTElTNAiVhdIk9k48662FkPI0QSlwStNkEl8CS54FDpmxSPhgRD4EjYJTDoJDSZpo4izGvqpm2aAMLboUI3m2yFnIS/kUiF/9QKh8qGkSa4PFgSJHPiwClIBfbigEisLSBkG58rAsIGul7MarSS6tPJQPRe5rbu2Fmw0JhWsBpwSQdQpDOb7ippCrqkqUEUVtsbEYOZ3Sd22mkKSDtzJZ2y0AFlx98EESsoBAW/AoQwRNHTYelL02sgJqB7JKSVKYymWN8R6GiL/F2tU4K4PCh4X08ISf9yV49pET/VLelauF2FggIeVd45VyVjerh3bCGx7eKVt7LKb6ok1Ihj7DWV79YRWCBYxs1CheaZB3mJIV9ZIFvrhwtOjAmLwaR/El6CtMYFMwretNmzQLj3K0mczBEunQJmm9R/gtBuYYOSVr+qlvSAH50x6yYS5JL58F2cKIYGsTQkr+tdl8MH/IlkUKHhZU+RzbeoYTHPXdWFrYlKONytAGH7c19lsa+cmf8lj69cfGGIH0DpFi8UQckEnjizRKhxgrox7MV1ZfY2FzSb5hao5YxJExMm6ctVeZiJFnaWBtvpJvC7D3yIc2sYjrg3ZJo031ut0j3OJg5LmjQK+QYyQMBnBEwmx8yLANNv3I4mwMzXn9p1fILPKpv/qHkCO32kbOzOWOCIANmDzmjH6Y0/CgJ+ttNnawhBuLNMMGQg5LhFwdZWNHrlZZZZVk7OpluLcRRGq0Tx36WgJyrK/kX1rkDFlWL/kjn+YbAiievCNzrJXKM250pz6JF4y9jaA5amNAh9k026jAmz4zvuYj/Q9P8xgmCLEyGgNZNAeNLZk0pxBwp0olrT5aC+hh1nmyoI3WGWmMl3HUXnXrHyxZubVDGnPTmmcc9RPO2m2+iqdP6Srzm45kfLG2wYm80r3WtjL/yIK81l11aI95SsaV1yzAhg5QpvSusGFEkB5W8PVeG+kP66W4eoA9fcVlkN6mW/TfeGqfsdZ+Mq3tRQeUMqxx5E4awVyVj9yZJ3SdvtJPRY7NVVxAu80d+cgauTT2TkbMM3XISyfW5w5drnwbTWQcN6DrrAkwI0vKdrLlWRttGMmhTTcdQu8ov7thgsg3UE0qi0B3GxD5hw4CSB+5qIfSOxPVQleeEb96OvcUf4lHfFgJvaf4CT6lVOLLFRlihUSGWP48W3Qouar60J2C8qI0TTwTSTvLBEJi1VGCCVnKVgZXAvVTaJQrRYDomJTSuVpc1E+BeyeYvBYi5doksPBU1YftEd8sIEDaTonZrNjAsDog1+qh5JVXD8qxYBTFpY9wVL84/aSYSpkUIILJwuMqjWBRogiVrS8UdFX9f3spUGWLFxAueFiwPZdg4WNdK8+uxk4dvmaXnlIsit77Eig4irUQ/vLeFRbqNw6emwULgPrqwWmC9rAulffq1yaKvrxz1R8BUTVm4uVFCI1DXX7Vrz44siSRVf3zvh5gLI3yja1xrMcbH4SRjJU0Ra9aVL2rB7Jbf7Z419OrS1+lk58smHv6pV5tJE8IoP6xvJE7cfpYLxs5s5jW3ylPWgu0uWT+sHR51xgay9MeBK5eno0P7Orv1MmS2FieZ3MZWYS5jZSNgfmIkOmbfpJBbRNv3rEcwkUafaUL6vWRdRvm+jtyqr56QJKMIZJef9/sHkmql0evwKz+zpy0yUKw6+/dk3flwgGJN6bGC1bIg7j2ApmCC9lQliuZbkxPFpFa7WC4oF+1m3zAWXqEUxy8kU3vGgP9gwSqSzB36Av39VDywQG++qNtxse4lXjtslGX1zgiwPpU4l1xEPOYHNP55B1ZRb5sksTTy+KVI66un5VRDwgYnVvmIb1v7tbTVFWVyBO5UqZxs07V08BQPnqHvoJv4/ww5kUG1aOt2qwca5iySzDf4GEDBwvpEURlkAnyQO5tNEseV2uP8toL9L01Q1r9/h8245KXePjREY34S6ivZMLYq08/td+8l5/sljVFPWSIDpBXkN+4Wb/F0w1lblm/vKsHGJQ2e688sooQey4BFsqHqbldyqdXSvk2DCW9Kxkynu5LMEbKMXdgT2aLrvW+u2GCyHd3K438gUAgEAhAwMdXjnuo852NAAAQAElEQVQdG3JfQfi8H8yBBV3Qh2YWXO8jDHwEjJ1jbi4CXBcc7yPfA7/l0cKeRoAsKLPMa/fDKZR+uwrd6bv8gjLK1f1wC0G+h9uIR387RyBS9BkCLF+sy6wN/A77rOJeqojfIX9C3wRYWHwD4Ri7l6qLYnsRAa4H5JM1mIsDP+VerC6KHoAIkAFGAZsw93z2uX8184EegM3vkSZx++RKozDfz9iI0nOeuxq4hPjGii841yp+3cUlqatlDfb0Qb4H+whG+wOBQYwAn0juJn6T1/H1IO5Kbjo/RD6IfCT5OTqm5JeYI+PPoELAUTv/VT6jPlx03N9XHYh6BgYCvnMxf7n+FJ9ifsfFEj4wWtm7rfANBr9++oxrBl9sG5EJqRVph6dy+OmbY8qbkLIGe54g34N9BKP9gcAgRoCPN588xLuq/t/HfLB2Cdnmp+lDpRL4vw7W/gzndvND5gblGwg+4cMZi+Had/7Uvk8qc9mVPzrSOFwwsfHgX63vAp/+zr47aA8bfuF8zJVTQkff8bRXzlB4P8DJ91CAOPoQCAQCgUAgEAgEAoFAIBAIfIhAkO8PcYi/gUAgEAiMj0C8CQQCgUAgEAgEehiBIN89DGgUFwgEAoFAIBAIBAKBQE8gEGUMTQSCfA/NcY1eBQKBQCAQCAQCgUAgEAgMQASCfA/AQYkmNUMg3gUCgUAgEAgEAoFAIDD4EQjyPfjHMHoQCAQCgUAg0NsIRPmBQCAQCPQQAkG+ewjIKCYQCAQCgUAgEAgEAoFAIBDoDIEJId+dlRnxgUAgEAgEAoFAIBAIBAKBQCDQBIEg301AiVeBQCAwkBGItgUCgUAgEAgEAoMXgSDfg3fsouWBQCAQCAQCgUAg0NcIRH2BQDcRCPLdTQAjeyAQCAQCgUAgEAgEAoFAINAqAkG+W0Uq0jVDIN4FAoFAIBAIBAKBQCAQCHQBgSDfXQArkgYCgUAgEAgMJASiLYFAIBAIDD4EgnwPvjGLFgcCgUAgEAgEAoFAIBAI9DcCE1h/kO8JBC6yBQKBQCAQCAQCgUAgEAgEAl1FIMh3VxGL9IFAINAMgXgXCAQCgUAgEAgEAi0gEOS7BZAiSSAQCAQCgUAgEAgMZASibYHA4EEgyPfgGatoaRME3n333TRmzJj0wAMPpPfff79JingVCAQCEHjttdfS7bffnueL5/bCG2+8ke6555502223tUnyyCOPpP/85z/p1VdfbfPeg7LvvPPO9M9//jP997//bZpGut4IdIB+adt7773XYRXPPPNMuvHGG9PLL7/cYbqejNQ+WLbSvp6sdyiUZTyfffbZLHe9NWbvvPNOuvXWW7NcqK+ncPvggw+Stt9www3J/GgsV/zTTz+dyGRjXH8+v/LKK8lcvuuuu7rdDHjC4N///ndSbrcLbFKA8bv55pvTTTfdlNTXJMkEvTI+xsa8ffPNNyeojI4ydYl8E6Jf/vKXqR4A21EFEdf3CPR2jRbfq666Kp1wwglZFn71q1+lk08+Od1yyy3pueeeS/fee29vNyGX/+KLL6a//vWvadNNN02/+c1vkkmYI+JPtxGgfPfbb788vvX5vu+++6ZjjjkmXXvttYly6nZFUUCfIPDYY4+lk046KX3rW99KJ554Yrt1WiDNqR/84Adphx12aJPulFNOSeuvv34m5vWI559/Pv3ud7/LxPv3v/99+t73vpcOOOCAepJevUfKdtlll/T973+/KckplSNYv/71r9PXv/71vAkp73v7qn0777xzgmkzEtbb9Q/W8umXu+++O+2///7pa1/7Wrrjjjt6pSvG56c//WnaZJNN0uuvv95jddChBx10UFpttdXSgw8+OF651qvzzjuvT2VxvEY0vMDn6AdzeO+9926I7dojYxgM9tlnn7TKKqtkQt+1ElpL/eKLL6Yf//jHaauttkoMB63l6jyVDT3ZW3XVVdPjjz/eeYYupmiZfOvU7rvvnvbYY49x4W9/+1uaYoopulhlJB/MCDz66KPp5z//efrFL36RCP1nPvOZtPjii6eJJpooIeFrr712uvjii/ukiyNGjEhzzDFHnnA2BH1S6TCpZIYZZkgLLbRQGjVqVJ7vk046aVp66aUz3haMjTbaKB1yyCHDBI3B382pppoqLbPMMqkza9Zkk02WPvnJTyaEurHX6667bibu88wzT5uoM844IzHMbLDBBunggw9OK6+8crr88svbpOnNh6mnnjpvEhkDppxyynFVWfwvvfTScZbFmWaaKX3sYx9LTzzxxLg0fXGjfTatf/jDH1K9fX1R92CvY5ZZZkkf+chHepQUN2IyzTTTpAMPPDAbFXpyfIq8PfXUU41V5mecyuZiwQUXzM8D4Q8+N3LkyB6ZI1VV5fk2Yuw63ZObmkacpptuurwWHX744T3KR2eeeeY044wzjtMfjfV297ll8j169Oi07LLLZuuiHZvg+M7E6G4jIv/gQOCFF17Iu/jrr78+HXrooWnbbbdNa6yxRl5s7ZT/9Kc/JQLb2QLfU701qRGBj370oz1VZJTzPwSM45prrpk222yz/MYma/nll8+WT5ssJI1l9JJLLsnx8WdgIzDttNOmhRdeuNNGTj755GnOOedsuogh5UsttVRCJktBL730UnIKhsBYuBEOBPyKK64oSXr9amNIPrVtkkkmGVefI+gjjzwylSNjxLs/iE577RvX0LhpikBVVYkRYNZZZ00TTzxx0zQ98dL4LLbYYmnJJZfs0XrMhU984hPtNvGhhx7Kp4d0bbuJ+jgCn1tggQUSPdDdqquqyuS1L8bvs5/9bPrc5z5XG7/utj5lLjP77LN3v6B2SmiJfHMlOPXUU7NSfvLJJ7PAUHK9OSHaaW+87icE7NJ32223fPyy4447JhO0qqpxramqKgu+05FPfepTWUZS/DfoEaiq/x9jnamqKlvEkR3Hwuecc47XEYYpAk6/+ILXu+8UrL/XBvqKLuJuU29b3AcCAwUBupPxaqC0J9rRtwh0Sr7L0d3555+fNt9887Txxhun3/72t4nCtfj2bXOjtv5C4Morr8x+3Uj3iiuu2G4zWKJXX331Nh8/OnLyIRZrOR8qPqVlE1cvyMcNf/nLX/IR4GGHHZbU+dZbb9WTJB8v+bDiiCOOSI5yKTA+e20SNTyo37G4MseMGZO4TbCI+dhFUn6ujsm1jU8oS15jveT9pJNOynUqh/Xf3JC/BO+OPfbYnIYPvLpK3Omnn57fa7NQ/OIdgXsW9Fd6feRvxo+Wlfm0005LTh3EOXHiR3fcccdlP8JrrrkmOW5z9K/9yhHgon3ccWDqnaAMhMkR/WWXXeaxy0H7CrliAW8sgN+g9vAZh5W+sEJKp/1OzLzXHm3jP846yU/YO/qFfEh/wQUXjMOt4Gm8YQUb5cGdC4x8yJb2XXfdddkFQj18RWGhPEFdcGOhVac6kDVxzQI/XR8MSc/3j/wdeuihWQ8+NNZ6Vc+jPWRNW/T/j3/8Yx6nUr94ePCNJlP6YfwcPxsX46Y9+uiqj2THs3q4dGmH8Ws8zlae9zBUJlzl6YlgPhg3cs31TJkwNI9gIE69xx9//LiPGcns3//+9+z/rT3333+/bE0DTOQvQR1XX331uLH3vvTHKaxn8k5nsL7TL54VzlgEfzrC/NLGE088UVSbYA76fkE6+LeJbHiANb1hLppT7o2vsdFP+HjHx1dd0pcitO+KsScBXBvKO2495h8/enqIe4zyzAftL+lc1WfcfdeijLPOOit/WyNOEE/eyTrfYnPvqKOOym6B4utBO/m+6zeM77vvvuxuAYPGE0vruw9FpYU3vU1GhfKOvoOxOvRFOkH/5dcXp2NwI8Ncb2BmTskDh1GjRmWdb/zoYfpYXGdBOvIFF3pbPaXcktd8M1/hoV31YB5Jpz+jx57sl2fvBHPWd0xHH310lkN99SGyOIGe0V66QLnmRtFb4jsKsJD305/+dPYmIIt0Bd2uTm0x1nSJepQFz4cffjiZ4/SC9YjcwFoftaEE7+WBP3n0Xju9E7TTeHpPd+q/941BfuNlbMj322+/3SYJXX/mmWfmOa695mHjGLTJUHuAO9dlYyeYD4151Ue3mMPaWg9kVnFkSN7y7J1gzYELXSCfNZO8ixOUDSf9F09+YSmuL0Kn5LuqqnwcY2Jvs8022ReIRYFzu073RSOjjv5H4Nxzz82+1fx+O/KLc/Q811xzZSu4VptMJr1J5tja0a8FmvzUBZ2S51OK3Mw777zJgsTlgZJBlpQlWJB9AOjkZf75508WHQpKXLNggiEJO++8c2Kx1w7uMfzWKQoLF8WsHL7rZHrrrbfOBJ3yVaZfb/DRiHYsuuiiyYTm84w4iVeHMqSZfvrpk/5TbD5uK21zBGkBkgZBnG666ZL/HPNZRCgYx48Uho0uRe/Ii88Z5aHPFhILJ0XoAyFKUT