Spatial Analysis of the Determinants, Management and Outcomes of Traumatic Brain Injury in Rwanda, 2024

Spatial Analysis of the Determinants, Management and Outcomes of Traumatic Brain Injury in Rwanda, 2024 | 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 Article Spatial Analysis of the Determinants, Management and Outcomes of Traumatic Brain Injury in Rwanda, 2024 Hana Waleed Makki, Hiba Waleed Makki, Peter Hutchinson, Izis Atif Munir, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7760419/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 global health priority due to its preventability and its related expensive medical care. This research assessed the determinants, management and outcomes of TBI in Rwanda. Methods A multicentre cross-sectional study combined with a community-based telephone survey was implemented on a sample of 84 patients selected through a multi stage sampling technique. The data were collected in two reference hospitals through a standardized pre-tested questionnaire developed by the researcher who who included all the items of GOSE to determine the functional outcomes of TBI patients. Data collected were characteristics of the study participants, type of TBI, mode, mechanism, time and venue of the injury, mode of referencing from injury site to emergency department, clinical presentation and investigations on admission, treatment administrated, and outcomes of the management. The data were managed in SPSS23 and geo-referenced in Google Earth Pro. Descriptive statistics was implemented followed by determining association through Chi-square tests, correlation analysis and ANOVA. A multinomial regression established the relationship between determinants, management and outcomes of TBI. A spatial analysis through the kriging method of ArcGIS delineated TBI risk areas. A significance level of p < 0.05 was set for all the statistical tests. Results More than half (51.2%) of the TBI cases were aged 25–49 years; TBI affected predominantly male gender (77.4%). The identified types of TBI were mild (50.0%), moderate (39.7%) and severe (10.3%). The GOSE scores revealed that 69.0% of the TBI patients had good outcomes. The statistically significant determinants of TBI were conscious status in moderate (OR = 51.2,95%[CI:6.6-397.2], p = 0.000) and severe TBIs (OR = 48.8, 95%[CI: 1.8–1297.0], p = 0.020) and the length of stay in hospital in severe TBI (OR = 1.142. 95%[CI:1.013–1.287], p = 0.030). Three TBI risk areas were delineated in Rwanda through the kriging method; a high TBI risk area, an intermediate TBI risk area and low TBI risk area. Conclusion Traumatic brain injury is a country-wide public health concern in Rwanda. Its control and ultimately elimination indicate a public-private partnership between the affected communities, the public and private sectors, the armed forces, the Ministries of Transport, Education, and Health, the international organizations and non- governmental organizations. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Health sciences/Risk factors Loss of consciousness Post-traumatic stress disorder Seizures Spinal cord injury Traumatic brain injuries Figures Figure 1 Figure 2 Figure 3 Introduction Traumatic brain injury (TBI), a common disorder with high morbidity and mortality, accounts for one in every three deaths due to injury. It can be classified based on the Glasgow coma scale (GCS) into mild, moderate and severe TBI. TBI and spinal cord injury (SCI) are increasingly recognized as global health priorities because of their preventability, complexity and expensive medical care they necessitate [ 1 – 3 ]. TBI is a world-wide public health concern with 48.99 million prevalent cases, 27.16 million new cases and 7.08 million YLDs reported in 2019. Road traffic injuries accounted for 16.7 (UI: 13.1–20.2) deaths per 100,000 populations [. A decrease of − 5.5% (95% uncertainty interval − 8.9% to − 3.0%) in the global age standardized incidence rate of TBI was observed between 1990 to 2019; for the period, SCI had no changed significantly (− 6.1% (− 17.3% to 1.5%). Regionally in 2019, Eastern Europe had the highest global burden of TBI and North America accounted for the highest global burden of SCI. [ 4 ] The mechanisms of injury are due to accident/motor vehicle collision, falls, assault/ violence, self-harm, and sports injury. The violence-related TBI is experienced by young and middle-aged adults with more than half (54%) aged between 21–40 years. TBI predominantly affects male gender (81%) aged 31 years ± 11.8 (range:10–89). The severity of TBI can be measured based on post-resuscitation Glasgow Coma Scale scores, which identify mild TBI when GCS is 14–15, moderate when GCS equals 9–13 and severe when GCS equals 3–8. Severe TBI can lead to significant physical, psychosocial, and social deficits in > 60% of the cases and its mortality can reach 30% − 40% [ 2 , 3 , 5 , 6 ]. The pathoanatomic diagnosis of TBI is based on a combined clinical and radiological classifications as the clinical classification to determine the severity may not be the best reliable indicator of long-term cognitive outcome. Injury may result from the trauma directly or indirectly. Localized and diffuse injuries are possible fractures, haemorrhages, and contusions to the head are examples of focal injuries. Diffuse traumas can result in vascular damage, diffuse axonal injury, or hypoxic-ischemic damage [ 7 ]. Initial management of TBI includes the assessment of GCS to evaluate the mental status followed by initiating neuro-protective measures including intubation and mechanical ventilation for airway protection in moderate to severe TBI. Head CT is the first line imaging assessment to reveal an intracranial pathology and diagnose TBI. For those with severe TBI, identified on imaging and clinical assessment, admission to intensive care is indicated as well as a monitoring of the intracranial pressure to guide the therapy. This is the gold standard in high-income settings as recommended by Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) guidelines [ 7 , 8 ]. Focal injuries such as extra-axial bleeds may require surgical intervention including decompressive hemi-craniotomy. Raised intracranial pressure (ICP), haemorrhagic contusions, and cerebral oedema are all closely related to the morbidity and mortality of TBI [ 1 , 2 ]. In low- and middle-income countries (LMIC), high post-TBI morbidity and mortality rates are recorded, greater than in developed countries due to public health interventions including seatbelt legislation, helmet use, workplace health and safety regulations [ 9 ]. TBI survivors are at an increased risk of subsequent TBIs, which are associated with increased recovery time and utilization of services. Post injury complications include confusion, disorientation, alteration in psychomotor activity and mental inflexibility. Negative psychiatric consequences were also described as depression, mania and posttraumatic stress disorders [ 10 ]. These sequels can affect individuals regardless the severity of TBI. The Glasgow Outcome Scale Extended (GOSE) is a series of interviewer based questions. It is the most outcome instrument used to assess the global disability and the degree of recovery post-TBI [ 11 , 12 ]. This research, assessing the determinants, management and outcomes of traumatic brain injury in Kigali, Rwanda as of 2024 through a spatial analysis, fits in the national strategic plan of the country. Methods Study design A multi-centre descriptive cross-sectional study combined with a community-based telephone survey was conducted. Study setting and population The study was implemented in Kigali City, the capital of Rwanda, which is a landlocked country with a land square of 26,338 km² and four international boundaries (Burundi, Democratic Republic of Congo, Tanzania, and Uganda). Administratively, the country is divided in provinces, Kigali city is one of them. The province of Kigali is the home of 13.2% (1745555/13,246,394) of the country population and subdivided in three districts, Gasabo, Kicukiro and Nyarugenge [ 13 , 14 ]. There are eleven hospitals (public and private) geographically distributed in Kigali City, they are namely University Teaching Hospital of Kigali (CHUK), Hospital la Croix du Sud (HCS), Kacyiru Police Hospital, Muhima Hospital, Kibagabaga Hospital, Kanombe Military Hospital (Rwanda Military Hospital), King Faisal Hospital Kigali, Ndera Neuropsychiatric Teaching Hospital, Masaka Hospital, Nyarugenge Hospital and Wiwo Specialized Hospital [ 15 , 16 ]. Sampling technique and statistical tests A multistage sampling technique was used to select the study settings and participants. Firstly, a purposive sampling technique included the University Teaching Hospital of Kigali (CHUK) and Rwanda Military Hospital (RMH), which are two of the three hospitals (King Faisal Hospital is the third)) with neurosurgery department and CT scan facilities. Secondly, a stratified random sampling technique was used to distribute the estimated sample size proportionally to the number of beds in the emergency department, intensive care unit (ICU), high dependency unit (HDU) and resuscitation room of the two hospitals. Thirdly, in each of the two selected hospitals, the TBI incident cases admitted within the emergency, ICU, HDU departments during the period of December 2023 to March 2024 were included in the study; a total of 84 patients were obtained during this study period. The data were collected through a standardized pre-tested interviewer administrated questionnaire developed by the researcher; this research tool includes all the items of the Glasgow Outcome Scale extended (GOSE) [ 11 , 12 ]. The GOSE is a score used to determine the functional outcomes of the TBI patients. It further groups the patients into eight categories, namely death (D, scored as 1), vegetative state (VS, scored as 2), lower severe disability (LSD, scored as 3), upper severe disability (USD, scored as 4), lower moderate disability (LMD, scored 5), upper moderate disability (UMD, scored as 6), lower good recovery (LGR, scored as 7), upper good recovery (UGR, scored as 8). The data collected were the characteristics of the study participants (age, gender, education level, profession, residence, telephone number, hospital emergency department), the determinants of TBI (type of TBI, mode, mechanism, time and venue of the injury, mode of referencing from injury site to emergency department), the factors related to TBI (clinical presentation and investigation on admission, treatment administrated), and the outcomes of the management of the TBI. The data were computerized through Epi Info 7 then uploaded in the statistical package for social sciences (IBM© SPSS© Statistics Version 23). Data were summarized numerically (mean, standard deviation and median) and graphically (frequency tables and graphics). The frequency tables were geo-referenced (latitude and longitude) in using Google Earth Pro (Google Earth Pro 7.3.6.10201 (64-bit)). The statistical analysis included Chi-square tests, correlation analysis and analysis of variance (ANOVA) wherever appropriate to determine association between variables. A multinomial regression analysis established the relationship between determinants, management and outcomes of TBI. Further, a spatial analysis was performed through the modelling technique of ArcGIS 10.3 for Desktop version 10.3.0.4.322 to generate a predictive risk map of TBI in Rwanda. This modelling technique is known as kriging method. This spatial interpolation or spatial autocorrelation assumes that close samples tend to be more similar than distant samples. This property of spatial data is implicitly used in inverse distance weighted (IDW) interpolation to determine cell values using a linearly weighted combination of a set of sample points. IDW is a method of interpolation that estimates cell values by averaging the values of sample data points in the neighbourhood of each processing cell. The closer a point is to the centre of the cell being estimated, the more influence, or weight it has in the averaging process. The weight is a function of inverse distance. The surface being interpolated should be that of a location dependent variable. In kriging, one must model the spatial autocorrelation using a semivariogram instead of assuming a direct linear relationship with separation distance [ 17 , 18 ]. Results Characteristics of the study participants A total of 84 patients were enrolled from two hospitals. Rwanda Military Hospital (RMH) received more than half of the patients (69.0%, 58/24), while the Centre Hospitalier Universitaire de Kigali (CHUK) received 31.0% (26/84). The majority of the patients (79.8%) were referred from other hospitals and 20.2% were admitted directly in CHUK and RMH; Fig. 1 displayed the distribution of referring hospitals. The length of stay in the two reference hospitals ranged from 0 to 91 days with a median length of stay of 5 days. This average length of stay varied across the hospitals, it was lower in RMH (mean = 9.6 days, 95% [CI:0.2–19.0], n = 50) than in CHUK (10.0 days, 95% [CI: 0.5–19.5], n = 26), however, this difference was not statistically significant (F 1,74 =0.011, p = 0.917). Male patients were