Evaluating the Impact of Road Traffic Accidents on the Outcome of Traumatic Brain Injury (TBI) in African Urban Centers: A Systematic Review

Evaluating the Impact of Road Traffic Accidents on the Outcome of Traumatic Brain Injury (TBI) in African Urban Centers: A Systematic Review | 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 Systematic Review Evaluating the Impact of Road Traffic Accidents on the Outcome of Traumatic Brain Injury (TBI) in African Urban Centers: A Systematic Review Godswill Uzoechina, Abdulbasit Opeyemi Muili, Vidushi Joshi, F. Abdul Abbas Hussein, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7653423/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Traumatic brain injury (TBI) is a major contributor to morbidity and mortality in low- and middle-income countries, particularly in African urban centers where road traffic accidents (RTAs) are a leading cause. Limited access to neurosurgical care, imaging, and critical care infrastructure may exacerbate outcomes in these settings. This systematic review evaluates the burden, outcomes, and healthcare system factors associated with RTA-related TBI in African urban centers. Methods: We systematically searched PubMed and Google Scholar for studies published from January 2010 to May 2025. Observational studies, clinical audits, and hospital-based registries reporting on TBI from RTAs in African urban centers were included. The primary outcome was mortality and functional outcome (e.g., Glasgow Outcome Scale), and secondary outcomes included morbidity, hospital length of stay, and time to neurosurgical intervention. Risk of bias was assessed using the Newcastle-Ottawa Scale and QUIPS tools. Data were synthesized narratively, and no meta-analysis was conducted. Quality of evidence was graded using the GRADE approach. Results: A total of 13 studies involving 6,453 participants across 8 African countries were included. The majority of patients were young males (aged 20–35), and RTAs, especially motorcycle crashes, were the dominant mechanism of injury. Severe TBI (GCS ≤8) was common, and mortality rates ranged from 30% to 70% among this subgroup. Predictors of poor outcome included low GCS, hypotension, and delayed presentation. Access to neurosurgical intervention, CT imaging, and ICU care varied widely across centers, with several studies noting financial barriers as a major contributor to discharge against medical advice (DAMA). Only three studies reported long-term outcomes beyond hospital discharge. Risk-of-bias assessment found that most studies were at moderate risk of bias, with common limitations including single-centre hospital sampling, retrospective data collection in several cohorts, incomplete reporting of missing-data handling and sample-size justification, and limited follow-up or attrition for longer-term outcomes. Conclusion: RTA-related TBI in African urban centers is associated with high mortality and unfavorable functional outcomes, largely due to delayed access to care, limited imaging and ICU capacity, and socioeconomic constraints. Improved trauma systems, expanded neurocritical care services, and financial protection mechanisms are urgently needed to reduce preventable mortality and improve outcomes in this high-risk population. Traumatic brain injury Road traffic accidents Neurosurgery Africa Urban health Mortality Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 10 Oct, 2025 Editor assigned by journal 24 Sep, 2025 Submission checks completed at journal 24 Sep, 2025 First submitted to journal 18 Sep, 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. 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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-7653423","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":519229965,"identity":"3beb7a94-cf56-4237-9fbf-68322d98bee3","order_by":0,"name":"Godswill Uzoechina","email":"data:image/png;base64,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","orcid":"","institution":"University of Nigeria Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Godswill","middleName":"","lastName":"Uzoechina","suffix":""},{"id":519229972,"identity":"b202460d-88fe-4547-9543-8d668899989d","order_by":1,"name":"Abdulbasit Opeyemi Muili","email":"","orcid":"","institution":"Ladoke Akintola University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Abdulbasit","middleName":"Opeyemi","lastName":"Muili","suffix":""},{"id":519229973,"identity":"9feeccc1-0086-46a1-8c82-eceed8accb17","order_by":2,"name":"Vidushi Joshi","email":"","orcid":"","institution":"China Medical University","correspondingAuthor":false,"prefix":"","firstName":"Vidushi","middleName":"","lastName":"Joshi","suffix":""},{"id":519229974,"identity":"b578a9da-a503-481b-b2d9-18bf2e5db371","order_by":3,"name":"F. 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Review","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"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":"Traumatic brain injury, Road traffic accidents, Neurosurgery, Africa, Urban health, Mortality","lastPublishedDoi":"10.21203/rs.3.rs-7653423/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7653423/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eTraumatic brain injury (TBI) is a major contributor to morbidity and mortality in low- and middle-income countries, particularly in African urban centers where road traffic accidents (RTAs) are a leading cause. Limited access to neurosurgical care, imaging, and critical care infrastructure may exacerbate outcomes in these settings. This systematic review evaluates the burden, outcomes, and healthcare system factors associated with RTA-related TBI in African urban centers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe systematically searched PubMed and Google Scholar for studies published from January 2010 to May 2025. Observational studies, clinical audits, and hospital-based registries reporting on TBI from RTAs in African urban centers were included. The primary outcome was mortality and functional outcome (e.g., Glasgow Outcome Scale), and secondary outcomes included morbidity, hospital length of stay, and time to neurosurgical intervention. Risk of bias was assessed using the Newcastle-Ottawa Scale and QUIPS tools. Data were synthesized narratively, and no meta-analysis was conducted. Quality of evidence was graded using the GRADE approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 13 studies involving 6,453 participants across 8 African countries were included. The majority of patients were young males (aged 20–35), and RTAs, especially motorcycle crashes, were the dominant mechanism of injury. Severe TBI (GCS ≤8) was common, and mortality rates ranged from 30% to 70% among this subgroup. Predictors of poor outcome included low GCS, hypotension, and delayed presentation. Access to neurosurgical intervention, CT imaging, and ICU care varied widely across centers, with several studies noting financial barriers as a major contributor to discharge against medical advice (DAMA). Only three studies reported long-term outcomes beyond hospital discharge. Risk-of-bias assessment found that most studies were at moderate risk of bias, with common limitations including single-centre hospital sampling, retrospective data collection in several cohorts, incomplete reporting of missing-data handling and sample-size justification, and limited follow-up or attrition for longer-term outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eRTA-related TBI in African urban centers is associated with high mortality and unfavorable functional outcomes, largely due to delayed access to care, limited imaging and ICU capacity, and socioeconomic constraints. Improved trauma systems, expanded neurocritical care services, and financial protection mechanisms are urgently needed to reduce preventable mortality and improve outcomes in this high-risk population.\u003c/p\u003e","manuscriptTitle":"Evaluating the Impact of Road Traffic Accidents on the Outcome of Traumatic Brain Injury (TBI) in African Urban Centers: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 03:33:11","doi":"10.21203/rs.3.rs-7653423/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-10T20:39:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-24T11:06:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-24T11:06:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2025-09-19T01:24:36+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":"5cc7e9dd-5dbc-4549-acaf-875adb3f2e67","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T11:53:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 03:33:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7653423","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7653423","identity":"rs-7653423","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}