Clinical Outcomes and Prognostic Determinants of Surgically Treated Depressed Skull Fracture in Addis Ababa University Neurosurgical Teaching Hospitals: A Prospective Multicenter Observational Study.

BACKGROUND: Depressed skull fracture is one of the most common neurosurgical emergencies in Ethiopia. The clinical outcome after surgical management and what factors predict the outcome are not well studied. Our study aimed to assess the outcome and identify predictors of the outcome in surgically treated adult patients. METHODS: A prospective, multicenter, observational study was undertaken on 197 cases, at 4 selected neurosurgical teaching hospitals in Ethiopia. Relevant data were collected and analyzed using Statistical Package for the Social Sciences software (IBM, Armonk, New York, USA). The outcome was assessed by the extended Glasgow Outcome Scale. Multivariate analysis was done to identify independent predictors of the outcome. RESULTS: The outcome was favorable in 81.2%. The mean age was 27. The mode of injury was violence in 79.7%. Motor deficit witnessed in 24.4%. Based on the Glasgow Coma Scale, 92.2% of patients had mild traumatic brain injury. Associated intracranial lesions were identified in 87.3%. The median hospital stay was 4.7 days. Reoperation and mortality rates were 4.1% and 0.5%, respectively. Five factors were statistically significant independent predictors of unfavorable outcome in multivariate analysis: motor deficit (adjusted odds ratio [AOR] 13.8, 95% confidence interval [CI]: 4.13-46.17, P = 0.000), Glasgow Coma Scale ≤13 (AOR 10.36, 95% CI: 1.93-55.56, P = 0.006), pneumocephalus (AOR 12.93, 95% CI: 3.12-53.52, P = 0.000), hospital stay for ≥3 days (AOR 4.39, 95% CI: 1.18-16.3, P = 0.027), and reoperation (AOR 6.92, 95% CI: 1.09-43.97, P = 0.04). CONCLUSIONS: The overall outcome was favorable. The presence of motor deficit, postresuscitation Glasgow Coma Scale ≤13, pneumocephalus, reoperation, and hospital stays for ≥3 days were independent predictors of an unfavorable outcome.

Neurosurgery in Ethiopia: A New Chapter and Future Prospects.

BACKGROUND: Inequitable access to surgical care is most conspicuous in low-income countries (LICs), such as Ethiopia, where infectious diseases, malnutrition, and other maladies consume the lion's share of the available health resources. The aim of this article was to provide an update on the current state of neurosurgery in Ethiopia and identify targets for future development of surgical capacity as a universal health coverage component in this East African nation. METHODS: Publicly available data included in this report were gathered from resources published by international organizations. A PubMed search was used for a preliminary bibliometric analysis of scholarly output of neurosurgeons in Ethiopia and other low-income countries. Statistical analysis was used to determine the correlation between the number of neurosurgeons and academic productivity. RESULTS: Neurosurgeon density has increased >20-fold from 0.0022 to 0.045 neurosurgeons per 100,000 population between 2006 and 2020. The increase in neurosurgeons was strongly correlated with an increase in total publications (P < 0.001) and the number of new publications per year (P = 0.003). Despite recent progress, the availability of neuroimaging equipment remains inadequate, with 38 computed tomography scanners and 11 magnetic resonance imaging machines for a population of 112.07 million. The geographic distribution of neurosurgical facilities is limited to 12 urban centers. CONCLUSIONS: Ethiopian neurosurgery exemplifies the profound effect of international partnerships for training local surgeons on progress in low-income countries toward improved neurosurgical capacity. Collaborations that focus on increasing the neurosurgical workforce should synchronize with efforts to enhance the availability of diagnostic and surgical equipment necessary for basic neurosurgical care.