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

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 Specia...

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Autores principales: Landes, Megan, Venugopal, Raghu, Berman, Sara, Heffernan, Spencer, Maskalyk, James, Azazh, Aklilu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: African Federation for Emergency Medicine 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234141/
https://www.ncbi.nlm.nih.gov/pubmed/30456124
http://dx.doi.org/10.1016/j.afjem.2017.04.001
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author Landes, Megan
Venugopal, Raghu
Berman, Sara
Heffernan, Spencer
Maskalyk, James
Azazh, Aklilu
author_facet Landes, Megan
Venugopal, Raghu
Berman, Sara
Heffernan, Spencer
Maskalyk, James
Azazh, Aklilu
author_sort Landes, Megan
collection PubMed
description 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.
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spelling pubmed-62341412018-11-19 Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre Landes, Megan Venugopal, Raghu Berman, Sara Heffernan, Spencer Maskalyk, James Azazh, Aklilu Afr J Emerg Med Original Article 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. African Federation for Emergency Medicine 2017-09 2017-05-24 /pmc/articles/PMC6234141/ /pubmed/30456124 http://dx.doi.org/10.1016/j.afjem.2017.04.001 Text en © 2017 Publishing services provided by Elsevier B.V. on behalf of African Federation for Emergency Medicine. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Landes, Megan
Venugopal, Raghu
Berman, Sara
Heffernan, Spencer
Maskalyk, James
Azazh, Aklilu
Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre
title Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre
title_full Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre
title_fullStr Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre
title_full_unstemmed Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre
title_short Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre
title_sort epidemiology, clinical characteristics and outcomes of head injured patients in an ethiopian emergency centre
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234141/
https://www.ncbi.nlm.nih.gov/pubmed/30456124
http://dx.doi.org/10.1016/j.afjem.2017.04.001
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