Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre

Abstract

IntroductionHead injury is a leading cause of mortality in Africa. We characterise the epidemiology and outcomes of head injury at an Ethiopian emergency centre.MethodsWe 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 7 days in hospital. Consent was obtained from the patient or substitute decision maker.ResultsAmong 204 head injured patients enrolled, the majority were <30 years 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 60 years (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).ConclusionHead 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.

Thirty-day clinical outcome of traumatic brain injury patients with acute extradural and subdural hematoma: a cohort study at Mulago National Referral Hospital, Uganda

“…According to [21], the international pooled annual incidence of TBI, for all ages, is reported at 349 per 100,000, disproportionately affecting developing countries. TBI is the number one cause of mortality among trauma patients in low-income countries [18], in both pre-hospital and in-patient settings [5]. Intracranial hemorrhage alone contributes to 80% mortality of admitted trauma patients [7].…”

Quantitative Assessment of Upper Limb Motor Function in Ethiopian Acquired Brain Injured Patients Using a Low-Cost Wearable Sensor

“…Each year, acquired brain injuries as stroke and traumatic brain injury, affect millions of persons worldwide (1). The global incidence of these neurological disorders occurs at much higher rates in low-and middle-income countries than in developed countries (2,3). For example, approximately one-third of all sub-Saharan African patients with traumatic brain injury suffer poor outcomes (4,5), with severe head injury patients exhibiting twice the risk of dying compared to counterparts from developed countries (4).…”

Magnitude of Severe Head Injury and Its Associated Factors among Head Injury Patients in Gedeo Zone, Southern Ethiopia: A Two-Year Retrospective Study

“…For example a study done in Ethiopia, nearly three fourth (66.7%) of patients were sustained severe head injury and 5.9 % were died among severe head injury patients ( 16 ). The finding of another study also indicated that a significant number of head injury patients manifested incidence of severe head injury ( 6 ).…”

“…Severe head injury is nowadays a major public health threat that is the main cause of morbidity and mortality in all age groups in the world's populations including Ethiopia. Even if sever traumatic head injury is common in young populations mainly in males ( 1 – 3 ), mortality associated with severe head injury was higher in all age groups ( 4 – 6 ). Head injury was mild in the majority of head injury victims followed by severe and moderate based on Glasgow Coma Scale (GCS) score ( 7 , 8 ).…”

“…Head injury is a significant public health problem in Ethiopia and one of the most common reasons for emergency department visit with admission increasing from time to time ( 6 , 14 ). Like in other countries, in Ethiopia, the most common identified risk factors for severe head injuries were RTA, interpersonal violence and falling accidents ( 15 , 16 ).…”