Traumatic brain injury from a developing country in the CT-scan era: a 13-year prospective in-hospital cohort study
7 affiliations
- 1Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan
- 2Department of Neurological Surgery, University College Hospital
- 3Division of Neurosurgery, Department of Surgery, Federal Medical Center Owo
- 4Department of Neurosurgery, Spencer Fox Eccles School of Medicine, University of Utah
- 5Department of Surgery, Osun State University
- 6Department of Neurosurgery, Duke University Health System
- 7Duke Global Neurosurgery and Neurology
Abstract
Introduction: Most previous reports from Africa and other low middle-income countries (LMIC) on cranial neurotrauma address a more loosely defined subject of head injury (HI), rather than traumatic brain injury (TBI), and lack deployment of standardized scoring systems. We present a prospective TBI cohort from an academic neurosurgery practice at Ibadan, Nigeria, the nation's foremost university teaching hospital where TBI constitutes a core component of our clinical activity.
Materials and methods: This was a prospective cohort study of patients enrolled in a TBI registry over 13 years. We analyzed the clinical epidemiology of TBI, defined as cranial trauma with definite perturbation of brain function, qualified/quantified using relevant clinical features, the Glasgow Coma Scale (GCS), the Abbreviated Injury Scale-Head (AIS-Head), and Injury Severity Score (ISS). Brain imaging was graded using the Rotterdam CT scoring system. In-hospital outcome was assessed with Glasgow Outcome Scale (GOS), dichotomized for analysis.
Results: There were 1,440 TBI cases, 1,110 (77.1%) males, mean age [32.2 Standard deviation (SD), 19] years. Most (76%) were referrals, with delayed presentation from outlying health facilities, median duration 13 [interquartile range (IQR) 5, 48] hours. Road trauma accounted for 1,173 (82%), even in the elderly, predominantly by two- and three-wheelers (57%); fall for 136 (9.4%), this mainly in childhood. Clinically, loss of consciousness (LOC) occurred in 89%, median duration 11.0 (IQR 2, 48) hours, vomiting 25%, seizures 16%, and anisocoria in 27%. In 86% the AIS-head was >2; the TBI was moderate-severe, GCS 3–12, in 47.0%. Brain CT was obtained in 1,046/1,440 (72.6%), while 13% received acute operative treatment. In-hospital mortality was 21%, mostly among the young and the severely injured. Good outcome (GOS: good recovery/moderate deficit) was 75%. The outcomes were significantly associated with the TBI severity per the GCS scores and brain CT severity.
Conclusions: The clinical epidemiology of TBI from this single-institution LMIC series differs substantially from that of high-income countries. A 21% mortality predominantly affecting young economically productive adults represents a serious public health burden. Substantial gaps persist across many aspects of the TBI-management continuum, presenting clear opportunities to improve the current sub-optimal outcome-metrics in sub-Saharan Africa.
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BibTeX
@article{adeleye2026traumatic,
title = {{Traumatic brain injury from a developing country in the CT-scan era: a 13-year prospective in-hospital cohort study}},
author = {A. O. Adeleye and O. O. Agboola and T. A. Oyemolade and T. A. Malomo and A. L. Azeez and T. B. Rabiu and A. K. Ukachukwu},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1889484},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1889484/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Traumatic brain injury from a developing country in the CT-scan era: a 13-year prospective in-hospital cohort study
AU - A. O. Adeleye
AU - O. O. Agboola
AU - T. A. Oyemolade
AU - T. A. Malomo
AU - A. L. Azeez
AU - T. B. Rabiu
AU - A. K. Ukachukwu
PY - 2026
DA - 2026/10/26
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1889484
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1889484/full
AB - Introduction: Most previous reports from Africa and other low middle-income countries (LMIC) on cranial neurotrauma address a more loosely defined subject of head injury (HI), rather than traumatic brain injury (TBI), and lack deployment of standardized scoring systems. We present a prospective TBI cohort from an academic neurosurgery practice at Ibadan, Nigeria, the nation's foremost university teaching hospital where TBI constitutes a core component of our clinical activity. Materials and methods: This was a prospective cohort study of patients enrolled in a TBI registry over 13 years. We analyzed the clinical epidemiology of TBI, defined as cranial trauma with definite perturbation of brain function, qualified/quantified using relevant clinical features, the Glasgow Coma Scale (GCS), the Abbreviated Injury Scale-Head (AIS-Head), and Injury Severity Score (ISS). Brain imaging was graded using the Rotterdam CT scoring system. In-hospital outcome was assessed with Glasgow Outcome Scale (GOS), dichotomized for analysis. Results: There were 1,440 TBI cases, 1,110 (77.1%) males, mean age [32.2 Standard deviation (SD), 19] years. Most (76%) were referrals, with delayed presentation from outlying health facilities, median duration 13 [interquartile range (IQR) 5, 48] hours. Road trauma accounted for 1,173 (82%), even in the elderly, predominantly by two- and three-wheelers (57%); fall for 136 (9.4%), this mainly in childhood. Clinically, loss of consciousness (LOC) occurred in 89%, median duration 11.0 (IQR 2, 48) hours, vomiting 25%, seizures 16%, and anisocoria in 27%. In 86% the AIS-head was >2; the TBI was moderate-severe, GCS 3–12, in 47.0%. Brain CT was obtained in 1,046/1,440 (72.6%), while 13% received acute operative treatment. In-hospital mortality was 21%, mostly among the young and the severely injured. Good outcome (GOS: good recovery/moderate deficit) was 75%. The outcomes were significantly associated with the TBI severity per the GCS scores and brain CT severity. Conclusions: The clinical epidemiology of TBI from this single-institution LMIC series differs substantially from that of high-income countries. A 21% mortality predominantly affecting young economically productive adults represents a serious public health burden. Substantial gaps persist across many aspects of the TBI-management continuum, presenting clear opportunities to improve the current sub-optimal outcome-metrics in sub-Saharan Africa.
SN - 1664-2295
ER -