mostly affected (77.4%, 65/84) as displayed in Table 1 . The patients were aged 2–84 years (median age: 34 years) with more than half (51.2%) aged 25–49 years. More than half (58.3%, 49/84) were married and 35.7% (30/84) were single. Most of them (82.2%, 69/84) had a formal education ranging from primary to university. The main occupations reported by TBI patients were cultivators (38.5%, 20/84) and students (26.9% 14/84) which represented 65.4% of the six types of jobs reported. Regarding substance abuse, 34.5% (29/84) TBI patients reported consuming either alcohol, or both alcohol and tobacco. Chronic diseases prevailed in 15.5% (13/84) of the patients with hypertension and asthma being the most frequent chronic diseases with respectively 23.1% and 15.4%. The majority of the patients (89.3%, 75/84) were not under chronic medication at the time of the data collection; all the participants reported holding a health insurance. A history of TBI was found in 8.3% (7/84). Table 1 Characteristics of study participants (n = 84) Variable Number % Variable Number % Hospital (n = 84) Job (n = 84) CHUK 26 31.0 Cultivator 20 38.5 RMH 58 69.0 Students 14 26.9 Referred (n = 84) Employee 8 15.4 No 17 20.2 Armed forces 6 11.5 Yes 67 79.8 Self-employed 3 5.8 LOS in days* (n = 76) Not working 1 1.9 Median 5 Substance abuse (n = 84) Min-Max 0–91 No Substance Abuse 55 65.5 Age in years (n = 84) Alcohol only 21 25.0 Median 34 Alcohol & smoke 8 9.5 Min-Max 2–84 Chronic health (n = 84) 0–4 years 2 2.4 No 71 84.5 5–14 years 5 6.0 yes 13 15.5 15–24 years 15 17.9 Chronic disease (n = 13) 25–49 years 43 51.2 Hypertension 3 23.1 =>50 years 19 22.6 Asthma 2 15.4 Gender (n = 84) Diabetes 1 7.7 Male 65 77.4 Hypertension & Diabetes 1 7.7 Female 19 22.6 Neurofibromatosis & Potts dx** 1 7.7 Marital status (n = 84) Chronic Gastritis 1 7.7 Married 49 58.3 Mental Health 1 7.7 Single 30 35.7 Alcoholic liver Cirrhosis 1 7.7 Widow 4 4.8 Chronic back pain 1 7.7 Divorced 1 1.2 HIV 1 7.7 Educational level (n = 84) Chronic medications (n = 84) No schooling 11 13.1 No 75 89.3 Primary school 29 34.5 Yes 9 10.7 Secondary school 25 29.8 History of TBI (n = 84) University/Post graduate 4 4.8 No 77 91.7 Not Available 15 17.9 Yes 7 8.3 *LOS: Length of hospital stay in days. **dx: disease. Types of traumatic brain injuries The most prevalent type of TBI was mild TBI, accounting for half of the patients (39/78, 50.0%). Moderate TBI accounted for 39.7% (31/78), followed by severe TBI (10.3%, 8/78). According to the age of TBI patients (n = 78), mild and moderate TBI affected younger patients with respectively a mean age of 34.1 years (95% [CI: 28.7–39.5], n = 39), and 36.8 years (95% [CI: 30.8–42.8], n = 31). Severe TBI was recorded in patients > 45 years (mean = 48.0 years, 95% [CI: 32.2–63.8], n = 8) with no a statistical difference (F 2,75 =2.045, p = 0.137) between the severity of TBI and the age of TBI. Half of the male and female patients were rendered with mild TBI with respectively (50%, 30/60) and (50%, 9/18). Moderate TBI were prominent in males than females with respectively 41.7% (25/18) and 33.3% (6/18). Severe TBI prevailed in females than males with 16.7% (3/18) vs 8.3% (5/60). Mechanism of injury Road traffic accident (RTA) ranked first accounting for 52.4% of the 84 TBI patients. Falls and violent attack/assault ranked second with respectively 19.0% (16/84) followed by pedestrian injury and wall collapsed with respectively 8.3% (7/84) and 1.2% (1/84). Table 2 summarises the mechanism, venue of the injuries and the type of TBI. More than half of mild TBI was sustained predominantly by RTA (51.3%, 20/39) followed by falls (23%,9/39). Moderate TBI prevailed in RTA accounting for 48.4% (15/31) followed by violence/Assault with 29.0% (9/31). Half of the severe TBI patients were injured through RTA (50.0%, 4/8) followed by falls (37.0%, 3/8). Table 2 Mechanism of injury by place of occurrence and type of TBI (n = 84) Type of TBI Mechanism of injury Venue Mild TBI % Moderate TBI % Sever e TBI % Total % p RTA Not available 1 50.0 1 50.0 0 0.0 2 5.1 Workplace 6 75.0 1 12.5 1 12.5 8 20.5 0.681 Street 8 47.1 7 41.2 2 11.8 17 43.6 Home 5 41.7 6 50.0 1 8.3 12 30.8 Total 20 51.3 15 38.5 4 10.3 39 100.0 Wall collapsed Workplace 0 0.0 0 0.0 1 100.0 1 100.0 Total 0 0.0 0 0.0 1 100.0 1 100.0 Falls Not available 0 0.0 1 33.3 2 66.7 3 20.0 Street 2 66.7 1 33.3 0 0.0 3 20.0 0.073 Home 7 77.8 1 11.1 1 11.1 9 60.0 Total 9 60.0 3 20.0 3 20.0 15 100.0 violence attack/Assault Workplace 2 40.0 3 60.0 0.0 5 31.3 Street 3 75.0 1 25.0 0.0 4 25.0 0.313 Home 2 28.6 5 71.4 0.0 7 43.8 Total 7 43.8 9 56.3 0.0 16 100.0 Pedestrian injury Workplace 0 0.0 1 100.0 0.0 1 14.3 Street 3 60.0 2 40.0 0.0 5 71.4 0.243 Home 0 0.0 1 100.0 0.0 1 14.3 Total 3 42.9 4 57.1 0.0 7 100.0 Total Not available 1 20.0 2 40.0 2 40.0 5 6.4 Workplace 8 53.3 5 33.3 2 13.3 15 19.2 0.537 Street 16 55.2 11 37.9 2 6.9 29 37.2 Home 14 48.3 13 44.8 2 6.9 29 37.2 Total 39 50.0 31 39.7 8 10.3 78 100.0 Factors associated to the outcomes of TBI management Time between the trauma and arrival of the rescue It was measured in four categories < 15 minutes, 15–30 minutes, 31–59 minutes and ≥ 60 minutes. Fifty-five patients (79.7%, 55/69) were rescued in < one hour with 52.7% (29/55) in < 15 minutes and 47.3% (26/55) between 31and 59 minutes; they were 20.3% (14/69) rescued in ≥ 1 hour with a no statistically significant difference ( p = 0.313) between the time of rescue and the types of TBI. Time from injury to admission in the reference hospital More than half (64.3%,54/84) of the TBI patients were admitted in 0–24 hours post trauma, 14.3% (12/84) in 25–72 hours and 21.4% in > 72 hours with a no statistically significant difference ( p = 0.676) between the time of admission and the type of TBI. The time delay (time of admission in hospital minus time of injury) was not also significantly different across gender and type of TBIs with a p -value of respectively 0.267 and 0.104. Transport of TBI patients from injury venue to reference hospitals The three main means of transport used to refer the patients from the venue of trauma to the reference hospitals were motorcycle (36.9%, 31/84), ambulance (27.0%, 24/84), private transport (15.5% ,13/84). 4.8% (4/84) of the patients were evacuated through traffic police car, 2 patients (2.4%, 2/84) were evacuated with stretcher and 13.1% (11/84) of the participants could not recall the mean of transportation used to evacuate them to hospitals. Of those admitted within less than an hour, the two frequent mode of transportation were ambulance 36.8% and motorcycle 34.2%. Of the patients who were admitted between 1 and 8 hours the predominant mode of transport was motorcycle (47.8%, 11/23). All patients admitted > 8 hours from the occurrence of the trauma were transported by motorcycle (5/5). Despite those differences observed, there was no statistically significant (likelihood ratio = 15.1, p = 0.056) between the mean of transport and the time between the occurrence of the injury and the arrival to the hospital. Management of TBIs at the reference hospitals Medical and Radiological evaluation of TBI patients in the reference hospitals TBIs were primarily restricted to the head (65.5%, 55/84) and 34.5% (29/84) were poly-trauma, either affecting the head and maxillofacial regions (93.1%, 27/29) or the head and neck (6.9%, 2/29). The head was the predominant region affected across the three types of TBI, mild (71.8%), moderate (58.1%) and severe (62.5%). With respect to the severity of TBI cases and their conscious status upon arrival in the hospital of reference, more than half (59.0%, 46/78) were managed solely in the emergency unit. Of those, 63.0% (29/46) were mild TBI (GCS:14–15) cases and 37.0% (17/46) were moderate TBI (GCS: 9–13) cases with a statistically significant association (Likelihood Ratio = 5.878, p = 0.015) between conscious status and the severity of the TBI. They were 23.1% (18/78) of the TBI cases managed in the intensive care units of whom 44.4% (8/18) were admitted as severe TBI (GCS: 3–8) and 55.6% (10/18) were diagnosed as moderate TBI (GCS: 9–13) with a statistically significant association (Likelihood Ratio = 5.609, p = 0.018) between the type of the TBI and their conscious status. A no statistically significant association (Likelihood Ratio = 0.483, p = 0.487) was found between the type of the TBI and the conscious status for 17.9% (14/78) of trauma patients of whom 71.4% (10/14) were admitted as mild TBI (GCS:14–15) cases and 28.6% (4/14) as moderate TBI (GCS: 9–13) cases. On admission, CT scan was requested for most (98.8%, 82/83) of the trauma patients except a 28-year male conscious patient referred by ambulance and diagnosed as mild TBI (GCS:14–15) case who was transferred from the emergency unit to ward. Across the types of TBI, the CT scan findings were normal for 15.8% (12/76) of the trauma patients and abnormal for 84.2% (64/76) with acute subdural haemorrhage (19.7%, 15/76) and epidural haemorrhage (10.5%, 8/76) being the most frequent CT scan imaging findings (supplement S1). S-1: CT scan findings by type of traumatic brain injury (n = 76) Surgical and medical management of TBI patients in the reference hospitals Of the 82 patients, half (50.0%) did not require a surgical intervention. The predominant surgical intervention was craniotomy accounting for 36.6% (30/82), conducted mainly in moderate TBI (53%,16/30) patients followed by mild (30%,9/30) and severe TBI (17%, 5/30). Burr hole and elevation of skull fracture were second accounting respectively for 3.7% (3/82). Burr hole was preformed mainly in mild TBI patients (67%, 2/82). On the other hand, all patients who underwent elevation of depressed skull fracture were mild TBI patients (3/39). Of 83 TBI patients, 89.2% received a medical treatment and for 10.8% the treatment data were not available; either the medications received were not recorded (8.4%, n = 7) or they were not treated (2.4%, n = 2). For those treated (n = 74), half received a combined medication of analgesic, antibiotic and antiepileptic; six cases of severe TBI benefited of this combined therapy. Analgesic associated to antiepileptic were administrated to 21.6% of the TBI patients; the therapy analgesic and antibiotic and analgesic only was received by respectively 12.2% of TBI patients. The association antiepileptic and antibiotic was given to 4.1% of TBI patients. Complications of TBI and length of hospitalization During hospitalization, patients were closely monitored for TBI complications; they were 88.1% (74/84) who experienced complications, which were absent in 11.9% (10/84). The three frequent complications recorded during the hospitalization were an alteration of conscious associated to physical complications (45.2%, 38/84), physical complications (23.8%, 20/84) and an alteration of the conscious (11.9%, 10/84). A statistically significant association (Likelihood Ratio = 44.724, p = 0.000) was found between the complications during hospitalization and types of TBI, the statistically significance was related to severe TBI (GCS: 3–8) as displayed by Supplement S2. S-2: Complications during hospitalization by type of traumatic brain injury. The average length of hospitalization of TBI cases of 9.8 days (95% [CI:6.1–13.5], n = 72) varied across the types of TBI. It was statistically (F 2,69 = 4.198, p = 0.019) higher in severe TBI (mean = 19.8 days (95%[CI:2.3–37.2), n-8) than in moderate TBI (13.4 days, 95%[CI:5.7–21.1), n = 27) and mild TBI (5.0 days, 95% [CI:3.2–6.8], n = 37). Post discharge Glasgow Outcome Scale Extended Glasgow outcome scale extended (GOSE) was measured based on 21 items. Each item was recorded as a dichotomous variable (0 when the item was absent and 1 when it was present). Then a Cronbach alpha test was performed on the 21 items to measure the reliability of the answers provided by the patients. A computed Cronbach alpha value of 0.919 was obtained, which was in the range of validity of 0.70–0.95. The GOSE score for determining the functional outcomes of the TBI patients was computed and regrouped as recommended elsewhere in the literature [ 11 , 12 ]. This categorization enabled to identify seven categories (Fig. 2 ). The seven categories were regrouped as good and poor outcomes. The good outcomes included upper moderate disability, low moderate disability, lower good recovery and upper good recovery. Death, lower severe disability and upper severe disability were classified as poor outcomes. In the overall, 69.1% (58/84) of the TBI patients had good outcomes and 30.1% (26/84) had poor outcomes. Of the 39 mild TBI cases, 82.1% (32/39) had good outcomes and 17.9% (7/39) had poor outcomes. Those with moderate TBI (n = 31), 58.1% (18/31) had good outcomes and the outcomes were poor for 41.9% (13/31). In severe TBI cases (n = 8), the outcomes were good for 75.0% (6/8) and poor for 25.0% (2/8). However, the difference was not statistically significant (Likelihood Ratio = 4.931, p = 0.085) between the GOSE and the types of TBI. This indicated the importance of proper care form all types of TBI. Determinants of traumatic brain injuries A multinomial regression analysis was performed to assess the determinants of TBI. Of the three types of TBI (mild, moderate and severe), the mild TBI was considered as reference category. The regression equation fitting perfected models revealed that the conscious status during hospitalization was a statistically significant determinant in the models moderate TBI versus mild TBI (OR = 51.2, 95% [CI: 6.6-397.2], p = 0.000) and severe TBI vs mild TBI (OR = 48.8, 95% [CI: 1.8–1297.0], p = 0.020). The length of stay in hospital contributing for 1 time (OR = 1.043, 95% [CI: 0.960–1.134], p = 0.320) in the model moderate TBI vs mild TBI, was a statistically significant determinant in the model severe TBI vs mild TBI (OR = 1.142. 