3KRNSQE3PTQs9Xsqqq5EiVm4B0XAPUCWsL/U9+8hOPXQ4WIO21GKywwgpt8lPqCK3rEksskX2Bf/SjH+VfEpDQV+l0iaNIG7mLLrooWXSQX8eGFh6LKTmQfrbZZssfWu255575F20QGYs1lxcnMYiGRUifvfvZz36WLAbGWF177bVX9gcu5RlD8nf22WcnR8364GM9C6d7ddaD9MZZuWRI2RY/hF99u+66a5uv+NVrESAH8803X1IPowWZUa4r7I2fMTGGxtYcQaqktUgYUwuKQB6dPCKwyAb52GmnnbI8K1NAunxvgUA5lVAPH+z2FlV5Wg3kE7HRX7KHAMhrDM0HckV2Hdv7TsCGDN7rrbdeJonm6YUXXpjWWWedZEzkbQzcC/xiEfm1WaJH6Aqk3Dv6QH3ymUtwRryNjzGBJxkRLy//di4m5hc83IsrgfwiysYR0SGjJa7xql3wp48s1IinRVufjA15MDY2Tt7TM+ascugTMqp9ZNE7hEZahix1I3fmgU2/8v785z9nQlbSkg/4M2zA2vyRzrgwLJB9LoBkkXwgW+71TRkl0Gf67Xud7bffPmmr+m0skQ8fhNpIlPTahBSZg8aH/JNLmCONdI62IPHyzD333PmbAuNl/JHGU045JZk78GBMQHC0TbwxFUe/LrLIIvm7Ic+HHnpop7+Wo04f/9IX5AsO2267bZ7rdIT26K8+GA/P5IDu0D7P9D0ZghldCAPvS9A/hFLfybU+wA1BloYMiif7TnvNazJozMV3FOhqRizrmF/TMK/MaXJGTugoemnLLbfMRihlWUvJLNLKzeKhsRv/oiutydYzfTN/zB15uGaaA3RKcc+kv3E5facDrQdbbLFFsj7JUwJMrUPWXDIuj01gibeO0QnWJNga7+222y4hyvKWdM2uDAUbbrhh/tjUOkCWjYG1w8ZEHmsh3vF/7N0HrGVFGQfwGaxgW1tERYXEGE00ktgFFSyoURMhNixxwd6JibGii9h77y0mlqgRMWoM2CFq1Fhir7GEqNgLUkLx/WaZdHy0UAAAEABJREFU5ezZ+96+cu/b+977bxjOuXOmfPOfr803c87Dd+yYOTBXxuhYDN3Dh2DTvXBpLtTriYyRV/qC/NPLeMH4lWE3PKdXDjnkkIK3paEMKDertCzn++CDDy7HHntswVgmGGgmAeGzIiztzg8ChAHDEgaO8ZgykQ+KhEAMEyVEcD/96U8Xiv2BD3xguzIcFL6Xd7WlfQaBc04AlWNw7nCHO7ToIgFUjlD4ooGzx5QFZ4PwMw6eT0ocgSOPPLK9LEgZ+02h4F9bfgwX5c8QHnXUUYWC4fRSxBxCio6BIQPHH398O/PuyuHukTzKk2BTmhxuTgajRglqFw5HHHFEcwo5eM4BUgjopTTRbzECWwpN9MtCxFvy27dvL962pvjRSuH4DWdG3OKEg4VeiokhYqBhWWttZ/c43+pw7PTJ6MDeuPxeSeLomAMKl4Ew78P6FJqouHF7xqAwtCK9+MdihGNqjo855pjCKemGwryaq2F7jLyvU/TFirPLnDpjgiWDYhwU8N3udrfCIYIhQ4g+fMQA96g5Zw5evmygL8aNIaOUGaNh3+4ZL+NgIBgXjgeDx1nn3Jr7HjXlADMARx99dDF/+JPOJB+UOnr1dZ/73KfgQ/OnvAiY55wJvMC5Pe6449oLzHCDgfk19wwbZ47RRIO20clhI1PevYAXORJN40B4vpYEa1+bsNASOe1tkYnDDz+8mIODDjqowInMwgye5gPO3h0wPnOP78hVb6Nf8QAeZwglDgOHBn8wjPgaTysPoyMW5Ikjol/8CE/PJDJlIYAussAR99uznsik/uCLBzi+nJn+fHjVP+OOr4zf/Jk3iyCyrA3zwQE3J3DirGgDr+MTTpbfErrwsGcih86q41c8bMHKxtI7+EUf5pW+o6/IMJ1Af9E3xmpu8JXFOUeQU0gO0KG/nhwHMj8CKPIshNBMHxofR7Y77Mb64Ac/uHA27WTqF87aFszQxrh9GNN/2pY4TOSAXtM2ebfg5AB7UZ5jzwnjNBsDxw3/GhcMtLFY4piqi5/oSQ4ZXMypRax6ZNVv84d2csHO0CHmHw8JbqgHa3V6Mn4+D5rhQF/haTqdw6ccbPCpcsZp7LDpukaZxRKd9ZCHPKSQFXNypzvdqb3YJzLrGZvEpph7ss1GcmjNGf3CVun/rne9a+sCxniPzOCrLivoYyvQBwMOPFnEt3iKXaAr5Fuwt8Yu/Z+xsmX0HT1iXBZslz5uXxjDv2wmmbBwgpfFlcVFLzfpinaLL/Nm/uhJOBo73lWHQ26hK4hBXsyB8vSRfsk1fmdryKU6PeEN+XSweYEZPqP/1VWOUw8rY9Q3+TJ/Fnaezzrtt9wOaq1tZcoIihoSSMwxHnTJv02HAEeTYjcwkWLXYWIsGQOOl7IMCOeMkbHNKArLSNZaS621HHbYYUWkg9Hi1IvGMMwUAQOhbVd8Rkly+EQzRHTkM/i1VsUK40o4249F/qeO5LG6vvwgyspgizziaY6KhQLhFDlDD2UjiYqrx5hog9Arz0EyXgZSPjpqrW2MokAcD0rA81prkUdJUWTdcRch5pRamWtDFIITwBGkCChfi4b999+/cLqMg3Nbay0UMMWqLmde/kknndS+s8zYMSjkU+SWce70M9gU8d3vfnddLitRlowEQ6Q+5cpo1Vp3q2/hQKHBD57GKXJkzMZJcYrmWpAZI6eLEe/OSa27t6fxWnfPM85ad+Zx+NSVjIdhNVb9KMcpwkMMl7bMBTzNK/rMt3L4ixOszDjBHI/I7/2pw9B1h9wzRgrGIjS17qTPLog6HA6GU1uS8niB8fUiJIy06ZnfHEy/YcmQwomhNU5jE2kyv92Q+H3ve9+7kEWLVDykD2Vc15rQJS2nHZiSaWPHJ3DuDrcFSqdt3BbsGEF1+qKC7jA2uoUzZTwWTxx79NRa2y5brTvxLsv813kOxmTHPFgkTqpea219lIV/8DU/6tEfFkScO3NubrTFsST3C8WbLlC21svoq7W29sy59tRVRn3zDCt8ReeKRsKRLi0L/2qtbTHOeRIxhyccJG3Qa3Qih17eQpXd/pNH/+mLLLuqpz3Ydv0uAgt7DhA9JJEBjicnjd7T1m6NL/yo9bJxLvxsPkOttdBRfRzwI5MCFAIBeFxZ828BDg++hbxJiWN6xhlnFPSjXRm0+OQs3e14hIUtGuk+eb0cWaKn6QD1aq1tLmrdnW47mbAho7XufGZhQJ9x2svCP84ges2T+YbNQnaBo+tiyWKd049vlEG7hAc5guYCFgJWnEa7HsajjH4s7OzGGBP6ONjawSMWUcrTb/LMJ4eZv1Zrbd/uZ8/ImfaUsbjXrui73z3hJTpOP2jFk+yV5xYnAgH0K76QRx7oOvguFZhl08wLR13b6qKFs8ye2S2kj8kBXcDe9HJ4iB3tGNdaJ86fRSU80VPrzvljr2Fv4VgW/pk/egSfCHhYDPR2Fx7P/L9lO99DSqw2RDMQul6rhGH/uV9fBCgKUS4CwvAt1jue8IwBYVjcK0+RUGR+S4TVSp1AcRIpEsaWkHneE8HXr2ccCluW2mE8epm1XjkCFKotKomisr0rsqIvxo3RN4ZJfTFO6qO91p1C3stRzCIWBL7nibI5GkCpkB/38CBTynAAOFToQI9EgarHqVRmqWSRQDnZ4qUsO3YcmFp3p2+pdsbPOJacU9Ej8wW3cRm/RW4YR3RLxnnkws6DqC7+4SDDRQTDDghn3RxzKNWfdYIvQ2MxgD4Jr5pvfLuW/i0ojJER6u0w/PgJfzB6PX/aV8aVo8bwWvDin2n3sdz2yCqZEU2Gb08w5lB0Z2HcHuwsKBlCDh754ETQA+yMiBh5s/DFz+P6m+23xSr5wU90ZR8ffczB4UAOdUt/Po0r3C3c+9y5nn322cUccsrW2ocdo1rrHp9epActXjj7i/VhzPhgzEd0tOg7/hDJpb85jRw5DrL28BTcBIP8XizZAah1T/qG5QWP9EfeLFbo8uHzxe5F9UX6F3ve843HQoWu5YhaVIkqCyAI7NgNwxfkQx3j5Wwq5+iOPFjRPeyt3xxMjvNabSgHmrxqW7s9WUzClnPd88ZXEXXBkHFdzrLFGJqN1/jxAn3ClmnH/EkWKH4vlvAP+ujfxcrY8aFHzB/dKRC4WNlZ5K/K+UaICbfSWqvB0lbS/CPAYSIcIrOU2ySKJzE6RUdRUobDOhwewkHZEiaJUzQs4170haLQNydX3jQT+kSvbEfa+h0mCstzEQ1OLBon9S2fQlN2+FwUjOEkJz2fsDNeFhKMm6i+1Tcl2suQKVt5Q1rciwz0Motd4WWrjYIXYeYIU3KU2GJ1lpuvHVuWDJotOw7SuK5xcKDQO06Mg7GJztsOFqWGu989ojJubxa/HSHhRIzpMw9r6c/8m1NHBobtMIYiOqLZw/xp3psL26YMtQi4beZptr+atkQmxxjbQVmKF8kHA2xRBk98jO8t0PAKw42PHA1bDU0brQ7dwvnAV0Pa6c1aazvyM8yf5j3n3yJ5PIcWevTaWvoyLvNLbw7bISf0zFLzq546ggCuPbEndK1IOseNzRANtwtnEWM8FoScdrusvd6kK/o4fIIJk57LE7kXLeYIiorbEZW/VGIHRbHx+FLlPKu1FrxuruEtWbyKfNu5cRXA4AgrL1noO8bhCBPZscihr2HiuXFJdqb9Xm0yB/BhF4dtwJwfwAEf5g/v9S/RVcN8tgOd5tC46U1HPM2dxZAFlB0PZfa2eNG+iPaYR4b9OfYkqES3ONbSI+LDMrO8X7XzzRFyZgkjz5LAOWx7S5Jkrm1liko5/oGxlwOELTpCNnau/BbtdPzEQs6K2dGVcZuEm/IgkNri2HAox+VW+5szKErYX6Lp7aDFIsM2lzyOLGXjvifbbhYG6BdRGCs0UVaKwrZer8M5tt1FMdqao6SMrz8X1aJo0ETB9XwLGFtp/fdiVwqMYkITB160kDNMcS9WZyX5toQ5UCITtjzHxok+sG1ofoftOo8IP8rTMxFwDrizswzFGP9h3WneM2Siw45FDNu1w+E86jBvpfecEtvp4wgK54kxcWxnpW0ut7wFDEfGGXsyRbaWW3fa5RhNTpT3Mez89PYZRIZ0qbkmH3Zv8BC+wE8WSxYWju3IYyz10dvdrFeyjGfgJXo7HKedADrRWfhh/rTuLRTtwDnjPWyT/vfuyXL1/7Du8N5xBfqN/tBPf2bHxE4f57Lnja+i/vSuaPzwmfboYUdc8AeZ4xQ7ruW8rzzvxXipb2+4oQ8t4z7YBPaHjDubLijF2eWA629Iz6R7tpBs4vNJz4d55IWeFRxCO8fd8TU6WPCDHsMHjtn0xRk970iJwIaXiC1WOZV4SdvsC1vrJXe/h8n56uHvpe4FkCxm4EHn9bIi2ugUAOh546v5IdfoHj5jH/AC/eW5sXhfgt9hLGypqD+nmX0b1h3f2yVmM9m/4TN4CCCKrltUso3sJTu8nPkbtrXW+70634C0vQIojE0JYD4rKi9hrJWA1N8YCIgq4AORKc63M3Gcy66EKQlblbXWdgarXPqPA8j5UMeKn0KxcOvMT6Bs3TmaQLEwrhSJVS4HlAA6suCqLfW9ue24CsPOOSdkaOF8dHou7b5dKAlKwQ9lXXuiqDhezkB7QU9kxNURAgJJqXphw5lTZywJLt73Ih/HnJPhuA1l7cUVNDACFgnOaIumUn69v1pre/lTVN22obZrvew4iHYkLx9R7hSsIxKUDyWkbWOhqPTR2x1e0SzyadXP0R1HWeSLIprPYb3xvT66YqUHYF/rzjOnzntTlObEosNz9ekEusKXIcylRQZj53x3rbUw3pxctFN2DClnyvyqj1btmgdYmmeRHTyhLl5iFPGH8u5dzTEaXOWhVT6sXPGnq21ZV+f/RD04g+j0MhVD6tk4waHzDTr6c2175qo/7ygYB8OGx5WzayIqDQ87IeYPLeiEgTI9adszY/NcviueljyXd+GFF+76wzH6Nkf6gbG+8DOHTVkyBzeY9P6G7SszTmgwLv3pvz8nb36r3/O0q7xn6sjH23jeWW/nOuELZ5FC27tLGc5aa7Gow8P4n+zXWgsnSlRNO/SFfnoa0um+5+Mv9Bk/h1E+HnGV72reYGteOj7yx6nP/3D8xqs/9SV1ep77XkcZ9eS5d1WeLdWvOvIkz9HmueitqD+9KsqpPeU5EGQY/3LK1O/j6ldtTUrqK4Me89bLuIeFZ8rYPbM76YtCdongR66dxUYbPqfb8J054QQ666+cNmFufGgzJu27eiaZXy9LOqrhvRt8rH9tKCfCqxxa1O1XeRwrx9/oNgEQdY2HI08WBDc4b/iUjnPOuwdTBAE4f55pS9Kf+vp3L0/EHLZ0PvpgLihiR0ZZTqey8u3YkjdyJw8WaNMePLVnTv1WBm0ccPnDBCv2xXj1YY7hyb5YaBkn3cKBV08ggT22U1DrZTaE/JEbNGnTb+UlYxfEYlPIF90tCQSZV/r7UJsAABAASURBVGX0D29jQUfPc1VGvt0rR2DoZ3au10G/OvSr8u7RrT0YyCO/FixwczxSXXTCFF4W2qLnysPfYoMdtOBhh0X3ldeWpJz24Ys2eT5gABd+Cvpg4SiKezTxP9Tr8+cKV3noMn/aRLv20Og6zbRX5xuTilZhRudOnZNhUDktjOY0iUlb840Ao0n5cLA4xhw4Asy5sv3mN2eyKz+jsUL2HHNT4latHHEKoCtYyojjwqFzVo1SpuT15S1obWhLHV/34HDjRUcgnCknsISG4I+FhPAw+L6YQug4AGjXniTCom/C7Byd35xDW+aMvfPY3gq3OqZsKAZvdVPM3ZHjLBubaAMH3HgpDfU52K766okytOKmICmSnu9quxU9on+MK0fEFx8YHI6pL3cwIJwdGFHG6o0T51t0CMbj/hlMb9BL43r9N+UkMmAhIo/cG5cFuAWHqKZ5FlmwcIENJ4Ge4GiKUtot4XxRfLZ5RV8oR0duRG60hwaYim7qR8TNmH3JAs50D0MNJ9FqhgKPoE95NHLynNuzeGN8GVyGktMnuq6cPMoXhhZOoj/GwIGAszFYCCo7TBweNOIfyp2x54QwAvqzUBAxskBAu3k3RjxsfBaKolxkptZaRG6MX7sMnrOi+oMRXmdgLO7QJJ+8OCvOaGvTvWik8/eeM17kAdbwZfTwBSNpV8eYGUhODT5SB/9z5tyPk/mFpYUPrBkvtCkPT+P1nIPB6UInuePcwJWs4TdjIc8MKlniLFkYeCEM/4z7Hf62IBPxVZYD6JmFsCgYuXEvT8LLcMR75BtvWIh7ZjHl3jxwrNEGL89cybm5ZJDpCe2wbZ4PExyMR575wQMwIdt4j26DA4fTfHOYlCUT9JN2PWNLfc3BHMrDM/LRTF7wfJ8v8452Okbfdt7IjH7IPPtLxo0LL3quffXwvv7HCT52FPAcnYlX8bZAA2zoQLqZTLPtZN6uHX6ie+2qyLew0rbzyPSSsTiewqETpeXsOurBiTEmcgsv/AE/dSUBBosqcmSMsMHXeJjDxflxdtg80evodUxPXXZHOc96XbTTPZ0+4yFLZF8+/c4ps9Bmrzhb+BxmnC19mFs8hQeNW6SYrWHX9ElPGSMHkq2AGz3FQRextQDGU9rCS+YGvcaGVnOqDcEs+cNkfgQd0MO22RVkd8i2haSy+ER/9B5bRj7suFkMed4Tmjns9O/wGXtGrvAPmuhlZS2U6G7zpH96FHb4mc5i27Ut8Ip/zjvvvGI3gWwb+44dO9rfmzBm9pK+Nh6yYM7YZ7oY/2kH/Y56aEtdWMNSXR9sUIYOw0f0K9rG80fmJTwmyGAMeMQc2NkgV2yguuaPvOJnvHXHO96x4Gm2FF+bG/yMD4yXLOFFuhot5G68CyJ/LWmvzjcnAyMQeIPHcAw64in7tXSeuhsPAcoXszoCgQ+cc8PQnBjnzygvyoIBNjpXCpYiF02xUiewji54poykXUJPYAgFpS7qQkl43pM+8SKFa/XMAFGukq0uDnAv60ppEUQCyoHiBHGSPJPwN4XMCFGalANh90WWWmt7Wx+vo4uRItyUHoHWdln4J0LlrXQ0iFBz8NCinHEtFNntP+VhxZna7cHCD21yMDgH+kMzBcB4eCbiwIlCJ2Ps5cqFanv8xzlnDLQ1fmgOOFP6GD/rv+HIAaKg4cJQqicioQzFzjGjkCyIOMwUHYePkaWQ1aN4OT8WHOopp19GAd9QwJS49jxXX3n0UcSe+wIAhw8/wJZxZRS0b0uZc0txUuiUKKMsD/ZwU84cy0O/NhlF+eh3z8jVeln0CC2SuRItMu/K4zfOH+OiP9vYeEEUSvk+PhFL4/ObsVfHczRx+vXrakErf9u2bYUMwQvfWHzJJ1/mgGEiF6LnjAfDjB6yZdFgnJwYRoIxRSfa4KQenieX6uA7bWh/nMgkucJz5Myco838kQHzSiYtmI0Z36MNhuSkjwefott86NO46Ay7ReM+x79hziDrZ/jMohTWwzzz6TNtFolkwr2IlzLslf7xDXnUN15DDz3iuBdHUR5Zo5Pwn7rDBF9Oinr4gG6CCT4kA3gT/+B/c87IK2vBYZGHJo6hPmBkDsmWMuhGG/63iNce3PUHY/rJ3NIt2lPGIoQ8opFjhfe7Y2PBo33PxqnWWswPbPXtPC1MzBUe7TwJE7YdHxgbupWnI2GKLm3DBR50O1lFJ37HI4IQ9K4FEHk3/2SVXlFXgiFe5AjzK2BnfvGpBVqttZAb8442co02dY2R3iEr6sKFjJtXPKwMPjIvxoEOY9U/p85ixeIIr9D1nDCLMPOCp9Rnp8ybIBBe1pcoND2sf3MCE/xjvGyLBSos0UnmyDjsyKn+0Uova3+czCV5ogc49zCl6y0AlIUXuSTfeFBb5pJ+8nyY7BAqg0eH+e7JND1hTugHiyd0Grc+6A7jMG94yxzYmTYO9l19/IEu/ZsHxwjlo41uN5ZaaxE4cSSOHTM3eA0N8KPn2Xx1zR/bSTebe2XMo/kjC33+yIP5EwnXN5mjKznx+I7jrp76xkEv0U90lzHjBfNHd5k/824xYg7RTl/QA4JgaBdUM2680GnX9jTSXp1vKzSdGjwggGSCptF52tiYCBAOSpxRwRNSFyBMTTCHI1Oe8WZkOIOULEEflnGPr0S5tUcBUWDyh4lQq68dZThUflP0+hmWda88JaTNnkQePOsJLRQHw0Gh6Xc4BjLAiBqjMXAAKe1SSm+ivRjDsaKkehmKfleB0Q3hppxH2e2n/rRF5rQl0oJGDynaPg7XScpVOUqaA9gNpbye0K6e6E7PG185IfrWxzANt0uVGT4ThdGOeWTE4Ml5NEfG5JkxU5bmT13lhjjBvY/d/GoL9vQO3qJsGXF1JfPFqBmP3z1po/NSz8OzaMATxo4+kUW8yVB7Nk4UOYXe23DFb5P6U5di1zdeURbvDcfH6ZXfk/GrZ4w9r1/l9/t+NYYhPcYPU3MKL+OxMEAHGskozMbty9f+ODFu2un9uVeXg9LzXDleaHE/TJyG3qa2/PYcH6jTn+3tyjEel0eHNKyrDzTqQ8IbeEYZuJNHGE+aR/zBuVBPwg94Qd1h4nzAWRlJH+hwP0wcaJj3PPKDz8b0wc2CqJdzZehdh6mPg+x3uUeHezyMRvNufMN6sPNsnMggx29Y1mKAfhnmaZ8c1lrLkJfx/VDH1lqbM48m7dANnCpzThfgwWG7ZJ4uGNJl/uhTWJEZ2PSx1bqz/WEbyvb6+Jp8qWueBSL02Z/bneGkCQZwYjmZAiuS6L7dMzw2nAu6CU3agBdZMj5yxcYM28cX8s25uVKvj6HXHdKOVuMzZ9ofp1proePwl3pwHOpvOoocsQueGzM7oq9xWxZx9D/eGT/z2zwZN+zok97PmK/JPZ4xd/qU6GK01FoLGTMu7aAHv3imD3TBT52e2FnPJPxCBtVFC2zwnWeSo3t2iUTdx/NnB9iuGj7Tb28fvdpVX1vkzxxJ7uV5JvFrjcv8GQdeMH/GgHa6oLfriv/Vm1baq/M9rY7SThAIArNFQLTYCl/kzPahlf9se0zrQSAI7FsE0vtiCIhaOubiqIajWY4jODblqI+orwj1YnXXM9/xGseeHGtzPMPv1fQvUm0nQkTXeB21WE0781LHroh3Ahybcxykz5+jJnb1+u7PvNC7UjrifK8UsZQPAnOKAKXLoIh62H7uEaQ5JTdkBYEgEARmhoBjSyLJjviJAjsW47iioxYi2I6zzazzZTbsbDhH0pEJxykETryT4czxMpvYVcyREBFi74Q4UrPrwQa9MX92ExxH6fPnqIn5E9F3jHWDDq2RvWmc7zaa/C8IbGEEKCXnM51zszVZ655nmLcwPBl6EAgCWwgBLyKKBnvXwFeZnOkVlHA23NnqeYDCMQjHLbxH5Z0NtDnO4tjDSunjdJ966qnFewSOgqy0/ryV90K/9wns5jqX3efPYsrZ+3mjd6X0xPleKWIpHwTmFAFnNZ1bdTaxn7ubU1I3I1kZUxAIAnOEQK21vbDpnLSX9iTne52v5/TOA6l2JznKXgTsyTtJq6HPeWpnmL0Ds5r684DHkAYLEHPlDLy5k7yrstrFybDtebiP8z0PsxAagkAQCAJBIAgEgSCwagRScSMhEOd7I81WaA0CQSAIBIEgEASCQBDY0AjE+d7Q0xfiJyGQvCAQBIJAEAgCQSAIzCsCcb7ndWZCVxAIAkEgCGxEBEJzEAgCQWBJBOJ8LwlPHgaBIBAEgkAQCAJBIAgEgekhMFvne3p0pqUgEASCQBAIAkEgCASBILDhEYjzveGnMAMIAkFgMQSSHwSCQBAIAkFg3hCI8z1vMxJ6gkAQCAJBIAgEgc2AQMYQBCYiEOd7IizJDAJBIAgEgSAQBIJAEAgC00cgzvf0MU2LkxBIXhAIAkEgCASBIBAEgkCJ8x0mCAJBIAgEgU2PQAYYBIJAEJgXBOJ8z8tMhI4gEASCQBAIAkEgCASBzYjAbmOK870bHPkRBIJAEAgCQSAIBIEgEARmh0Cc79lhm5aDQBCYhEDygkAQCAJBIAhsYQTifG/hyc/Qg0AQCAJBIAhsNQQy3iCwrxGI872vZyD9B4EgEASCQBAIAkEgCGwZBOJ8b5mpnjTQ5AWBIBAEgkAQCAJBIAisJwJxvtcT7U3W1/nnn1++853vlK9+9avlvPPOW/Ho/vOf/5TTTz+9vPOd7ywf+9jHyp/+9KdyyimnlC984Qsrau8vf/lL+chHPlJ+8IMfrJiGVAgCQWAfIpCug0AQCAJbEIE431tw0qcx5LPOOqu8/e1vL8cdd1x517veVc4555wVNfuvf/2rPO1pTyt/+9vfytlnn11OPPHE8rjHPa684AUvKB/84AdX1N7vf//78tKXvrR86UtfWhENKRwEgkAQCAJBIAhsXQT21cjjfO8r5Dd4vwceeGA5/vjjy/77719EwFc6nA996EPlxz/+cXnQgx5Unv3sZ5cnPelJ5dvf/nb5zGc+U97ylreUa17zmstu8ta3vnX52te+Vp7whCfsUefkk0/eIy8ZQSAIBIEgEASCQBDYVwjE+d5XyG/wfi93ucuVq1/96uWKV7ziikdy4YUXltNOO63Vv/zlL9/aOOGEE9qxk0MOOaTl77ff8llTG9e61rXKAQccsIuWiy++uB1n+eMf/7grLzdLIZBnQSAIBIEgEASCwHogsHwPZz2oSR9bAgHHTP7xj3/MdKzf//73y8tf/vKZ9pHGg0AQCAJBYEoIpJkgsIUQiPO9hSZ7GkP1cuVTn/rU8rCHPay84x3vmHg2W7T5zW9+c3n4wx9eHvvYx7YjIaLd+lffEZOf/vSn5Uc/+lFr50UvelFRx4uT73nPe8pb3/rW4mVM5SWO+kc/+tHyiEc8ojzykY8sr3nNa1p5z0S4f/nLXzZH+5Of/KSsdnzlWc96VvnDH/7QXuhE66c+9ami7Je//OXylKc8pTz60Y8ur3ueRbecAAAGm0lEQVTd69oRl1Yp/wsCQSAIBIEgEASCwDogEOd7HUBeYRdzW/xzn/tcO1d93/vetzz/+c8v3/rWt5oDPSTYF0ue+9znlqtd7WrNSd62bVs7G+4LJpdcckm5/e1vX1784heXm970puVmN7tZecMb3lCe8YxnlH/+85/l4x//eLvnoF9wwQWtWS9mvuQlL2lfMnnFK15RHvWoR7UXPZ/3vOe1L6I4N/7a1762vPrVr95Fy61udavWh/Pohx9+eOvjXve6V/ne975XnvnMZ7aXRDnnvo7i5c7WUf4XBIJAEAgCQSAIBIF1QCDO9zqAvBm68EnBY489tpx00knlfve7X+Hgvv71r9/jxUifDfQypij1DW5wg/ZFk6te9arlve99b3OWOcTXve51yxWucIV21ltZ57VvcYtblCc/+cnl0EMPLZz0jhmH3xESL1Pe6EY3Kpxp0W/nvJVBh6+k6KvXu/KVr1y0WWttL4Tq4ypXuUo588wzizPlt7zlLYv0pje9qaBFO0lBIAh0BHINAkEgCASBWSIQ53uW6G6itj/xiU+U//3vf+Woo47aNaprXOMaLXq9K2PhxldM/v73v5f3ve997YVH9Ray27fAV/NVFO3c/OY3LwcddJBmCifaAuDd73534WS3zGX+7+CDDy7f+MY3WiRcxFx03ucOl1k9xYJAEAgCQSAIBIFZI7AF2o/zvQUmea1DdOZa9Nm57b19AvDPf/5z2bZtW/tiia+hiEj7lOAb3/jG3b5GslyafH5QlLxHupdbb1K5e97znsWRmFNPPbWd+T7hhBMKx35S2eQFgSAQBIJAEAgCQWAWCMT5ngWqm6xNf71yuVFrDjqH2xGVcVrNZwlFur046WXMtcKqLUdb/DVMR2e83OllTH+kZ61tz6h+mg0CQSAIBIEgEAQ2GQJxvjfZhM5iONe//vXLjW9841JrLR/+8IfbV0OG/ThrLcm7yU1uUnx1RKTcS5Py//vf/5YPfOAD5dxzz1VkRenOd75z+e53v9teuNSWyhYCHGiLAr/3ltRDi+i7yLzjJ46unHLKKeUXv/hF+cpXvrK3JvI8CASBILAFEciQg0AQmAUCcb5ngeombNOn+Tjgvp19+umnl7POOqt885vfLM53u/dC5kUXXdS+JuKrIj4n+MpXvrKd+37hC1/YPh3oD/OAxhdMzjnnnPLXv/61uJcncaodceFUc5blPf7xj29Ouy+eOE/+2c9+tn3ikBNda1Wkfe5QHbS0jIX/6avWWn77298Wnxf84Q9/2BYNL3vZy9onCH128IY3vGE7N37ggQcu1Mh/QSAIBIEgEASCQBCYPQJxvpeJ8VYvdpe73KX4Osi2bdva5wBPPPHE5tgecMABRWR8v/12stJDH/rQcvLJJxfR7h07dpQdC8mZ7Qc84AHt6yZnnHFGefrTn15+/vOfl5/97Gft04HaFX1+zGMeU371q1+173T7rCCH+rDDDiuvetWryr///e/2NZTnPOc57RvfRx99dLnSla7UviGOFgsAkWyfIDRXHOv73//+RX8i8ehG49e//vX27XFfTEGbM+Ci6+okBYEgEASCQBAIAkFg1gjsN+sO0v7mQIADzZn1suIXv/jF9kdtjjnmmPL5z3++vP/97y/3uMc9imizL4g4Vy3a/Lvf/a44fsLJdRwFEre5zW1aeX9k59e//nV529ve1v54zu1ud7siUv6b3/ymiKJzojnXnHt/rOe0004rP/nJT9ofzRFJF4XX3m1ve9siIu4P7XCsfTNcvvPd/ggQB1/U3CcGOffa8QUVDr0/5vPEJz6x+BSiOklBYI4RCGlBIAgEgSCwSRCI871JJnI9hiFy7PvZosrXu971WiT7Ote5Tvu6Cce70+DFSvk+D+hIh29717rziAhnWv4wXfva126fENRuz9d+rTvr+NLJsD1t1Lrzmftex1W9ToevrWizR7052b7rLa+Xtajo5XMNAkEgCASBIBAEJiGQvGkiEOd7mmimrSAQBIJAEAgCQSAIBIEgsAQCcb6XACePgsAkBJIXBIJAEAgCQSAIBIHVIhDne7XIpV4QCAJBIAgEgfVHID0GgSCwwRGI873BJzDkB4EgEASCQBAIAkEgCGwcBDa2871xcA6lQSAIBIEgEASCQBAIAkGgTHS+zzzzzLJ9+/akYBAeCA+EB5bgge15Fv4ID4QHwgPhgRXywETn+9BDD21/HMX3mZN2BIsdwWBHMIgchAfCA+GB8MB88UDmY4POx/8BAAD//+q3B0cAAAAGSURBVAMA1PNszh1CQzUAAAAASUVORK5CYII=\"\u003e\u003c/p\u003e\n\u003cp\u003eThe volumes of hematomas were measured using the ABC/2 method.(\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data from the registry were filtered, reviewed, and checked for validity before being transferred to a statistical package for analysis purposes. The cleaned data were imported into SPSS version 29 for analysis. Mean and standard deviation (SD) were used to summarize the numerical data, whereas frequency and proportions were employed to summarize categorical variables using tables and figures. The relationship between variables was tested using the Chi-square test at a 95% confidence interval, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated a statistically significant association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was sought from the Kilimanjaro Christian Medical University College Research Ethics Committee. Permission was sought and granted from the Department of General Surgery. Informed consent was sought from clients or their relatives(for patients whose GCS was low to give informed consent ) for the study, and no names of clients were used in the analysis and reporting of research findings. Access to this information was only for research purposes. Privacy and confidentiality were ensured using password encryption.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eClinical and demographic characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 295 participants were included in this study, with 274 (92.9%) being males. The mean age of the participants was 36.5 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2). The mean Glasgow Coma Scale (GCS) score on arrival at the Emergency Medical Department (EMD) was 11.4 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5. Thirty-six participants (12.2%) had known medical conditions. The leading mechanism of injury was motor-traffic accidents, accounting for 215 cases (72.9). The average duration of injury time was 24.3 hours (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;23.0). Most patients had mild TBI (50.8%), followed by severe (25.1%) and moderate (24.1%) TBI. At presentation to the emergency department, the majority had systolic blood pressures between 90\u0026ndash;149 mmHg (63.7%). Additionally, 25.4% of patients exhibited pupillary dilation, and 16.9% had polytrauma, i.e., long bone fractures and chest injury. Mean hospital waiting time for surgery 13.8hrs\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3hours. The most prevalent pre- op GCS category was 13\u0026ndash;15 with 151 participants (51.2%). (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGCS at arrival\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMechanism of injury\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssault\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e215\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCommodities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical factors of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime interval from injury to presentation at ED\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSeverity of TBI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSystolic blood pressure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90\u0026ndash;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e150\u0026ge;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePresence of Pupillary dilation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePolytrauma\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime from admission to surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePre GCS score\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRadiological findings for patients who underwent craniotomy surgery for acute extra-axial hematomas\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOne hundred seventy-eight participants (60.3%) had AEDH, followed by ASDH (n\u0026thinsp;=\u0026thinsp;108, 36.6%), and ICH (n\u0026thinsp;=\u0026thinsp;9, 3.1%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The proportion of patients with hematoma volume equal to or more than 30cm\u003csup\u003e3\u003c/sup\u003e was 106 (35.9%), whereas the majority of patients had hematomas below 30cm\u003csup\u003e3\u003c/sup\u003e. Two hundred seventy-five patients (93.2%) had midline shift\u0026thinsp;\u0026gt;\u0026thinsp;0.5cm, and 78 patients (26.4%) had herniation syndromes, and the participants with head CT scans showing other abnormalities were 196 (67.5%), Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The most common additional finding was skull fractures (n\u0026thinsp;=\u0026thinsp;71, 24.1%), followed by intracerebral hemorrhage in 44 patients (14.9%). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRadiographic findings on brain CTs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (N)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematoma type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAEDH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASDH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHematoma Volume\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSize Of Midline Shifts\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e275\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHerniation syndromes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e73.