Outcomes of Home Rehabilitation with Tracheostomy and PEG Tube Placement in Severe TBI Patients in Rural Africa

Abstract

Background: Traumatic brain injury (TBI) remains a leading cause of death and disability worldwide, particularly among young adults. Severe cases often require tracheostomy and percutaneous endoscopic gastrostomy (PEG) to facilitate ventilator weaning, reduce ICU complications, and enable rehabilitation. While outcomes of these interventions are well-documented in high-income countries (HICs), limited data exist for low- and middle-income countries (LMICs), where specialized rehabilitation facilities are scarce and home-based care predominates. Objective: This study evaluates outcomes of severe TBI patients undergoing tracheostomy and PEG tube placement at a rural Kenyan mission hospital, comparing actual outcomes with predictions based on the IMPACT prognostic calculator, which is derived from HIC data. Methods: A retrospective cohort of severe TBI patients requiring tracheostomy and PEG between 2023–2025 was analyzed. Inclusion criteria included GCS ≤8 for >48–72 hrs, prolonged ventilator dependence, feeding difficulty >7–10 days, extensive injury with slow recovery, and hemodynamic stability. Both procedures were performed concurrently by general surgeons to reduce cost. Primary outcome was Glasgow Outcome Scale–Extended (GOSE) at up to 12 months follow-up. Results: Thirteen patients (mean age 29) underwent procedures at a mean of day 19 post-injury. Mean GOSE improved from 2 at baseline to 5 at follow-up (mean 10 months). Mortality was 23% (vs predicted 14%), with causes including neglect, sepsis, and pressure sores. Among survivors, 90% achieved good functional outcomes (GOSE >4), with 50% returning to work. Actual severe disability rate was 10% (vs predicted 27%). Conclusion: Tracheostomy and PEG are feasible and safe for severe TBI patients in LMICs, even in resource-limited home rehabilitation settings. Despite higher-than-predicted mortality, functional recovery was better than expected, underscoring the need to refine prognostic tools for LMIC contexts.