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

Abstract

Background: Although head injury (HI) is a major public health problem in Nigeria and other low and middle income countries of the world, there is a paucity of data from these societies. This is largely due to under-reporting. We carried out a prospective study of the clinicoepidemiological profiles and outcomes following the first hospitalization of a cohort of head-injured patients in Ikeja, Nigeria, a metropolitan African city. Methods: In an 8-month period from May until December 2005, data from all HI cases seen in our neurosurgical unit were prospectively recorded for subsequent analysis. These include demographics, mechanism of injury, pre-neurosurgical care received, severity of injury using the Glasgow Coma Scale, presence of hemodynamic instability, pupillary anomalies and associated systemic injuries, cranial computed tomography (CT) findings and the number of surgical interventions, as well as outcomes after the first hospital admission using the Glasgow Outcome Scale. Determinants of outcome were explored using the χ² test and the level of significance was put at p = 0.05. Results: There were 143 cases of HI, which is about one fifth of our total workload, including 122 males and 21 females aged 0.5–85 years (mean age 29.15). The majority (88%) were either school children or low income earners. Road accidents accounted for 75% of the cases; three quarter of the cases had some initial care in other health facilities before the arrival in our unit, at an average of 33 h. Mild, moderate and severe HI accounted for 60, 18 and 22%, respectively. About a quarter of the patients sustained other systemic injuries. Cranial CT scanning was obtainable in 40 patients (28%); 9 of these revealed surgical mass lesions, of whom 5 had life-saving operations. Many well-known determinants of a poor outcome of HI were prevalent in this study group and found to have a significantly adverse effect on patient outcome. Conclusions: HI is a major public health problem in Nigeria, taking up at least one fifth of the neurosurgical workload. The prehospital emergency medical service is poorly organized. Determinants of a poor outcome of HI are highly prevalent, including poor accessibility to cranial CT scanning, absence or inadequacy of logistics for neurocritical care and an inadequate number of neurosurgeons.

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

“…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 cerebral contusion in mild traumatic head injury patients

“…Nearly similar findings were observed by Bruns et al who concluded that male gender and young adults are at increased risk of succumbing traumatic brain injury compared to female and other age groups. 3,4 The study findings revealed that 63 (14.8%) of the study population deteriorated within 24 hours of observation and 3 (0.7%) died. As the level of consciousness on admission was decreasing; deterioration increased i.e., 12.7%, 16.7% and 33.3% with GCS of 15, 14 and 13 respectively.…”

Breaking Bad News to a Prospective Cross-Sectional Sample of Patients’ Relatives in a Nigerian Neurosurgical Service

“…Males (68%) predominate amongst the patient population, male:female ratio 2:1, whereas the overwhelming majority of the carers of the patients were females, 73%, male:female ratio 1:3. This may be partly because much of the grave neurosurgical disease profiled in this study is due to neurotrauma and the young, probably more adventurous males are known to be more prone to injury than their female counterparts in this part of the world (12). It may also be another affirmation of that apparent trend where females are the more likely of the two genders to be seen available caring for their wards in hospital settings (13).…”