Head injury burden in a major referral hospital emergency centre in Botswana

Introduction:This study describes the demographics, aetiology, emergency centre diagnosis and severity indicators of patients with head injuries presenting to the largest referral hospital emergency centre in Botswana.Methods:Cross-sectional retrospective data was collected from July 2015 to September 2015 for all emergency centre head injury presentations at Princess Marina Hospital. Information was extracted from emergency centre records regarding patient demographics, mechanism of injury, clinical observations, diagnosis, and treatment.Results:Three-hundred and sixty head injury patients presented to the emergency centre in the three months, averaging four per day. 80% were less than 40 years of age and males accounted for 69% of all presentations. 58% of injuries were listed as being accidental, 39% recorded from assaults and 38% from road traffic accidents. The most common emergency centre clinical diagnosis was concussion and the most common radiological diagnosis skull fracture. The median Glasgow Coma Scale was 15 with a range from 3 to 15; and, among patients for whom Revised Trauma Score could be calculated, 79% scored the lowest probability of death in the Revised Trauma Score.Discussion:Head injury disproportionately overburdened males in this study, and head injury aetiology and demographic picture was similar to regional data. Severity scoring using the Glasgow Coma Scale was only available among 66% of patients and Revised Trauma Score calculable in half of presentations. Only 55% of head injury patients were discharged from the emergency centre, despite the preponderance of low severity scores. Head CTs appear to have been over-utilised and implementation of a Traumatic Head CT guideline for our setting is proposed. This study improves understanding of the burden of head injury in Botswana and advocates for national referral guidelines for patients with head injury in Botswana

Undergraduate emergency medicine in an african medical school : experiences from Botswana

Introduction: In August 2011; the first cohort of students at the University of Botswana School of Medicine (UBSOM) began their third year of undergraduate medical training. As part of their 2011-2012 curriculum they each completed a 10 week rotation in Emergency Medicine (EM); involving problem based learning (PBL) sessions; maintenance of log books; case presentations; and clinical time at the Emergency Centre (EC) of the main tertiary referral hospital in Gaborone; Princess Marina Hospital. Methods :Since EM rotations are often undertaken in the final year of medical training; students were given an anonymous voluntary survey to study the effect of an EM experience in their first clinical year of training. A 5-point Likert scale was used to evaluate learning opportunities and the overall EM experience. Students described which procedures they had observed or performed in their rotation. The survey concluded with open-ended questions seeking additional feedback. Results : These were very encouraging for both early exposure to EM and the PBL approach. More than 90 of students agreed or strongly agreed that they felt more confident in clinical settings; improved their clinical decision making process; and found the PBL model to be effective over the rotation. 22 different procedures were observed in the EC with 100 observing venesection and plaster applications. 14 different procedures were performed with 83 students performing venesection and over 65 performing chest compressions and venous cannulation. Discussion : It is hoped that this study will provide valuable practical information about undergraduate EM learning in a PBL based Medical School within Sub Saharan Africa that can be replicated across other medical education institutions throughout the region