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

Megan Landes; Raghu Venugopal; Sara Berman; Spencer Heffernan; James Maskalyk; Aklilu Azazh

doi:10.1016/j.afjem.2017.04.001

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

Afr J Emerg Med. 2017 Sep;7(3):130-134. doi: 10.1016/j.afjem.2017.04.001. Epub 2017 May 24.

Authors

Megan Landes^{1

2

3}, Raghu Venugopal^{1

3

4}, Sara Berman^{1

3}, Spencer Heffernan⁵, James Maskalyk^{1

4

6}, Aklilu Azazh⁷

Affiliations

¹ Global Health Emergency Medicine, University of Toronto, ON, Canada.
² Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
³ University Health Network, Toronto, ON, Canada.
⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Department of Anesthesia, University of Toronto, Toronto, ON, Canada.
⁶ St. Michael's Hospital, Toronto, ON, Canada.
⁷ Addis Ababa University, School of Medicine, Department of Emergency Medicine, Addis Ababa, Ethiopia.

Abstract

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 7 days in hospital. Consent was obtained from the patient or substitute decision maker.

Results: Among 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).

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.

Keywords: Emergency medicine; Epidemiology; Head injury; Low resource setting; Outcomes.