Blood Sugar Patterns in Critically Ill Patients With Traumatic Brain Injury at Kenyatta National Hospital

Abstract

Background: Traumatic Brain Injury (TBI) is a significant source of morbidity and mortality, contributing to a significant proportion of admissions to Critical Care Units (CCUs) internationally and in Kenya. Outcomes are largely poor and have a significant negative impact on the patient’s life as well as on their families and the larger society itself. Severe cases of TBI are often admitted to CCUs where the mainstay of management is the prevention and hindering the development of secondary brain injury. Identification and management of recognized Secondary systemic insults has been shown to improve outcomes. Deranged blood sugar levels rank high among the most common of secondary systemic insults and is associated with poorer outcomes. The challenge herein arises from the heterogeneous nature of the clinical course of patients with TBI as well as the paucity of current evidence on the optimum blood sugar levels in these patients. Observation of patterns of blood sugar levels in patients with TBI is an essential baseline in the assessment of deranged blood sugar levels in patients with TBI. Study Objective: To determine patterns of blood sugar levels for patients admitted at KNH Critical Care Units (CCUs) with traumatic brain injury. Study Design: This was a prospective observational study. Study Area and Setting: A single center study conducted in the Accident and Emergency and Critical care units at Kenyatta National Hospital. Study Population: Critically ill patients with Traumatic Brain Injury (TBI) requiring admission at the Kenyatta National Hospital (KNH) Critical care units (CCU). Methodology: The sampling technique employed was consecutive sampling technique. Patients that met the inclusion criteria were recruited on admission to the Critical care units. 2 Data collected included the study subjects’ demographic data, CT scan diagnosis, Admission GCS and serial blood sugar levels. Blood sugar control methods were recorded during the study period as well. Data collection was done through a standardized glucometer and input into an electronic data collection tool (REDCap). Data was analysed using SPSS version 26. Descriptive statistics were used to describe the sociodemographic and clinical characteristics of patients. Categorical data was summarized as frequencies and percentages while continuous data as means and standard deviations or medians and interquartile ranges. The blood sugar control methods used were tabulated using frequencies and percentages then compared with blood sugar levels of patients at different stages using the chi-square test of association. Admission and final blood sugar levels were compared for any differences using paired t-test/Wilcoxon signed-rank test. Results: The study enrolled 66 subjects predominantly male (60) with a mean age of 35. Majority (53%) had severe TBI with subdural hematoma as the most common diagnosis at 39.4%. The proportion of patients within the hyperglycemic range on first reception to the hospital was at 9.1%. The daily mean blood sugar levels were between 7-8 mmol/l with the highest proportion of standard deviation occurring in the first 2 days of admission. Active blood sugar lowering with insulin was noted only on 8 incidences throughout the study period with no significant bearing on daily mean averages. Conclusion: There exists varying prevalence of hyperglycemia in moderate to severe TBI. Significant glycemic variability occurs in the first 2 days of hospital stay. This study is the framework for which extended research into understanding glycemic derangement and control in patients with TBI is formed. Evidence from this study should aid in the design of a suitable glycemic control protocol for TBI patients in ICU settings in the region.