95% [CI: 1.013–1.287], p = 0.030). Table 3 summarizes the determinants contributing to the occurrence of TBIs. Table 3 Multinomial regression estimating the determinants of TBI in the study population 95% CI for OR Variable B SE Wald df P OR lower upper Model moderate TBI (GCS: 9–13) vs mild TBI (GCS:14–15) Intercept -5.055 3.343 2.287 1 0.130 Age in years 0.018 0.025 0.513 1 0.474 1.018 0.969 1.070 Substance abuse -0.605 0.556 1.183 1 0.277 0.546 0.184 1.624 Chronic health condition 0.526 1.178 0.199 1 0.655 1.693 0.168 17.041 Place of occurrence of TBI 0.226 0.519 0.190 1 0.663 1.254 0.454 3.467 Consciousness status during hospitalization 3.935 1.046 14.159 1 0.000 51.153 6.588 397.161 Body region affected 0.997 0.838 1.414 1 0.234 2.710 0.524 14.017 CT Scan findings -2.011 1.211 2.756 1 0.097 0.134 0.012 1.438 Hemorrhage - CT scan -0.048 0.243 0.039 1 0.843 0.953 0.592 1.536 Length of stay in hospital 0.042 0.043 0.990 1 0.320 1.043 0.960 1.134 GOSE post discharge 0.011 0.288 0.001 1 0.970 1.011 0.574 1.779 Model severe TBI (GCS: 3–8) vs mild TBI (GCS:14–15) Intercept -11.303 5.383 4.409 1 0.036 Age in years 0.074 0.041 3.307 1 0.069 1.077 0.994 1.166 Substance abuse -0.698 1.021 0.467 1 0.495 0.498 0.067 3.684 Chronic health condition -0.632 1.759 0.129 1 0.719 0.532 0.017 16.709 Place of occurrence of TBI -2.328 1.194 3.800 1 0.051 0.098 0.009 1.013 Consciousness status during hospitalization 3.889 1.673 5.401 1 0.020 48.840 1.839 1297.027 Body region affected -0.106 1.519 0.005 1 0.944 0.899 0.046 17.634 CT Scan findings -2.647 2.366 1.252 1 0.263 0.071 0.001 7.316 Hemorrhage - CT scan -0.341 0.438 0.607 1 0.436 0.711 0.301 1.677 Length of stay in hospital 0.133 0.061 4.735 1 0.030 1.142 1.013 1.287 GOSE post discharge 1.652 0.890 3.445 1 0.063 5.218 0.912 29.862 Spatial distribution and risk map of traumatic brain injuries For public health perspective, the data collected from the two reference hospitals were georeferenced at district level to determine the epidemiological distribution of TBI in Rwanda as the TBI cases originated from various districts of the country. Figure 3 displays the epidemiological distribution of traumatic brain injury prevalence across Rwanda districts. The prevalence data were plotted as red dots. Each dot represented the number of TBI cases per 100,000 total populations in the concerned district. TBI was recorded in 66.7% (20/30) of the country districts. its ranged 2.0/100,000 population (Rusizi district) to 19.4/100,000 (Kicukiro district of Kigali City). The predictive TBI risk map (Fig. 3 ) generated through the modelling technique of ArcGIS 10.3, known as krigging method delineated three TBI risk areas in Rwanda: (i) a high TBI risk area, an intermediate TBI risk area and low TBI risk area. The high TBI risk area in orange (prevalence 6.7–12 TBI cases/100,000) delineated up down a north-western to south western belt including 17 districts of which four share boundaries with Tanzania (Rwanda sea port), and six have international borders with Burundi. In this high risk area, a very high TBI risk focus (prevalence: 12 case/100,000-19.4/100,000) can be identified in the south-western districts. The intermediate TBI risk area (4.0 cases/100,000–6.7 cases/100,000), north-south downwards, covered 14 districts. In this area, high risk foci exist in the districts of Burera and Musanze bordering Uganda. The low TBI risk area (2.0 cases/100,000–4.0/100,000) covered seven districts out which five districts (Nyabihu, Nyamasheke, Rubavu, Rusizi and Rutsiro) share boundaries with the Democratic Republic of Congo. In the overall, TBI is country-wide public health problem in Rwanda with a high risk area covering 17 districts. Discussion This study analysed the determinants, management and outcomes of TBI in Rwanda in a sample 84 patients from two reference hospitals (Rwanda Military Hospital, 69.0% and Centre Hospitalier Universitaire de Kigali, 31.0%). The TBI cases were predominantly (77.4%) males indicating a potential gender disparity in TBI incidence as confirmed by Krebs E et al [ 3 ] who reported that TBI predominantly affected male gender (81.0%, n = 684). The proportion of males affected was higher (94.7%, n = 4689) in the study of Patel et al [ 14 ] who used Rwanda police data to determine the epidemiology of road traffic injury hotspots in Kigali. In this study, the average age of TBI patients of 36.1 years (95%[CI:32.2–40.0], n = 84) ranged from 35.5 years (95%[CI:23.9–47.2], n = 19) in females to 36.3 years (95%[CI: 32.5–40.1], n = 65) in males, with over half (51.2%) aged 25–49 years, suggesting that younger adults were more frequently affected by TBI. The vulnerability of this population was pointed out elsewhere in the literature by Krebs E. et al. and Petroze R.T. et al [ 3 , 19 ] who respectively revealed an average age of 31years ± 11.8 (range:20–40 years, n = 684) and of 31.0 years (IQR 17–43, n = 3599 patients). About 34.5% of the patients reported substance abuse with primarily alcohol consumption, which is known as a contributing factor to the incidence of TBI. Chronic disease was present in 15.5% of the patients with hypertension (23.1%, 3/13) and asthma (15.4%. 2/13) being the frequent chronic conditions. Regarding the mechanism and venues of occurrence of the TBI, this study found that. RTA ranked first (52.4%) followed by falls and violent attack/assault ranking second with respectively 19.0%, pedestrian injury (8.3%) and wall collapsed (1.2%). These findings were confirmed by the global modelling data of the Lancet neurology commission which indicated that the incidence of TBI in LMICs is mainly driven by road traffic collisions, primarily involving motorcyclists [ 20 ]. Over half (69.2%, 54/78) of the TBI patients arrived conscious to the reference hospitals and 30.8% (24/78) were admitted unconscious. Of the unconscious patients 33.3% (8/24) were severe TBI. A statistically significant association (Likelihood Ratio = 32.972, p = 0.000) was found between the conscious status on arrival and the types of TBI. In this study, a multinomial regression identified ten determinants of TBI of which two were statistically significant contributors. The conscious status during hospitalization in the models moderate TBI versus mild TBI (OR = 51.2, 95%[CI:6.6-397.2], p = 0.000) and severe TBI vs mild TBI (OR = 48.8, 95% [CI: 1.8–1297.0], p = 0.020). The length of stay in hospital contributing in the model severe TBI vs mild TBI (OR = 1.142. 95% [CI: 1.013–1.287], p = 0.030). Abebe T et al [ 21 ] study, the factors statistically associated with head injury were the place of residence (AOR = 1.6, 95%[CI: 1.18–2.16], p = 0.002),, the mechanisms of injury with AOR = 5.5 (95%[ 2.27–13.34], p = 0.000) for road traffic accident and AOR = 3.4 (95%[CI: 1.35–8.37], p = 0.009) for assault and the comorbidity of chronic disease (AOR = 2.2, 95%[CI: 1.13–4.18], p = 0.019 ). The spatial modelling of this study revealed a high TBI risk area with a prevalence of 6.7–12 TBI cases/100,000 population with a very high TBI risk focus (prevalence: 12 cases/100,000-19.4/100,000). An intermediate TBI risk area (4.0 cases/100,000–6.7 cases/100,000), north-south downwards, covered 14 districts. A low TBI risk area (2.0 cases/100,000–4.0/100,000). In the overall, TBI is country-wide public health problem in Rwanda with a high risk area covering 17 districts. As stated by Maas A.I. R et al. [ 20 ] on the burden of TBI, the consequences of TBI go beyond the dynamics of their occurrence or fatality, and are better reflected in measures of disease burden in terms of years of lost life and years lived with disability. TBI burden can be underestimated in LMICs, while its long-term consequences among of which dementia, stroke, parkinsonism and epilepsy could lead to unplanned socioeconomic challenges for affected communities and national governments [ 4 , 14 , 22 ]. Particularly, in this study, which revealed three predominant Glasgow outcome scale extended (GOSE) categories upper moderate disability (38.1%), low moderate disability (26.2%) and lower severe disability (10.7). Limitations Limitations of this study were its restriction to two reference hospitals geographically located in Kigali City and the use population data to compute the prevalence of TBI, which may underestimate the burden of TBI in Rwanda. Nonetheless, as an explorative research, the findings can inform legislators and policy makers for further country-wide research to explore the short and long-term outcomes of TBI patients and the effectiveness of different treatment protocols to be administrated. In conclusion, traumatic brain injury is a country-wide public health concern in Rwanda. Its control and ultimately elimination indicate a public-private partnership between the affected communities, the public and private sectors, the armed forces, the Ministries of Transport, Education, and Health, the international organizations and non-governmental development organizations. Abbreviations Acronym Definition CHUK: Centre Hospitalier Universitaire de Kigali CT: Computed Tomography GCS: Glasgow coma scale GOSE: Glasgow Outcome Scale Extended ICP: intracranial pressure LMICs: Low and Middle Income countries RMH: Rwanda Military Hospital RTA: Road traffic accident SCI: Spinal cord injury SIBICC: Seattle International Severe Traumatic Brain Injury Consensus Conference TBI: Traumatic brain injury YLDs: Years Lived with Disabilities Declarations Ethics approval and consent to participate The proposal was reviewed by the Review Board of the Faculty of Medicine of the University of Medical Sciences and Technology, Kigali Rwanda. Ethical approval was granted by the Ethic Committee of the Ministry of Health, Rwanda. Implementation of the study was authorized by the Administration of the two reference hospital (Centre Hospitalier Universitaire de Kigali and Rwanda Military Hospital). Treating medical doctors authorized access to the digital medical records of TBI patients who provided their verbal informed consent to participate in the post hospitalization online survey conducted in Ki Rwanda. Consent for publication Not applicable Availability of data and materials All the data related to this manuscript were included in this manuscript or attached as supplements. Competing interests The authors declared no competing interest Funding All the costs related to this research were bore by Hana Waleed in the framework of the fulfilment of MBBS degree. Authors' contributions H.W: Conceptualization and implementation of the research proposal, data analysis, participation in geospatial analysis, drafting initial/ final manuscript. H.W: Participation in Data curation, statistical analysis, review the subsequent and read the final manuscript, comment the geospatial analysis P.H: Proof reading the final manuscript prior to submission I.A: participation in data curation, read and proof read the final draft of manuscript M.E: Read and prof read the initial and final draft of manuscript S.M: facilitate access to the data, read and proof read the final manuscript prior its submission K.C: facilitate access to the data, co-supervise the research implementation, read and proof read the final manuscript prior its submission S.V: Co-supervise the research proposal development and its implementation, evaluate critically the data analysis findings, read and proof read the initial and final manuscript prior to submission. M.N: Co- supervise the development and implementation of the research, guided in the data curation and analysis, supervised the spatial analysis of the data, read the initial and subsequent draft and proof read the manuscript prior to submission. Acknowledgements The authors would like to thanks all the TBI patients who participate freely to the population online survey post discharge. We are grateful for Giramahoro Raissa; she assists in implementing the online telephone survey in Kinyarwanda and provided immense support throughout the implementation of this study. We would like also to thanks the administration of the Centre Hospitalier Universaire de Kigali and Rwanda Military Hospital for authorizing the implementation of this study. We are grateful to the treating doctors and the database managers of the two hospitals for facilitating access to the medical records of the patients. References Abdelmalik PA, Draghic N, Ling GSF. 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Salazar, Handbook of Clinical Neurology, Elsevier, Volume 127, 2015, Pages 3-13, ISSN 0072-9752, ISBN 9780444528926, https://doi.org/10.1016/B978-0-44452892-6.00001-5.jj. Jiang JY, Gao GY, Feng JF, Mao Q, Chen LG, Yang XF, Liu JF, Wang YH, Qiu BH, Huang XJ. Traumatic brain injury in China. Lancet Neurol. 