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Abstract
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Introduction
Head injury is a leading cause of mortality in Africa. We characterise the epidemiology and outcomes of head injury at an Ethiopian emergency centre.
Methods
We conducted a prospective cohort study of all head injured patients presenting to the Emergency Centre of Tikur Anbessa Specialised Hospital, Addis Ababa. Data was collected via a standardised form from the patient's chart, radiology reports and operative reports. Patients were followed until discharge, facility transfer, death, or 7days in hospital. Consent was obtained from the patient or substitute decision maker.
Results
Among 204 head injured patients enrolled, the majority were<30years old (51.0%) and male (86.8%). Forty-one percent of injuries occurred from road traffic accidents (RTAs). A significant number of patients had at least one indicator of severe injury on presentation: 51 (25.0%) had a GCS<9, 53 (26.0%) had multi-system trauma, 95 (46.6%) had≥1 abnormal vital sign and of the 133 patients with data available, 37 (27.8%) had a Revised Trauma Score (RTS)<6. Patients injured by RTA were more likely to have indicators of severe injury than other mechanisms, including multi-system trauma (OR 3.2, 95% CI 1.7-6.2, p=0.00), GCS<9 (OR 3.7, 95% CI 1.8-7.4, p=0.00),≥1 abnormal vital sign (OR 2.5, 95% CI 1.4-4.6, p=0.00) or an RTS score<6 (OR 3.6, 95% CI 1.6-8.1, p=0.00). Overall, 149 (73.0%) patients were discharged from hospital, 34 (16.7%) were transferred to another hospital, and 21 patients died (10.3%). In multivariable analysis, death was significantly associated with age over 60years (aOR 68.8, 95% CI 2.0-2329.0, p=0.02), GCS<9 (aOR 14.8, 95% CI 2.2-99.5, p=0.01), fixed bilateral pupils (aOR 39.1, 95% CI 4.2-362.8, p<0.01) and hypoxia (oxygen saturation<90%; aOR 14.2%, 95% CI 2.6-123.9, p=0.01).
Conclusion
Head injury represents a significant risk for morbidity and mortality in Ethiopia, of which RTA's increase injury severity. Targeted approaches to improving care of the injured may improve outcomes.
Language: en |