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther Head CT Scan Findings\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome of participants post-surgery.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAt 3 months post operatively, overall mortality was 54(18.3%), on further analysis severe TBI patients had mortality rate of 29% (26 patients) of all death with mild and moderate TBI contributing to 13,2% and 25%(20 and 8 patients respectively), severe disability and moderate disability was observed in 6 (2.0%) and 24 (8.1%) of participants respectively, and those with unfavorable outcome were 84 (28.5%) (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFactors associated with unfavorable outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFactors linked to poor outcomes after adjusting for possible confounding were aged\u0026thinsp;\u0026gt;\u0026thinsp;50 years, male gender, shorter time from injury to presentation at ED, polytraumatic injuries, and higher admission systolic blood pressure (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The absence of pupillary dilation, moderate and mild post-resuscitation GCS, and shorter time from admission to surgery were associated with favorable outcomes post-adjustment. Mechanisms of injury and comorbidities did not show significant associations with outcomes. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Larger midline shifts and the presence of a herniation syndrome significantly increased the risk of unfavorable outcomes, 0.001 and 0.000, respectively. Hematoma volume had no significant effect on outcomes. Other head CT findings significantly increased the risk of unfavorable outcomes both before and after adjustment for other factors. (p value\u0026thinsp;=\u0026thinsp;0.000)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical factors associated with outcome, crude odds ratios, and adjusted odds ratios with chi-square p value\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUNFAVOURABLE N(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFAVOURABLE N(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-VALUE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAGE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u0026ndash;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e88(37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.288 (0.645\u0026ndash;2.573)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.272(0.272\u0026ndash;0.272)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.474\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.232 (1.073\u0026ndash;4.643)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.594(1.051\u0026ndash;3.939)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSEX\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19((\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82(98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e192(91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.057 (0.924\u0026ndash;17.820)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.057(2.947\u0026ndash;89.820)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTIME FROM INJURY TO ED\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.323(0.143\u0026ndash;0.730)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.43(1.184\u0026ndash;6.509)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53(63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82(39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.250(0.133\u0026ndash;0.470)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.303(0.91\u0026ndash;4.138)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.321\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e99(47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSYSTOLIC BP\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51 (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e100\u0026ndash;149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48(57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140(66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.500(1.777\u0026ndash;6.894)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.515(0.508-227.282)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.743\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.100(2.148\u0026ndash;12.108)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.227(1.923\u0026ndash;189.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePUPILLARY DILATION\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e174 (82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.270(1.834\u0026ndash;5.829)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.023(1.128\u0026ndash;7.197)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37((\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePRE-OPERATIVE GCS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56(67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.278(0.145\u0026ndash;0.533)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.480(0.312\u0026ndash;0.928)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e133(63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.225(0.119\u0026ndash;0.426)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.280(2.942\u0026ndash;4.569)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePOLYTRAUMA\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59(70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e186(88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.273(1.167\u0026ndash;4.427)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.122(2-670-18.214)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTIME FROM ADMISSION TO SURGERY\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.133(0.064\u0026ndash;0.276)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.210(0.043\u0026ndash;0.918)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75 (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.385(0.182\u0026ndash;0.814)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.249(0.062\u0026ndash;0.942)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90(42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMECHANISM OF