2019 Mar;18(3):286-295. doi: 10.1016/S14744422(18)30469-1. Epub 2019 Feb 12. PMID: 30784557. Khellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury. J Neurol. 2019 Nov;266(11):2878-2889. doi: 10.1007/s00415-019-09541-4. Epub 2019 Sep 28. PMID: 31563989; PMCID: PMC6803592. Hawryluk GWJ, Aguilera S, Buki A, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019;45(12):1783-1794. doi:10.1007/s00134-019-05805-9. Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. 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BMC Public Health (2016) 16:697. DOI 10.1186/s12889-016-3359-4. The Government of Rwanda The Ministry of Health The National Health Research Agenda 20142018. Web site: http://www.moh.gov.rw Rwanda Medical and Dental Council. List of hospitals. Available online at https://rmdc.rw/spip.php?article11. ESRI. How Kriging works. http://desktop.arcgis.com/en/arcmap/10.3/tools/3d-analyst-toolbox/howkriging-works.htm Elbasheer MMA, Alkhidir AGA, Mohammed SMA, Abbas AAH, Mohamed AO, Bereir IM, et al. (2019) Spatial distribution of breast cancer in Sudan 2010-2016. PLoS ONE 14(9): e0211085. https://doi.org/10.1371/journal.pone.0211085. Petroze R.T. et al. Patterns of Injury at Two University Teaching Hospitals in Rwanda: Baseline Injury Epidemiology Using the Rwanda Injury Registry. Rwanda Medical Journal / Revue Médicale Rwandaise. RMJ Vol.71 (1); March 2014. Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21(11):1004-1060. doi:10.1016/S1474-4422(22)00309-X. Abebe T, Alemu T and Sorato MM (2024). Incidence, risk factors and outcomes of traumatic head injury among trauma patients visited at the Yanet Trauma and Surgery Specialized Centre, Sidama region, Hawassa, Ethiopia: cohort study. Front. Neurol. 15:1431999. doi: 10.3389/fneur.2024.14319. Altahla R, Alshorman J, Tao X. Epidemiological characteristics: traumatic cervical spinal cord injury in Wuhan-China. Academia Medicine 2024;1. https://doi.org/10.20935/AcadMed7318. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":344135,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeographical distribution of the referring hospitals across the provinces of Rwanda\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7760419/v1/d3dc03f8e15bb893ba06e06d.png"},{"id":92802620,"identity":"d62a6e9e-2154-44c5-b80b-9e677f9c8d9e","added_by":"auto","created_at":"2025-10-05 11:42:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":62237,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGlasgow outcome scale extended categories (n=84)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7760419/v1/fba8e40c9da19ff89fbed89d.png"},{"id":92802615,"identity":"9529a57e-da09-466a-b9e4-580ec69a7e87","added_by":"auto","created_at":"2025-10-05 11:42:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":606171,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePredictive Traumatic brain injury risk map by district of Rwanda\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7760419/v1/f51967179e6af14c1017f7f3.png"},{"id":92803405,"identity":"8e3312c5-195c-4fb0-8be0-1a06fcb4ab6d","added_by":"auto","created_at":"2025-10-05 11:58:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2626439,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7760419/v1/14a764c7-c2ce-4ea3-b07c-b7e7223c21ba.pdf"},{"id":92802613,"identity":"4c2b8e27-27ba-455b-882f-df32bcba8ed9","added_by":"auto","created_at":"2025-10-05 11:42:16","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":21593,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfiles26September2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-7760419/v1/4a88aeea5781e14b63b0b6a0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Spatial Analysis of the Determinants, Management and Outcomes of Traumatic Brain Injury in Rwanda, 2024","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic brain injury (TBI), a common disorder with high morbidity and mortality, accounts for one in every three deaths due to injury. It can be classified based on the Glasgow coma scale (GCS) into mild, moderate and severe TBI. TBI and spinal cord injury (SCI) are increasingly recognized as global health priorities because of their preventability, complexity and expensive medical care they necessitate [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTBI is a world-wide public health concern with 48.99\u0026nbsp;million prevalent cases, 27.16\u0026nbsp;million new cases and 7.08\u0026nbsp;million YLDs reported in 2019. Road traffic injuries accounted for 16.7 (UI: 13.1\u0026ndash;20.2) deaths per 100,000 populations [. A decrease of \u0026minus;\u0026thinsp;5.5% (95% uncertainty interval \u0026minus;\u0026thinsp;8.9% to \u0026minus;\u0026thinsp;3.0%) in the global age standardized incidence rate of TBI was observed between 1990 to 2019; for the period, SCI had no changed significantly (\u0026minus;\u0026thinsp;6.1% (\u0026minus;\u0026thinsp;17.3% to 1.5%). Regionally in 2019, Eastern Europe had the highest global burden of TBI and North America accounted for the highest global burden of SCI. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe mechanisms of injury are due to accident/motor vehicle collision, falls, assault/ violence, self-harm, and sports injury. The violence-related TBI is experienced by young and middle-aged adults with more than half (54%) aged between 21\u0026ndash;40 years. TBI predominantly affects male gender (81%) aged 31 years\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 (range:10\u0026ndash;89). The severity of TBI can be measured based on post-resuscitation Glasgow Coma Scale scores, which identify mild TBI when GCS is 14\u0026ndash;15, moderate when GCS equals 9\u0026ndash;13 and severe when GCS equals 3\u0026ndash;8. Severe TBI can lead to significant physical, psychosocial, and social deficits in \u0026gt;\u0026thinsp;60% of the cases and its mortality can reach 30% \u0026minus;\u0026thinsp;40% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe pathoanatomic diagnosis of TBI is based on a combined clinical and radiological classifications as the clinical classification to determine the severity may not be the best reliable indicator of long-term cognitive outcome. Injury may result from the trauma directly or indirectly. Localized and diffuse injuries are possible fractures, haemorrhages, and contusions to the head are examples of focal injuries. Diffuse traumas can result in vascular damage, diffuse axonal injury, or hypoxic-ischemic damage [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInitial management of TBI includes the assessment of GCS to evaluate the mental status followed by initiating neuro-protective measures including intubation and mechanical ventilation for airway protection in moderate to severe TBI. Head CT is the first line imaging assessment to reveal an intracranial pathology and diagnose TBI. For those with severe TBI, identified on imaging and clinical assessment, admission to intensive care is indicated as well as a monitoring of the intracranial pressure to guide the therapy. This is the gold standard in high-income settings as recommended by Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) guidelines [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Focal injuries such as extra-axial bleeds may require surgical intervention including decompressive hemi-craniotomy. Raised intracranial pressure (ICP), haemorrhagic contusions, and cerebral oedema are all closely related to the morbidity and mortality of TBI [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In low- and middle-income countries (LMIC), high post-TBI morbidity and mortality rates are recorded, greater than in developed countries due to public health interventions including seatbelt legislation, helmet use, workplace health and safety regulations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTBI survivors are at an increased risk of subsequent TBIs, which are associated with increased recovery time and utilization of services. Post injury complications include confusion, disorientation, alteration in psychomotor activity and mental inflexibility. Negative psychiatric consequences were also described as depression, mania and posttraumatic stress disorders [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These sequels can affect individuals regardless the severity of TBI. The Glasgow Outcome Scale Extended (GOSE) is a series of interviewer based questions. It is the most outcome instrument used to assess the global disability and the degree of recovery post-TBI [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This research, assessing the determinants, management and outcomes of traumatic brain injury in Kigali, Rwanda as of 2024 through a spatial analysis, fits in the national strategic plan of the country.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eA multi-centre descriptive cross-sectional study combined with a community-based telephone survey was conducted.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy setting and population\u003c/h3\u003e\n\u003cp\u003eThe study was implemented in Kigali City, the capital of Rwanda, which is a landlocked country with a land square of 26,338 km\u0026sup2; and four international boundaries (Burundi, Democratic Republic of Congo, Tanzania, and Uganda). Administratively, the country is divided in provinces, Kigali city is one of them. The province of Kigali is the home of 13.2% (1745555/13,246,394) of the country population and subdivided in three districts, Gasabo, Kicukiro and Nyarugenge [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. There are eleven hospitals (public and private) geographically distributed in Kigali City, they are namely University Teaching Hospital of Kigali (CHUK), Hospital la Croix du Sud (HCS), Kacyiru Police Hospital, Muhima Hospital, Kibagabaga Hospital, Kanombe Military Hospital (Rwanda Military Hospital), King Faisal Hospital Kigali, Ndera Neuropsychiatric Teaching Hospital, Masaka Hospital, Nyarugenge Hospital and Wiwo Specialized Hospital [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSampling technique and statistical tests\u003c/h3\u003e\n\u003cp\u003eA multistage sampling technique was used to select the study settings and participants. Firstly, a purposive sampling technique included the University Teaching Hospital of Kigali (CHUK) and Rwanda Military Hospital (RMH), which are two of the three hospitals (King Faisal Hospital is the third)) with neurosurgery department and CT scan facilities. Secondly, a stratified random sampling technique was used to distribute the estimated sample size proportionally to the number of beds in the emergency department, intensive care unit (ICU), high dependency unit (HDU) and resuscitation room of the two hospitals. Thirdly, in each of the two selected hospitals, the TBI incident cases admitted within the emergency, ICU, HDU departments during the period of December 2023 to March 2024 were included in the study; a total of 84 patients were obtained during this study period. The data were collected through a standardized pre-tested interviewer administrated questionnaire developed by the researcher; this research tool includes all the items of the Glasgow Outcome Scale extended (GOSE) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The GOSE is a score used to determine the functional outcomes of the TBI patients. It further groups the patients into eight categories, namely death (D, scored as 1), vegetative state (VS, scored as 2), lower severe disability (LSD, scored as 3), upper severe disability (USD, scored as 4), lower moderate disability (LMD, scored 5), upper moderate disability (UMD, scored as 6), lower good recovery (LGR, scored as 7), upper good recovery (UGR, scored as 8). The data collected were the characteristics of the study participants (age, gender, education level, profession, residence, telephone number, hospital emergency department), the determinants of TBI (type of TBI, mode, mechanism, time and venue of the injury, mode of referencing from injury site to emergency department), the factors related to TBI (clinical presentation and investigation on admission, treatment administrated), and the outcomes of the management of the TBI. The data were computerized through Epi Info\u003csup\u003e7\u003c/sup\u003e then uploaded in the statistical package for social sciences (IBM\u0026copy; SPSS\u0026copy; Statistics Version 23). Data were summarized numerically (mean, standard deviation and median) and graphically (frequency tables and graphics). The frequency tables were geo-referenced (latitude and longitude) in using Google Earth Pro (Google Earth Pro 7.3.6.10201 (64-bit)). The statistical analysis included Chi-square tests, correlation analysis and analysis of variance (ANOVA) wherever appropriate to determine association between variables. A multinomial regression analysis established the relationship between determinants, management and outcomes of TBI. Further, a spatial analysis was performed through the modelling technique of ArcGIS 10.3 for Desktop version 10.3.0.4.322 to generate a predictive risk map of TBI in Rwanda. This modelling technique is known as kriging method. This spatial interpolation or spatial autocorrelation