This document provides a breakdown of the Mbarara data. The data are from July 13, 2016 to December 29, 2017. There are 225 variables collected for 786 patients in the dataset.

Exploratory Data Analysis

To orient ourselves with the data, I have provided some descriptive figures. The treemap below maps out the most common admission diagnoses for neurosurgery patients at MRRH. Please note, there are other types of neurosurgery patients seen at MRRH (e.g. hydrocephalus), however, there are additional, smaller datasets where these other patients’ data are found. For example, there is a seperate pediatric neurosurgery spreadsheet. Interestingly, there are pediatric patients found in this larger dataset as well. I am still working to understand these datasets and plan to evenutally combine them.

A treemap of neurosurgery patient admission diagnosis at MRRH

A treemap of neurosurgery patient admission diagnosis at MRRH

The Table 1 below is for TBI patients only.

n = 630
n = 76
n = 554
Variable All Yes TBI Surgery No TBI Surgery
Sociodemographic
Age (m/sd) 27 ( 20.9) 27 ( 18.5) 27 ( 21.2)
Male (n%) 484 ( 79 ) 63 ( 84 ) 421 ( 78 )
Injury Details
GCS Total Mean (SD) 12.1 ( 3.2 ) 11.9 ( 3.4 ) 12.1 ( 3.2 )
Mild (n%) 344 ( 56 ) 41 ( 55 ) 303 ( 56 )
Moderate (n%) 162 ( 26 ) 18 ( 24 ) 144 ( 27 )
Severe (n%) 106 ( 17 ) 16 ( 21 ) 90 ( 17 )
RTI (n%) 419 ( 70 ) 44 ( 62 ) 375 ( 71 )
Violence (n%) 129 ( 21 ) 21 ( 30 ) 108 ( 20 )
Fall (n%) 37 ( 6 ) 4 ( 6 ) 33 ( 6 )
Glasgow Outcome Scale
one (n%) 13 ( 3 ) 3 ( 6 ) 10 ( 3 )
two (n%) 0 ( 0 ) 0 ( 0 ) 0 ( 0 )
three (n%) 0 ( 0 ) 0 ( 0 ) 0 ( 0 )
four (n%) 26 ( 6 ) 1 ( 2 ) 25 ( 6 )
five (n%) 405 ( 91 ) 44 ( 92 ) 361 ( 91 )

GRYMTR Translation

There are 17 variables needed for GRYMTR. The table below lists these needed variables and whether or not they are captured in the Mbarara database.

Variable Present
GCS Yes
Alcohol use at Injury No*
Intention of injury No
Pulse Ox Yes
Systolic BP Yes
Diastolic BP Yes
Mechanism of Injury Yes
Heart Rate Yes
Caus. Dept. Disposition No
Gender Yes
PERRLA Yes
Temperature Yes
Respiratory Rate Yes
Age Yes
Surgery to ICU No
TBI Surgery Yes*
GOS or GOse Yes*

*Possible concerns with variable as currently captured. More detail below in variable drilldown

Missing Analysis

The variables needed for GRYMTR found in the MRRH dataset have varying levels of missing data. Below is a figure providing the % missing for each GRYMTR variable.

Variable drilldown

TBI Surgery

One important variable for GRYMTR is if the patient received surgery for their TBI. The MRRH dataset has two variables which may capture this information:

  1. Management

  2. Did the planned operation occur?

The management variable output is as follows:

## 
##                               Conservative 
##                                        546 
##                                    CT done 
##                                          2 
##                         discharged CT scan 
##                                          1 
##                                   Surgical 
##                                        194 
##                      Surgical, reoperation 
##                                          1 
## Surgical,Died before surgery could be done 
##                                          1

The ‘Did the planned operation occur?’ output is as follows:

## 
##  No Yes 
##  20 123

I pressume the Management variable indicates if a surgery was planned. The Did planned operation occur variable may capture if a surgery did in fact occur. So a question is, should the final number of patients receiving surgery be 123? Also, can we pressume the latter variable, if yes for a TBI patient, refers only to a surgery for the TBI? Or could it indicate an other surgery?

Alcohol use

In the tanzania dataset, alcohol use was assessed in the emergency department at the time of injury. In other words, was alcohol involved in this TBI patient. The alcohol variable at MRRH may answer a slightly different question.

## 
##                    Current               Former(>1yr) 
##                         92                          5 
##         More than 2 drinks More than 2 drinks per day 
##                          1                          1 
##                      Never                    Unknown 
##                        289                        383

Outcome variables

The following figure is focused only on TBI patients. The outcomes for TBI patients are captured using discharge GCS, discharge GOS and free text categories. As we see below, there are large numbers of missing in discharge GCS and discharge GOS. Additionally, we see the majority of patients having a discharge GOS of 5, and no patients with a 2 or 3. This is extremely homogenous and suggests most the patient are leaving healthy. However, the scrupulous nature of this variable may be called into question.
Outcomes for TBI patients as captured by discharge GCS, discharge GOS and categories

Outcomes for TBI patients as captured by discharge GCS, discharge GOS and categories