INJURY\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssault\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.861(0.482\u0026ndash;1.543)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.892(.873\u0026ndash;4.102)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.242(0.673\u0026ndash;2.274)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.313(.600\u0026ndash;2.873\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.496\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64(76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e151(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.393(0.820\u0026ndash;2.331)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.888(.891\u0026ndash;4.002)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.971\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCOMORBIDITIES\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71(85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188(89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.599(0.270\u0026ndash;1.329)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.269(0.613\u0026ndash;8.394)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eRadiological factors associated with outcome, crude odds ratios, and adjusted odds ratios with chi-square p value\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUNFAVOURABLE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eFAVOURABLE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-VALUE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eHematoma type\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAEDH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e140(66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e2.947(0.754\u0026ndash;11.516)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.109(0.420-10.576)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.364\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASDH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.257(0.319\u0026ndash;4.950)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.182(0.225\u0026ndash;6.210)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSize of midline shift\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;0.0.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80(95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e195(92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.337(0.175\u0026ndash;0.650)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.034(1.097\u0026ndash;8.320)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHerniation syndrome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e191(91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58(69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e0.047(0.024\u0026ndash;0.090)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.88(10.219\u0026ndash;42.688)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHematoma volume\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;30 cc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 cc\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59(70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e151(72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e1.032(0.968\u0026ndash;1.099)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.143(0.519\u0026ndash;2.518)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.741\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOther head CT findings\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84(40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72(86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127(60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e3.969(2.030\u0026ndash;7.759)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.727(2.035\u0026ndash;10.981)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eKey results;\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of this study showed that of 295 participants in this study, 54 participants (18.3%) had died at 3 months postoperatively. Overall, 211 participants (71.5%) had favorable outcomes, while 84 participants (28.5%) had unfavorable outcomes.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study demographic distribution mirrors other research, with a majority of male patients (92.9%) and an average age of 36.5 years, similar to findings in Tanzania, Nigeria, and China. (\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This male predominance, particularly among middle-aged men, is likely due to their roles as primary earners, involvement in manual labor, and higher risk-taking behaviors. Motor-traffic accidents were the most common cause of injury (72.9%), followed by assaults (14.9%) and falls (9.5%). This pattern aligns with studies from LMICs like China, Lebanon, and Ethiopia, where rapid infrastructural development and inadequate road safety contribute to injury rates, contrasting with Europe and the USA, where falls are more prevalent. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt three months post-operative, the study reported an 18.3% mortality rate (54/296 patients). Severe disability occurred in 2.0%, moderate disability in 8.1%, mild disability in 17.6%, and good recovery in 53.9% of patients. Overall, 71.5% had favorable outcomes, while 28.5% had unfavorable outcomes.\u003c/p\u003e\u003cp\u003eThe overall mortality rate in this study is lower compared to studies from Turkey and India, which showed rates of 49.1% and 76% for severe TBI with herniation. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) And on further analysis, the mortality of severe TBI patients was still low in our study at 29%. These findings align more closely with studies from Nigeria and Uganda, where mortality rates were 16.9% and 16.2%, and favorable outcomes were 66% and 71%. The lower mortality in this study may be due to the higher proportion of patients with mild to moderate TBI and the predominance of AEDH cases, which typically have a better prognosis.\u003c/p\u003e\u003cp\u003eAge significantly impacted prognosis, with older patients experiencing worse outcomes, consistent with findings by Howard et al. (1989) and D\u0026rsquo;Amato et al. (2007)(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), but differing from studies in India and Turkey (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The likely reason is that older patients tend to have more severe injuries and slower recovery. Early surgical intervention from presentation at the emergency department (ED) was associated with better outcomes, aligning with findings from studies in India, China, and Turkey (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). However, a shorter duration from injury to surgery was paradoxically linked to unfavourable outcomes. This may be because patients with severe injuries are more likely to arrive at the hospital early, either directly from the scene or through referring centers, but they typically have a poorer prognosis compared to those with mild or moderate injuries. In contrast, due to limited resources, patients with less severe injuries often experience longer waiting times in the ED before surgery, either while receiving resuscitation or waiting for theatre availability. A study from Nigeria (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) found no added benefit from faster surgical intervention, highlighting the need for improved hospital referral systems, better resource allocation, and effective triaging.