assumes that close samples tend to be more similar than distant samples. This property of spatial data is implicitly used in inverse distance weighted (IDW) interpolation to determine cell values using a linearly weighted combination of a set of sample points. IDW is a method of interpolation that estimates cell values by averaging the values of sample data points in the neighbourhood of each processing cell. The closer a point is to the centre of the cell being estimated, the more influence, or weight it has in the averaging process. The weight is a function of inverse distance. The surface being interpolated should be that of a location dependent variable. In kriging, one must model the spatial autocorrelation using a semivariogram instead of assuming a direct linear relationship with separation distance [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of the study participants\u003c/h2\u003e\u003cp\u003eA total of 84 patients were enrolled from two hospitals. Rwanda Military Hospital (RMH) received more than half of the patients (69.0%, 58/24), while the Centre Hospitalier Universitaire de Kigali (CHUK) received 31.0% (26/84). The majority of the patients (79.8%) were referred from other hospitals and 20.2% were admitted directly in CHUK and RMH; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displayed the distribution of referring hospitals. The length of stay in the two reference hospitals ranged from 0 to 91 days with a median length of stay of 5 days. This average length of stay varied across the hospitals, it was lower in RMH (mean\u0026thinsp;=\u0026thinsp;9.6 days, 95% [CI:0.2\u0026ndash;19.0], n\u0026thinsp;=\u0026thinsp;50) than in CHUK (10.0 days, 95% [CI: 0.5\u0026ndash;19.5], n\u0026thinsp;=\u0026thinsp;26), however, this difference was not statistically significant (F\u003csub\u003e1,74\u003c/sub\u003e=0.011, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.917). Male patients were mostly affected (77.4%, 65/84) as displayed in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The patients were aged 2\u0026ndash;84 years (median age: 34 years) with more than half (51.2%) aged 25\u0026ndash;49 years. More than half (58.3%, 49/84) were married and 35.7% (30/84) were single. Most of them (82.2%, 69/84) had a formal education ranging from primary to university. The main occupations reported by TBI patients were cultivators (38.5%, 20/84) and students (26.9% 14/84) which represented 65.4% of the six types of jobs reported. Regarding substance abuse, 34.5% (29/84) TBI patients reported consuming either alcohol, or both alcohol and tobacco. Chronic diseases prevailed in 15.5% (13/84) of the patients with hypertension and asthma being the most frequent chronic diseases with respectively 23.1% and 15.4%. The majority of the patients (89.3%, 75/84) were not under chronic medication at the time of the data collection; all the participants reported holding a health insurance. A history of TBI was found in 8.3% (7/84).\u003c/p\u003e\u003cp\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 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of study participants (n\u0026thinsp;=\u0026thinsp;84)\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=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNumber\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital (n\u0026thinsp;=\u0026thinsp;84)\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\" 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colname=\"c1\"\u003e\u003cp\u003eRMH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStudents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e26.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReferred (n\u0026thinsp;=\u0026thinsp;84)\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\u003cp\u003eEmployee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.4\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\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eArmed forces\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11.5\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e79.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLOS in days* (n\u0026thinsp;=\u0026thinsp;76)\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\u003cp\u003eNot working\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eSubstance abuse (n\u0026thinsp;=\u0026thinsp;84)\u003c/b\u003e\u003c/p\u003e\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\u003eMin-Max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo Substance Abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e65.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge in years (n\u0026thinsp;=\u0026thinsp;84)\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\u003cp\u003eAlcohol only\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAlcohol \u0026amp; smoke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMin-Max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u0026ndash;84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eChronic health (n\u0026thinsp;=\u0026thinsp;84)\u003c/b\u003e\u003c/p\u003e\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\u003e0\u0026ndash;4 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e84.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026ndash;14 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eyes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eChronic disease (n\u0026thinsp;=\u0026thinsp;13)\u003c/b\u003e\u003c/p\u003e\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\u003e25\u0026ndash;49 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e=\u0026gt;50 years\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAsthma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender (n\u0026thinsp;=\u0026thinsp;84)\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\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHypertension \u0026amp; Diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\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\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeurofibromatosis \u0026amp; Potts dx**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status (n\u0026thinsp;=\u0026thinsp;84)\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\u003cp\u003eChronic Gastritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMental Health\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAlcoholic liver Cirrhosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChronic back pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational level (n\u0026thinsp;=\u0026thinsp;84)\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\u003cp\u003e\u003cb\u003eChronic medications (n\u0026thinsp;=\u0026thinsp;84)\u003c/b\u003e\u003c/p\u003e\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\u003eNo schooling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e89.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eHistory of TBI (n\u0026thinsp;=\u0026thinsp;84)\u003c/b\u003e\u003c/p\u003e\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\u003eUniversity/Post graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e91.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.3\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*LOS: Length of hospital stay in days. **dx: disease.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTypes of traumatic brain injuries\u003c/h2\u003e\u003cp\u003eThe most prevalent type of TBI was mild TBI, accounting for half of the patients (39/78, 50.0%). Moderate TBI accounted for 39.7% (31/78), followed by severe TBI (10.3%, 8/78). According to the age of TBI patients (n\u0026thinsp;=\u0026thinsp;78), mild and moderate TBI affected younger patients with respectively a mean age of 34.1 years (95% [CI: 28.7\u0026ndash;39.5], n\u0026thinsp;=\u0026thinsp;39), and 36.8 years (95% [CI: 30.8\u0026ndash;42.8], n\u0026thinsp;=\u0026thinsp;31). Severe TBI was recorded in patients\u0026thinsp;\u0026gt;\u0026thinsp;45 years (mean\u0026thinsp;=\u0026thinsp;48.0 years, 95% [CI: 32.2\u0026ndash;63.8], n\u0026thinsp;=\u0026thinsp;8) with no a statistical difference (F\u003csub\u003e2,75\u003c/sub\u003e=2.045, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.137) between the severity of TBI and the age of TBI. Half of the male and female patients were rendered with mild TBI with respectively (50%, 30/60) and (50%, 9/18). Moderate TBI were prominent in males than females with respectively 41.7% (25/18) and 33.3% (6/18). Severe TBI prevailed in females than males with 16.7% (3/18) vs 8.3% (5/60).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMechanism of injury\u003c/h3\u003e\n\u003cp\u003eRoad traffic accident (RTA) ranked first accounting for 52.4% of the 84 TBI patients. Falls and violent attack/assault ranked second with respectively 19.0% (16/84) followed by pedestrian injury and wall collapsed with respectively 8.3% (7/84) and 1.2% (1/84). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises the mechanism, venue of the injuries and the type of TBI. More than half of mild TBI was sustained predominantly by RTA (51.3%, 20/39) followed by falls (23%,9/39). Moderate TBI prevailed in RTA accounting for 48.4% (15/31) followed by violence/Assault with 29.0% (9/31). Half of the severe TBI patients were injured through RTA (50.0%, 4/8) followed by falls (37.0%, 3/8).\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 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMechanism of injury by place of occurrence and type of TBI (n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"13\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"9\" nameend=\"c12\" namest=\"c4\"\u003e\u003cp\u003eType of TBI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMechanism of injury\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eVenue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMild TBI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate TBI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSever e TBI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRTA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eNot available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e20.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.681\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eStreet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e41.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e43.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e41.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e8.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e30.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e51.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e38.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWall collapsed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFalls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eNot available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eStreet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.073\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e77.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eviolence attack/Assault\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e31.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eStreet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.313\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e71.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e43.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e56.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePedestrian injury\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e14.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eStreet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e71.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.243\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e14.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e42.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e57.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eNot available\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e40.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eWorkplace\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e53.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eStreet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e55.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e37.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e37.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e48.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e37.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e100.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eFactors associated to the outcomes of TBI management\u003c/h3\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eTime between the trauma and arrival of the rescue\u003c/h2\u003e\u003cp\u003eIt was measured in four categories\u0026thinsp;\u0026lt;\u0026thinsp;15 minutes, 15\u0026ndash;30 minutes, 31\u0026ndash;59 minutes and \u0026ge;\u0026thinsp;60 minutes. Fifty-five patients (79.7%, 55/69) were rescued in \u0026lt;\u0026thinsp;one hour with 52.7% (29/55) in \u0026lt;\u0026thinsp;15 minutes and 47.3% (26/55) between 31and 59 minutes; they were 20.3% (14/69) rescued in \u0026ge;\u0026thinsp;1 hour with a no statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.313) between the time of rescue and the types of TBI.