Factors influencing the outcome of severe head injury at Kenyatta National Hospital

Clinicoepidemiological Profiles and Outcomes during First Hospital Admission of Head Injury Patients in Ikeja, Nigeria

“…This is similar to that in studies from Pakistan [25] , Tunisia [23] and rural Kenya [19] . The high mortality rate for severe HIs (72%), accounting for much of the deaths in this series, is also similar to those in series from other LIMC [1,18,23] , but compares very poorly with rates of 19-30% in developed nations [9,11,15] . Many reasons, including the unfavorable politico-economic climates in many LMIC, may account for this.…”

“…It is most frequently caused by road accidents, a significant portion of which involved pedestrians, and occurs in the setting of poorly organized pre-hospital emergency services. Many of the well-known poor prognostic factors for HI [16][17][18][19][20][21] are notably prevalent and have adversely affected the outcome of HI. Even so, its optimal management in a dedicated neurosurgical facility is further hampered by other socioeconomic constraints such as inaccessibility and/or non-affordability of essential neuroimaging like cranial CT [22] and inadequacy or lack of equipment and personnel needed for neurocritical management [1,11,22] .…”

Effect of demographic and injury etiologic factors on intensive care unit mortality after severe head injury in a low middle income country

“…The u-shaped relationship between age and mortality risk among our patients is consistent with prior studies that documented higher mortality rates at extreme ages of life. [31,32] The change point among our patients, which occurred in the age group of 20-30 years suggest that although adults in this age group are often the most vulnerable to a head injury in LMIC, [26] they are most probably the least likely to experience ICU mortality. A similar analysis in HIC found a change point for functional disability at 6 months at the older age group of 30-40 years.…”

“…The proportion of patients who died during ICU admission is similar to 56% reported by a study in Kenya. [26] Other studies of severe head injury patients presenting to tertiary hospitals in other African countries [27] and in other centers in Nigeria [28] have reported higher mortality rates in the range of 70-90%. When contrasted with much lower mortality rates in more affluent societies, which are in the range of 16-38%, [18,29,30] these findings underscore the impact of severe head injury on the most economically active populations of LMIC and the importance of putting in place effective accident prevention and injury control measures and organized trauma care systems, which are currently lacking in many of these countries, Nigeria inclusive.…”

Outcome of severe traumatic brain injury at a critical care unit: a review of 87 patients

“…The factors commonly associated with secondary insults include hypotension, hypothermia, hypoxia, acidosis and raised intracranial pressure (1,3,5). When these are present, mortality rises to 35-36% (1,5) as documented in the Traumatic coma Data Bank study and that by Jeremitsky et al In an earlier study at the Kenyatta National Hospital (KNH), patients with a pulse rate of less than 60 per minute at the time of admission had a mortality of 100% while 69% of those with pulse rate greater than 120 per minute had poor outcome (7). In managing severe TBI therefore, avoiding secondary brain injury is key.…”