\u003c/p\u003e\u003cp\u003eElevated systolic blood pressure (SBP) above 150 mm Hg was associated with worse outcomes, consistent with studies from Poland, Kenya, and Tanzania (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Maintaining normotensive SBP through early resuscitation is crucial for better outcomes in TBI cases. Pupillary abnormalities were strongly linked to poor outcomes, similar to findings in India, Ethiopia, Uganda, and Tanzania (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In contrast, the absence of pupillary dilation was associated with better outcomes, emphasizing the importance of rapid response. Polytrauma increased the odds of unfavorable outcomes, though not statistically significant in our study, unlike other studies that showed a stronger correlation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Higher preoperative Glasgow Coma Scale (GCS) scores were associated with better outcomes, consistent with prior reports. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eComorbidities like hypertension, diabetes, and cardiovascular disease did not independently affect outcomes, aligning with studies from India and Ethiopia (Michael et al., 2023; Tanwar et al., 2024). The mechanisms of trauma\u0026mdash;motor vehicle accidents, followed by falls\u0026mdash;did not significantly impact outcomes, consistent with findings from Turkey, Kenya, and Tanzania (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRadiologically, ASDH showed a trend towards unfavorable outcomes, though not statistically significant, similar to findings from Turkey and contrasting with studies from China and Tanzania. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Larger hematomas volumes were not significantly associated with unfavorable outcomes, which contrasts with studies from Poland and India.(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Larger midline shifts and the presence of herniation syndromes significantly increased the risk of unfavorable outcomes, consistent with studies from China, India, Poland, and Tanzania. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Additional CT findings also increased the risk of unfavorable outcomes, emphasizing the need for early surgical intervention.\u003c/p\u003e\u003cp\u003eIn summary, our study identifies key factors influencing TBI outcomes, including age, injury duration, SBP, pupillary abnormalities, GCS scores, and radiological findings. These insights underscore the need for tailored patient management and further research to better understand these associations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSurgery was associated with good functional outcomes despite high mortality and morbidity, and is highly recommended in trauma patients with extra-axial hematoma. Though updates on referral systems, triage guidelines, treatment protocols, and documentation are needed.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003cp\u003e This study was approved by the ethical committee of the university, and all procedures were conducted per the ethical standards of the institution and the Declaration of Helsinki. Written informed consent was obtained from all participants and their relatives before their inclusion in the study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e Written informed consent for publication of the study findings was obtained from all participants.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThere are no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eAuthor contributions\u003c/h2\u003e\u003cp\u003eE.U.Wampembe: data collection \u0026amp; analysis, manuscript writing, patient clerkship, and surgery.\u003c/p\u003e\u003cp\u003eB.R. data cleaning and analysis\u003c/p\u003e\u003cp\u003eD.M-manuscript writing\u003c/p\u003e\u003cp\u003eL.M.F: literature search and manuscript review\u003c/p\u003e\u003cp\u003eK.A.V: critical review\u003c/p\u003e\u003cp\u003eS.K. C: Critical review and final approval of the manuscript.\u003c/p\u003e\u003cp\u003e*H.R. - Critical review and final approval of the manuscript\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.U.Wampembe: data collection \u0026amp; analysis, manuscript writing, patient clerkship, and surgery. B.R-data cleaning and analysisD.M-manuscript writingL.M.F: literature search and manuscript review K.A.V: critical reviewS.K. C: Critical review and final approval of the manuscript.*H.R - Critical review and final approval of the manuscript\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003e\"The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\"\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCoronado V, McGuire L, Faul M, Sugerman D, Pearson W. Brain Injury Medicine, 2nd Edition: Principles and Practice. In. 2012. pp. 72\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2019;130(4):1080\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdegboyega G, Zolo Y, Sebopelo LA, Dalle DU, Dada OE, Mbangtang CB, et al. 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J Glob Heal Rep. 2022;6(February).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo Z, Ding W, Cao D, Chen Y, Chen J. Decompressive Craniectomy vs. Craniotomy Only for Traumatic Brain Injury: A Propensity-Matched Study of Long-Term Outcomes in Neuropsychology. Front Neurol. 2022;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKumara MG, Dhugasa MB. Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia. J Spine Neurosci. 2020;1(2):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLan Z, Richard SA, Li Q, Wu C, Zhang Q, Chen R, et al. Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation. Med (Baltim). 2020;99(43):e22742.