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTime from injury to admission in the reference hospital\u003c/h2\u003e\u003cp\u003eMore than half (64.3%,54/84) of the TBI patients were admitted in 0\u0026ndash;24 hours post trauma, 14.3% (12/84) in 25\u0026ndash;72 hours and 21.4% in \u0026gt;\u0026thinsp;72 hours with a no statistically significant difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.676) between the time of admission and the type of TBI. The time delay (time of admission in hospital minus time of injury) was not also significantly different across gender and type of TBIs with a \u003cem\u003ep\u003c/em\u003e-value of respectively 0.267 and 0.104.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTransport of TBI patients from injury venue to reference hospitals\u003c/h2\u003e\u003cp\u003eThe three main means of transport used to refer the patients from the venue of trauma to the reference hospitals were motorcycle (36.9%, 31/84), ambulance (27.0%, 24/84), private transport (15.5% ,13/84). 4.8% (4/84) of the patients were evacuated through traffic police car, 2 patients (2.4%, 2/84) were evacuated with stretcher and 13.1% (11/84) of the participants could not recall the mean of transportation used to evacuate them to hospitals. Of those admitted within less than an hour, the two frequent mode of transportation were ambulance 36.8% and motorcycle 34.2%. Of the patients who were admitted between 1 and 8 hours the predominant mode of transport was motorcycle (47.8%, 11/23). All patients admitted\u0026thinsp;\u0026gt;\u0026thinsp;8 hours from the occurrence of the trauma were transported by motorcycle (5/5). Despite those differences observed, there was no statistically significant (likelihood ratio\u0026thinsp;=\u0026thinsp;15.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.056) between the mean of transport and the time between the occurrence of the injury and the arrival to the hospital.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eManagement of TBIs at the reference hospitals\u003c/h2\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003eMedical and Radiological evaluation of TBI patients in the reference hospitals\u003c/h2\u003e\u003cp\u003eTBIs were primarily restricted to the head (65.5%, 55/84) and 34.5% (29/84) were poly-trauma, either affecting the head and maxillofacial regions (93.1%, 27/29) or the head and neck (6.9%, 2/29). The head was the predominant region affected across the three types of TBI, mild (71.8%), moderate (58.1%) and severe (62.5%). With respect to the severity of TBI cases and their conscious status upon arrival in the hospital of reference, more than half (59.0%, 46/78) were managed solely in the emergency unit. Of those, 63.0% (29/46) were mild TBI (GCS:14\u0026ndash;15) cases and 37.0% (17/46) were moderate TBI (GCS: 9\u0026ndash;13) cases with a statistically significant association (Likelihood Ratio\u0026thinsp;=\u0026thinsp;5.878, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.015) between conscious status and the severity of the TBI. They were 23.1% (18/78) of the TBI cases managed in the intensive care units of whom 44.4% (8/18) were admitted as severe TBI (GCS: 3\u0026ndash;8) and 55.6% (10/18) were diagnosed as moderate TBI (GCS: 9\u0026ndash;13) with a statistically significant association (Likelihood Ratio\u0026thinsp;=\u0026thinsp;5.609, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018) between the type of the TBI and their conscious status. A no statistically significant association (Likelihood Ratio\u0026thinsp;=\u0026thinsp;0.483, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.487) was found between the type of the TBI and the conscious status for 17.9% (14/78) of trauma patients of whom 71.4% (10/14) were admitted as mild TBI (GCS:14\u0026ndash;15) cases and 28.6% (4/14) as moderate TBI (GCS: 9\u0026ndash;13) cases. On admission, CT scan was requested for most (98.8%, 82/83) of the trauma patients except a 28-year male conscious patient referred by ambulance and diagnosed as mild TBI (GCS:14\u0026ndash;15) case who was transferred from the emergency unit to ward. Across the types of TBI, the CT scan findings were normal for 15.8% (12/76) of the trauma patients and abnormal for 84.2% (64/76) with acute subdural haemorrhage (19.7%, 15/76) and epidural haemorrhage (10.5%, 8/76) being the most frequent CT scan imaging findings (supplement S1).\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eS-1: CT scan findings by type of traumatic brain injury (n\u0026thinsp;=\u0026thinsp;76)\u003c/h2\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003eSurgical and medical management of TBI patients in the reference hospitals\u003c/h2\u003e\u003cp\u003eOf the 82 patients, half (50.0%) did not require a surgical intervention. The predominant surgical intervention was craniotomy accounting for 36.6% (30/82), conducted mainly in moderate TBI (53%,16/30) patients followed by mild (30%,9/30) and severe TBI (17%, 5/30). Burr hole and elevation of skull fracture were second accounting respectively for 3.7% (3/82). Burr hole was preformed mainly in mild TBI patients (67%, 2/82). On the other hand, all patients who underwent elevation of depressed skull fracture were mild TBI patients (3/39).\u003c/p\u003e\u003cp\u003eOf 83 TBI patients, 89.2% received a medical treatment and for 10.8% the treatment data were not available; either the medications received were not recorded (8.4%, n\u0026thinsp;=\u0026thinsp;7) or they were not treated (2.4%, n\u0026thinsp;=\u0026thinsp;2). For those treated (n\u0026thinsp;=\u0026thinsp;74), half received a combined medication of analgesic, antibiotic and antiepileptic; six cases of severe TBI benefited of this combined therapy. Analgesic associated to antiepileptic were administrated to 21.6% of the TBI patients; the therapy analgesic and antibiotic and analgesic only was received by respectively 12.2% of TBI patients. The association antiepileptic and antibiotic was given to 4.1% of TBI patients.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eComplications of TBI and length of hospitalization\u003c/h2\u003e\u003cp\u003eDuring hospitalization, patients were closely monitored for TBI complications; they were 88.1% (74/84) who experienced complications, which were absent in 11.9% (10/84). The three frequent complications recorded during the hospitalization were an alteration of conscious associated to physical complications (45.2%, 38/84), physical complications (23.8%, 20/84) and an alteration of the conscious (11.9%, 10/84). A statistically significant association (Likelihood Ratio\u0026thinsp;=\u0026thinsp;44.724, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) was found between the complications during hospitalization and types of TBI, the statistically significance was related to severe TBI (GCS: 3\u0026ndash;8) as displayed by Supplement S2.\u003c/p\u003e\u003cp\u003e\u003cb\u003eS-2: Complications during hospitalization by type of traumatic brain injury.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe average length of hospitalization of TBI cases of 9.8 days (95% [CI:6.1\u0026ndash;13.5], n\u0026thinsp;=\u0026thinsp;72) varied across the types of TBI. It was statistically (F\u003csub\u003e2,69\u003c/sub\u003e= 4.198, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019) higher in severe TBI (mean\u0026thinsp;=\u0026thinsp;19.8 days (95%[CI:2.3\u0026ndash;37.2), n-8) than in moderate TBI (13.4 days, 95%[CI:5.7\u0026ndash;21.1), n\u0026thinsp;=\u0026thinsp;27) and mild TBI (5.0 days, 95% [CI:3.2\u0026ndash;6.8], n\u0026thinsp;=\u0026thinsp;37).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePost discharge Glasgow Outcome Scale Extended\u003c/h2\u003e\u003cp\u003eGlasgow outcome scale extended (GOSE) was measured based on 21 items. Each item was recorded as a dichotomous variable (0 when the item was absent and 1 when it was present). Then a Cronbach alpha test was performed on the 21 items to measure the reliability of the answers provided by the patients. A computed Cronbach alpha value of 0.919 was obtained, which was in the range of validity of 0.70\u0026ndash;0.95.\u003c/p\u003e\u003cp\u003eThe GOSE score for determining the functional outcomes of the TBI patients was computed and regrouped as recommended elsewhere in the literature [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This categorization enabled to identify seven categories (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe seven categories were regrouped as good and poor outcomes. The good outcomes included upper moderate disability, low moderate disability, lower good recovery and upper good recovery. Death, lower severe disability and upper severe disability were classified as poor outcomes. In the overall, 69.1% (58/84) of the TBI patients had good outcomes and 30.1% (26/84) had poor outcomes. Of the 39 mild TBI cases, 82.1% (32/39) had good outcomes and 17.9% (7/39) had poor outcomes. Those with moderate TBI (n\u0026thinsp;=\u0026thinsp;31), 58.1% (18/31) had good outcomes and the outcomes were poor for 41.9% (13/31). In severe TBI cases (n\u0026thinsp;=\u0026thinsp;8), the outcomes were good for 75.0% (6/8) and poor for 25.0% (2/8). However, the difference was not statistically significant (Likelihood Ratio\u0026thinsp;=\u0026thinsp;4.931, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.085) between the GOSE and the types of TBI. This indicated the importance of proper care form all types of TBI.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eDeterminants of traumatic brain injuries\u003c/h2\u003e\u003cp\u003eA multinomial regression analysis was performed to assess the determinants of TBI. Of the three types of TBI (mild, moderate and severe), the mild TBI was considered as reference category. The regression equation fitting perfected models revealed that the conscious status during hospitalization was a statistically significant determinant in the models moderate TBI versus mild TBI (OR\u0026thinsp;=\u0026thinsp;51.2, 95% [CI: 6.6-397.2], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) and severe TBI vs mild TBI (OR\u0026thinsp;=\u0026thinsp;48.8, 95% [CI: 1.8\u0026ndash;1297.0], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). The length of stay in hospital contributing for 1 time (OR\u0026thinsp;=\u0026thinsp;1.043, 95% [CI: 0.960\u0026ndash;1.134], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.320) in the model moderate TBI vs mild TBI, was a statistically significant determinant in the model severe TBI vs mild TBI (OR\u0026thinsp;=\u0026thinsp;1.142. 95% [CI: 1.013\u0026ndash;1.287], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the determinants contributing to the occurrence of TBIs.\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 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultinomial regression estimating the determinants of TBI in the study population\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\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\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003e95% CI for OR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003elower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eupper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eModel moderate TBI (GCS: 9\u0026ndash;13) vs mild TBI (GCS:14\u0026ndash;15)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\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\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-5.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.343\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.287\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.969\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.070\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubstance abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.605\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.556\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.546\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.624\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic health condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.655\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e17.041\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlace of occurrence of TBI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.254\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.467\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsciousness status during hospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e51.153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.588\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e397.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody region affected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.838\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e14.