Background: The incidence of traumatic brain injury has paralleled the need for decompression surgery for acute subdural (ASDH) and extradural heamatoma (AEDH). However, there is paucity of data on key determinants and clinical outcomes of these patients in low income countries. Objective: To determine the thirty day clinical outcomes and associated factors among patients with acute subdural and extradural heamatomas at Mulago National Referral Hospital in Uganda. Methods: This was a prospective cohort study of 109 patients with Computed Tomography (CT) confirmed extra-axial heamatomas. Ethical Clearance was obtained from School of Medicine Research and Ethics Committee of College of Health Sciences, Makerere University (REC REF. 2018-185). Independent variables were documented and patients were reassessed thirty days later for Glasgow outcome scale (GOS) and final disposition. Bivariate and multivariate regression analyses were computed using Stata 14.0 (StataCorp. 2015), to determine the presence and strength of association, if any, between independent and dependent variables, at 95% confidence interval, regarding p<0.05 as statistically significant. Results. Of the 109 recruits, 99 (90.8%) were completely followed-up for analysis. The median age was 29 years and median post resuscitation GCS was 13. Of the 99 participants majority 90.9% (n=90) were male. Majority 71.7% (n=71) were diagnosed with AEDH and 2 participants had both heamatomas concurrently. The overall mortality rate was 16.2% (n=16) and overall proportion of unfavourable outcome was 28.9% (29). Only 22.2% (22) recovered with minor deficits. The following were found to be protective against unfavourable outcome at multivariate analysis; Admission Systolic BP>90mmHg [IRR=0.88 (0.26-0.94) 95%CI, p=0.032), Oxygen saturation>90% [IRR=0.5 (0.26-0.94) 95%CI, p=0.030] and Diagnosis AEDH rather than ASDH [IRR=0.53 (0.30-0.92) 95%CI, p= 0.025). Severity of TBI correlated with unfavourable outcome, moderate TBI [IRR=4.57 (1.15-18.06) 95%CI, P=0.03] and severe TBI [IRR=6.79 (2.32-19.86) 95%CI, p<0.001]. Conclusion. The study revealed that 28.9% of the patients with extra-axial heamatoma obtained unfavourable outcome by thirty days from injury date. Post resuscitation Systolic BP >90 mm Hg and SPO2 > 90% are associated with reduced odds of unfavourable outcome, while moderate and severe TBI correlates with increased odds of having unfavourable outcomes. These factors are valuable for the triaging teams based in resource constrained settings. Key words: Epidural Heamatoma, Subdural Heamatoma, Clinical Outcome, Factors, Uganda.

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