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChikhladze N, Halliday F, Pitskhelauri N, Tsiskaridze A. Epidemiological features of traumatic brain injuries from a first-level trauma care national medical center in Georgia. One Heal Risk Manag. 2023;4(2):5\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGurer B, Kertmen H, Yilmaz ER, Dolgun H, Hasturk AE, Sekerci Z. The surgical outcome of traumatic extraaxial hematomas causing brain herniation. Turk Neurosurg. 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTanwar V, Chand G, Thakur DS. Decompressive Craniotomy in Traumatic Brain Injury: A Prospective Study of Decompressive Craniotomy in Traumatic Brain Injury : A Prospective Study of 25 Patients. 2024;(May).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoward MA 3rd, Gross AS, Dacey RGJ, Winn HR. Acute subdural hematomas: an age-dependent clinical entity. J Neurosurg. 1989;71(6):858\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD\u0026rsquo;Amato L, Piazza O, Alliata L, Sabia G, Zito G, Frassanito L, et al. Prognosis of isolated acute post-traumatic subdural haematoma. J Neurosurg Sci. 2007;51(3):107\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArumugam G, Krishnaswamy V, Nair JN, Visweswaran V, Naidu B, Ganesh K. Arumugam Introduction: Interdiscip Neurosurg Adv Tech Case Manag [Internet]. 2021;101130. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.inat.2021.101130\u003c/span\u003e\u003cspan address=\"10.1016/j.inat.2021.101130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eInvestigation O, Kulesza B, Litak J, Grochowski C, Nogalski A, Article O. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.wnsx.2023.100257\u003c/span\u003e\u003cspan address=\"10.1016/j.wnsx.2023.100257\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyogu O, Onobun D, Igbokwe K, Ugwuanyi C, Mordi C, Ibeneme S. Factors affecting the outcome of traumatic brain injured patients with acute epidural haematoma in National Hospital, Abuja. J West Afr Coll Surg. 2021;11(1):1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShisoka JM, Omondi LA, Kimani ST. Determinants Of The Outcome On Traumatic Brain Injury Patients. Kenyatta Natl Hosp. 2019;32(1):34\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArticle O. Association of Outcome of Traumatic Extradural Hematoma with Glasgow Coma Scale and hematoma size. 2010;133\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"TBI, Trephination, craniotomy, decompressive craniectomy, Extra-axial hematoma, Glasgow outcome scale, Low resource settings","lastPublishedDoi":"10.21203/rs.3.rs-7075281/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7075281/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction\u003c/b\u003e: Traumatic brain injury (TBI) remains a major global health issue, particularly among young adults, with high rates of morbidity and mortality. Delays in surgical intervention can worsen secondary brain injuries. When performed promptly and appropriately, surgery significantly reduces mortality and morbidity. This study evaluated factors associated with unfavourable outcomes in patients with extra-axial hematomas at Kilimanjaro Christian Medical Centre (KCMC).\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e: To assess factors associated with unfavourable outcomes in TBI patients with extra-axial hematomas treated surgically at KCMC.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethodology\u003c/b\u003e: A retrospective study was conducted at a hospital using data from the KCMC TBI registry and general surgery operating theatre records. A total of 295 patients who received surgical treatment for extra-axial hematomas were included in the analysis. Clinical, radiological, and intraoperative information was examined using SPSS version 29.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e: The study included 295 participants, 92.9% of whom were male, with 89.5% aged 18\u0026ndash;49 years. Mild TBI was the most common (50.8%), followed by severe (25.1%) and moderate (24.1%) TBI. Motor traffic accidents (MTAs) were the leading cause (72.9%). The mean Glasgow Coma Scale (GCS) on arrival was 11.4. Most patients (63.7%) had systolic blood pressure between 90\u0026ndash;149 mmHg. Acute epidural hematomas (60.3%) were the most frequent, followed by subdural hematomas and intracerebral haemorrhages (36.6%). Additional injuries were present on CT scans in 67.5% of cases. At 3 months post-surgery, mortality was 18.3%, and unfavourable outcomes were noted in 28.5%.\u003c/p\u003e\u003cp\u003eFactors significantly associated with poor outcomes included age\u0026thinsp;\u0026ge;\u0026thinsp;50 years (p\u0026thinsp;\u0026lt;\u0026thinsp;0.002), early hospital arrival (p\u0026thinsp;\u0026lt;\u0026thinsp;0.007), polytrauma, elevated systolic BP (p\u0026thinsp;\u0026lt;\u0026thinsp;0.000), herniation syndromes, midline shift, and other CT abnormalities (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e: Craniotomy showed a positive impact on outcomes, but delays and secondary factors remain critical. Early referral, prompt triage, and adequate resuscitation are essential to improve outcomes. The findings highlight the need for tailored treatment approaches and strategies to minimize delays in TBI care.\u003c/p\u003e","manuscriptTitle":"Functional Outcomes of Tbi Patients Undergoing Craniotomy for Extra-axial Hematoma: A 2-year Experience at Kilimanjaro Christian Medical Centre-tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-08 08:44:56","doi":"10.21203/rs.3.rs-7075281/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"276000124354719057814738044418056537671","date":"2025-09-14T14:14:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-05T15:56:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293466399218028595617786724014307038866","date":"2025-09-05T15:47:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-28T04:50:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-13T04:22:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-22T08:36:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-20T14:44:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2025-07-20T14:41:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"362a0a2f-365a-4413-b563-87f83ef8369c","owner":[],"postedDate":"September 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T08:44:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-08 08:44:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7075281","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7075281","identity":"rs-7075281","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}