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT Scan findings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.756\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.438\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemorrhage - CT scan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.243\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.953\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.592\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.536\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of stay in hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.960\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGOSE post discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.970\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.574\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.779\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eModel severe TBI (GCS: 3\u0026ndash;8) vs mild TBI (GCS:14\u0026ndash;15)\u003c/b\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\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntercept\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-11.303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.383\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.307\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.994\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.166\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubstance abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.498\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.684\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic health condition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.632\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.759\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.719\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e16.709\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlace of occurrence of TBI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.800\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConsciousness status during hospitalization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.673\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e48.840\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.839\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1297.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody region affected\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.944\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e17.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCT Scan findings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.647\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7.316\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemorrhage - CT scan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.438\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.607\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.436\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.711\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.677\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of stay in hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.735\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.287\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGOSE post discharge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.652\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.445\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.063\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e29.862\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eSpatial distribution and risk map of traumatic brain injuries\u003c/h2\u003e\u003cp\u003eFor public health perspective, the data collected from the two reference hospitals were georeferenced at district level to determine the epidemiological distribution of TBI in Rwanda as the TBI cases originated from various districts of the country. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e displays the epidemiological distribution of traumatic brain injury prevalence across Rwanda districts. The prevalence data were plotted as red dots. Each dot represented the number of TBI cases per 100,000 total populations in the concerned district. TBI was recorded in 66.7% (20/30) of the country districts. its ranged 2.0/100,000 population (Rusizi district) to 19.4/100,000 (Kicukiro district of Kigali City).\u003c/p\u003e\u003cp\u003eThe predictive TBI risk map (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) generated through the modelling technique of ArcGIS 10.3, known as krigging method delineated three TBI risk areas in Rwanda: (i) a high TBI risk area, an intermediate TBI risk area and low TBI risk area. The high TBI risk area in orange (prevalence 6.7\u0026ndash;12 TBI cases/100,000) delineated up down a north-western to south western belt including 17 districts of which four share boundaries with Tanzania (Rwanda sea port), and six have international borders with Burundi. In this high risk area, a very high TBI risk focus (prevalence: 12 case/100,000-19.4/100,000) can be identified in the south-western districts. The intermediate TBI risk area (4.0 cases/100,000\u0026ndash;6.7 cases/100,000), north-south downwards, covered 14 districts. In this area, high risk foci exist in the districts of Burera and Musanze bordering Uganda. The low TBI risk area (2.0 cases/100,000\u0026ndash;4.0/100,000) covered seven districts out which five districts (Nyabihu, Nyamasheke, Rubavu, Rusizi and Rutsiro) share boundaries with the Democratic Republic of Congo. In the overall, TBI is country-wide public health problem in Rwanda with a high risk area covering 17 districts.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study analysed the determinants, management and outcomes of TBI in Rwanda in a sample 84 patients from two reference hospitals (Rwanda Military Hospital, 69.0% and Centre Hospitalier Universitaire de Kigali, 31.0%). The TBI cases were predominantly (77.4%) males indicating a potential gender disparity in TBI incidence as confirmed by Krebs E et al [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] who reported that TBI predominantly affected male gender (81.0%, n\u0026thinsp;=\u0026thinsp;684). The proportion of males affected was higher (94.7%, n\u0026thinsp;=\u0026thinsp;4689) in the study of Patel et al [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] who used Rwanda police data to determine the epidemiology of road traffic injury hotspots in Kigali.\u003c/p\u003e\u003cp\u003eIn this study, the average age of TBI patients of 36.1 years (95%[CI:32.2\u0026ndash;40.0], n\u0026thinsp;=\u0026thinsp;84) ranged from 35.5 years (95%[CI:23.9\u0026ndash;47.2], n\u0026thinsp;=\u0026thinsp;19) in females to 36.3 years (95%[CI: 32.5\u0026ndash;40.1], n\u0026thinsp;=\u0026thinsp;65) in males, with over half (51.2%) aged 25\u0026ndash;49 years, suggesting that younger adults were more frequently affected by TBI. The vulnerability of this population was pointed out elsewhere in the literature by Krebs E. et al. and Petroze R.T. et al [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] who respectively revealed an average age of 31years\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 (range:20\u0026ndash;40 years, n\u0026thinsp;=\u0026thinsp;684) and of 31.0 years (IQR 17\u0026ndash;43, n\u0026thinsp;=\u0026thinsp;3599 patients).\u003c/p\u003e\u003cp\u003eAbout 34.5% of the patients reported substance abuse with primarily alcohol consumption, which is known as a contributing factor to the incidence of TBI. Chronic disease was present in 15.5% of the patients with hypertension (23.1%, 3/13) and asthma (15.4%. 2/13) being the frequent chronic conditions. Regarding the mechanism and venues of occurrence of the TBI, this study found that. RTA ranked first (52.4%) followed by falls and violent attack/assault ranking second with respectively 19.0%, pedestrian injury (8.3%) and wall collapsed (1.2%). These findings were confirmed by the global modelling data of the Lancet neurology commission which indicated that the incidence of TBI in LMICs is mainly driven by road traffic collisions, primarily involving motorcyclists [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOver half (69.2%, 54/78) of the TBI patients arrived conscious to the reference hospitals and 30.8% (24/78) were admitted unconscious. Of the unconscious patients 33.3% (8/24) were severe TBI. A statistically significant association (Likelihood Ratio\u0026thinsp;=\u0026thinsp;32.972, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) was found between the conscious status on arrival and the types of TBI. In this study, a multinomial regression identified ten determinants of TBI of which two were statistically significant contributors. The conscious status during hospitalization in the models moderate TBI versus mild TBI (OR\u0026thinsp;=\u0026thinsp;51.2, 95%[CI:6.6-397.2], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) and severe TBI vs mild TBI (OR\u0026thinsp;=\u0026thinsp;48.8, 95% [CI: 1.8\u0026ndash;1297.0], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020). The length of stay in hospital contributing in the model severe TBI vs mild TBI (OR\u0026thinsp;=\u0026thinsp;1.142. 95% [CI: 1.013\u0026ndash;1.287], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Abebe T et al [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] study, the factors statistically associated with head injury were the place of residence (AOR\u0026thinsp;=\u0026thinsp;1.6, 95%[CI: 1.18\u0026ndash;2.16], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002),, the mechanisms of injury with AOR\u0026thinsp;=\u0026thinsp;5.5 (95%[ 2.27\u0026ndash;13.34],\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) for road traffic accident and AOR\u0026thinsp;=\u0026thinsp;3.4 (95%[CI: 1.35\u0026ndash;8.37],\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.009) for assault and the comorbidity of chronic disease (AOR\u0026thinsp;=\u0026thinsp;2.2, 95%[CI: 1.13\u0026ndash;4.18],\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019 ).\u003c/p\u003e\u003cp\u003eThe spatial modelling of this study revealed a high TBI risk area with a prevalence of 6.7\u0026ndash;12 TBI cases/100,000 population with a very high TBI risk focus (prevalence: 12 cases/100,000-19.4/100,000). An intermediate TBI risk area (4.0 cases/100,000\u0026ndash;6.7 cases/100,000), north-south downwards, covered 14 districts. A low TBI risk area (2.0 cases/100,000\u0026ndash;4.0/100,000). In the overall, TBI is country-wide public health problem in Rwanda with a high risk area covering 17 districts. As stated by Maas A.I. R et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] on the burden of TBI, the consequences of TBI go beyond the dynamics of their occurrence or fatality, and are better reflected in measures of disease burden in terms of years of lost life and years lived with disability. TBI burden can be underestimated in LMICs, while its long-term consequences among of which dementia, stroke, parkinsonism and epilepsy could lead to unplanned socioeconomic challenges for affected communities and national governments [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Particularly, in this study, which revealed three predominant Glasgow outcome scale extended (GOSE) categories upper moderate disability (38.1%), low moderate disability (26.2%) and lower severe disability (10.7).\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eLimitations of this study were its restriction to two reference hospitals geographically located in Kigali City and the use population data to compute the prevalence of TBI, which may underestimate the burden of TBI in Rwanda. Nonetheless, as an explorative research, the findings can inform legislators and policy makers for further country-wide research to explore the short and long-term outcomes of TBI patients and the effectiveness of different treatment protocols to be administrated. In conclusion, traumatic brain injury is a country-wide public health concern in Rwanda. Its control and ultimately elimination indicate a public-private partnership between the affected communities, the public and private sectors, the armed forces, the Ministries of Transport, Education, and Health, the international organizations and non-governmental development organizations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"616\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcronym\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCHUK:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eCentre Hospitalier Universitaire de Kigali\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCT:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eComputed Tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGCS:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eGlasgow coma scale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGOSE:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eGlasgow Outcome Scale Extended\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eICP:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eintracranial pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLMICs:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eLow and Middle Income countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRMH:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eRwanda Military Hospital\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRTA:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eRoad traffic accident\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSCI:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eSpinal cord injury \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSIBICC:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eSeattle International Severe Traumatic Brain Injury Consensus Conference\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTBI:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eTraumatic brain injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYLDs:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 507px;\"\u003e\n \u003cp\u003eYears Lived with Disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proposal was reviewed by the Review Board of the Faculty of Medicine of the University of Medical Sciences and Technology, Kigali Rwanda. Ethical approval was granted by the Ethic Committee of the Ministry of Health, Rwanda. Implementation of the study was authorized by the Administration of the two reference hospital (Centre Hospitalier Universitaire de Kigali and Rwanda Military Hospital). Treating medical doctors authorized access to the digital medical records of TBI patients who provided their verbal informed consent to participate in the post hospitalization online survey conducted in Ki Rwanda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data related to this manuscript were included in this manuscript or attached as supplements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the costs related to this research were bore by Hana Waleed in the framework of the fulfilment of MBBS degree.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH.W:\u003c/strong\u003e Conceptualization and implementation of the research proposal, data analysis, participation in geospatial analysis, drafting initial/ final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH.W:\u003c/strong\u003e Participation in Data curation, statistical analysis, review the subsequent and read the final manuscript, comment the geospatial analysis\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP.H:\u0026nbsp;\u003c/strong\u003eProof reading the final manuscript prior to submission\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eI.A:\u003c/strong\u003e\u0026nbsp; participation in data curation, read and proof read the final draft of manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM.E:\u003c/strong\u003e\u0026nbsp; Read and prof read the initial and final draft of manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.M:\u0026nbsp;\u003c/strong\u003efacilitate access to the data, read and proof read the final manuscript prior its submission\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eK.C:\u003c/strong\u003e facilitate access to the data, co-supervise the research implementation, read and proof read the final manuscript prior its submission\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS.V:\u003c/strong\u003e Co-supervise the research proposal development and its implementation, evaluate critically the data analysis findings, read and proof read the initial and final manuscript prior to submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eM.N:\u003c/strong\u003e Co- supervise the development and implementation of the research, guided in the data curation and analysis, supervised the spatial analysis of the data, read the initial and subsequent draft and proof read the manuscript prior to submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thanks all the TBI patients who participate freely to the population online survey post discharge. We are grateful for Giramahoro Raissa; she assists in implementing the online telephone survey in Kinyarwanda and provided immense support throughout the implementation of this study. We would like also to thanks the administration of the Centre Hospitalier Universaire de Kigali and Rwanda Military Hospital for authorizing the implementation of this study. We are grateful to the treating doctors and the database managers of the two hospitals for facilitating access to the medical records of the patients. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbdelmalik PA, Draghic N, Ling GSF. Management of moderate and severe traumatic brain injury. Transfusion. 2019;59(S2):1529-1538. doi:10.1111/trf.15171.\u003c/li\u003e\n\u003cli\u003eCapizzi A, Woo J, Verduzco-Gutierrez M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. Med Clin North Am. 2020;104(2):213-238. doi: 10.1016/j.mcna.2019.11.001. \u003c/li\u003e\n\u003cli\u003eKrebs E, Gerardo CJ, Park LP, et al. Mortality-Associated Characteristics of Patients with Traumatic Brain Injury at the University Teaching Hospital of Kigali, Rwanda. World Neurosurg. 2017;102:571-582. doi: 10.1016/j.wneu.2017.03.001.\u003c/li\u003e\n\u003cli\u003eGuan B, Anderson DB, Chen L, Feng S, Zhou H. Global, regional and national burden of traumatic brain injury and spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. BMJ Open. 2023;13(10):e075049. Published 2023 Oct 6. doi:10.1136/bmjopen-2023-075049.\u003c/li\u003e\n\u003cli\u003eMark Faul, Victor Coronado, Chapter 1 - Epidemiology of traumatic brain injury, Editor(s): Jordan Grafman, Andres M. Salazar, Handbook of Clinical Neurology, Elsevier, Volume 127, 2015, Pages 3-13, ISSN 0072-9752, ISBN 9780444528926, https://doi.org/10.1016/B978-0-44452892-6.00001-5.jj.\u003c/li\u003e\n\u003cli\u003eJiang JY, Gao GY, Feng JF, Mao Q, Chen LG, Yang XF, Liu JF, Wang YH, Qiu BH, Huang XJ. Traumatic brain injury in China. Lancet Neurol. 2019 Mar;18(3):286-295. doi: 10.1016/S14744422(18)30469-1. Epub 2019 Feb 12. PMID: 30784557. \u003c/li\u003e\n\u003cli\u003eKhellaf A, Khan DZ, Helmy A. Recent advances in traumatic brain injury. J Neurol. 2019 Nov;266(11):2878-2889. doi: 10.1007/s00415-019-09541-4. Epub 2019 Sep 28. PMID: 31563989; PMCID: PMC6803592.\u003c/li\u003e\n\u003cli\u003eHawryluk GWJ, Aguilera S, Buki A, et al. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019;45(12):1783-1794. doi:10.1007/s00134-019-05805-9.\u003c/li\u003e\n\u003cli\u003eRoozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. \u003cem\u003eNat Rev Neurol\u003c/em\u003e. 2013;9(4):231-236. doi:10.1038/nrneurol.2013.22.\u003c/li\u003e\n\u003cli\u003eFrost RB, Farrer TJ, Primosch M, Hedges DW. Prevalence of traumatic brain injury in the general adult population: a meta-analysis. Neuroepidemiology. 2013;40(3):154-159. doi:10.1159/000343275.\u003c/li\u003e\n\u003cli\u003eRanson J, Magnus BE, Temkin N, et al. Diagnosing the GOSE: Structural and Psychometric Properties Using Item Response Theory, a TRACK-TBI Pilot Study. J Neurotrauma. 2019;36(17):2493-2505. doi:10.1089/neu.2018.5998\u003c/li\u003e\n\u003cli\u003eKing JT Jr, Carlier PM, Marion DW. Early Glasgow Outcome Scale scores predict long-term functional outcome in patients with severe traumatic brain injury. J Neurotrauma. 2005;22(9):947-954. doi:10.1089/neu.2005.22.947.\u003c/li\u003e\n\u003cli\u003eNational Institute of Statistics of Rwanda. Fifth Population and Housing Census - 2022. Available online at https://www.statistics.gov.rw/datasource/fifth-population-and-housing-census-2022. \u003c/li\u003e\n\u003cli\u003ePatel et al. The epidemiology of road traffic injury hotspots in Kigali, Rwanda from police data. BMC Public Health (2016) 16:697. DOI 10.1186/s12889-016-3359-4.\u003c/li\u003e\n\u003cli\u003eThe Government of Rwanda The Ministry of Health The National Health Research Agenda 20142018. Web site: http://www.moh.gov.rw\u003c/li\u003e\n\u003cli\u003eRwanda Medical and Dental Council. List of hospitals. Available online at https://rmdc.rw/spip.php?article11.\u003c/li\u003e\n\u003cli\u003eESRI. How Kriging works. http://desktop.arcgis.com/en/arcmap/10.3/tools/3d-analyst-toolbox/howkriging-works.htm\u003c/li\u003e\n\u003cli\u003eElbasheer MMA, Alkhidir AGA, Mohammed SMA, Abbas AAH, Mohamed AO, Bereir IM, et al. (2019) Spatial distribution of breast cancer in Sudan 2010-2016. PLoS ONE 14(9): e0211085. https://doi.org/10.1371/journal.pone.0211085.\u003c/li\u003e\n\u003cli\u003ePetroze R.T. et al. Patterns of Injury at Two University Teaching Hospitals in Rwanda: Baseline Injury Epidemiology Using the Rwanda Injury Registry. Rwanda Medical Journal / Revue M\u0026eacute;dicale Rwandaise. RMJ Vol.71 (1); March 2014. \u003c/li\u003e\n\u003cli\u003eMaas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022;21(11):1004-1060. doi:10.1016/S1474-4422(22)00309-X.\u003c/li\u003e\n\u003cli\u003eAbebe T, Alemu T and Sorato MM (2024). Incidence, risk factors and outcomes of traumatic head injury among trauma patients visited at the Yanet Trauma and Surgery Specialized Centre, Sidama region, Hawassa, Ethiopia: cohort study. Front. Neurol. 15:1431999. doi: 10.3389/fneur.2024.14319.\u003c/li\u003e\n\u003cli\u003eAltahla R, Alshorman J, Tao X. Epidemiological characteristics: traumatic cervical spinal cord injury in Wuhan-China. Academia Medicine 2024;1. https://doi.org/10.20935/AcadMed7318.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Loss of consciousness, Post-traumatic stress disorder, Seizures, Spinal cord injury, Traumatic brain injuries","lastPublishedDoi":"10.21203/rs.3.rs-7760419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7760419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTraumatic brain injury (TBI) is a global health priority due to its preventability and its related expensive medical care. This research assessed the determinants, management and outcomes of TBI in Rwanda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA multicentre cross-sectional study combined with a community-based telephone survey was implemented on a sample of 84 patients selected through a multi stage sampling technique. The data were collected in two reference hospitals through a standardized pre-tested questionnaire developed by the researcher who who included all the items of GOSE to determine the functional outcomes of TBI patients. Data collected were characteristics of the study participants, type of TBI, mode, mechanism, time and venue of the injury, mode of referencing from injury site to emergency department, clinical presentation and investigations on admission, treatment administrated, and outcomes of the management. The data were managed in SPSS23 and geo-referenced in Google Earth Pro. Descriptive statistics was implemented followed by determining association through Chi-square tests, correlation analysis and ANOVA. A multinomial regression established the relationship between determinants, management and outcomes of TBI. A spatial analysis through the kriging method of ArcGIS delineated TBI risk areas. A significance level of \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set for all the statistical tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eMore than half (51.2%) of the TBI cases were aged 25\u0026ndash;49 years; TBI affected predominantly male gender (77.4%). The identified types of TBI were mild (50.0%), moderate (39.7%) and severe (10.3%). The GOSE scores revealed that 69.0% of the TBI patients had good outcomes. The statistically significant determinants of TBI were conscious status in moderate (OR\u0026thinsp;=\u0026thinsp;51.2,95%[CI:6.6-397.2], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) and severe TBIs (OR\u0026thinsp;=\u0026thinsp;48.8, 95%[CI: 1.8\u0026ndash;1297.0], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020) and the length of stay in hospital in severe TBI (OR\u0026thinsp;=\u0026thinsp;1.142. 95%[CI:1.013\u0026ndash;1.287],\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.030). Three TBI risk areas were delineated in Rwanda through the kriging method; a high TBI risk area, an intermediate TBI risk area and low TBI risk area.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eTraumatic brain injury is a country-wide public health concern in Rwanda. Its control and ultimately elimination indicate a public-private partnership between the affected communities, the public and private sectors, the armed forces, the Ministries of Transport, Education, and Health, the international organizations and non- governmental organizations.\u003c/p\u003e","manuscriptTitle":"Spatial Analysis of the Determinants, Management and Outcomes of Traumatic Brain Injury in Rwanda, 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-05 11:42:11","doi":"10.21203/rs.3.rs-7760419/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-05T03:29:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-04T20:28:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-03T07:28:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-01T14:22:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14d5477b-35ba-4c73-aa81-957ed3796614","owner":[],"postedDate":"October 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":55637196,"name":"Health sciences/Diseases"},{"id":55637197,"name":"Health sciences/Health care"},{"id":55637198,"name":"Health sciences/Medical research"},{"id":55637199,"name":"Health sciences/Neurology"},{"id":55637200,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-02-06T08:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-05 11:42:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7760419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7760419","identity":"rs-7760419","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}