Aspects épidémiologiques et thérapeutiques des pathologies neurochirurgicales chez l'enfant de moins de 5 ans à Libreville (Gabon) de 2019 à 2021 / Epidemiology and management of neurosurgical diseases of children aged 5 years or less in Libreville (Gabon) from 2019 to 2021

Introduction. Les pathologies neurochirurgicales sont un ensemble d'affections qui touche le cerveau, la moelle épinière, et les paires crâniennes nécessitant une prise en charge médico-chirurgicale. Leur incidence en Afrique sub-saharienne et plus particulièrement au Gabon est mal connue. Objectif. Décrire les aspects épidémiologiques et évolutifs des pathologies neurochirurgicales chez l'enfant de moins 5 ans à Libreville. Patients et méthodes. Il s'agit d'une étude rétrospective descriptive et analytique, multicentrique portant sur des patients de moins de 5ans pris en charge pour une affection neurochirurgicale de Janvier 2019 à Décembre 2021 à Libreville. Résultats. Sur 4811 enfants hospitalisés, 130 répondaient aux critères d'inclusion (prévalence : 2,7%). L'âge moyen était de 13,1 mois. Le sex-ratio était de 1,3. Les grossesses étaient mal suivies dans 72,2% des cas. Les pathologies neurochirurgicales malformatives représentaient 63,5%. L'hydrocéphalie était la plus observée dans 71,2%. Sur les 115 enfants, 71 ont bénéficié d'un traitement chirurgical, soit un taux de 61,7% et le taux de mortalité globale était de 6,1%. Dans le groupe des enfants présentant une malformation congénitale, 8,2% n'avaient pas été traités, le taux de mortalité était de 8,2%. Les complications à court termes étaient dominées par les infections. Conclusion. Les pathologies neurochirurgicales sont en fréquentes dans notre contexte. Une prise en charge immédiate reste de mise, nécessitant donc un plateau technique de pointe pour améliorer l'évolution à court terme voire à moyen et long terme de ces affections.

Introduction. Neurosurgical pathologies are a set of conditions that affect the brain, spinal cord, and cranial pairs requiring medical and surgical management. Their incidence in subSaharan Africa and more particularly in Gabon is poorly known. Objective. To describe the epidemiological and evolutionary aspects of neurosurgical pathologies in children under 5 years old in Libreville. Patients and methods. This is a retrospective descriptive and analytical, multicenter study of patients under 5 years of age treated for a neurosurgical condition from January 2019 to December 2021 in Libreville. Results. Of the 4811 hospitalized children, 130 met the inclusion criteria (prevalence of 2.7%) and 15 were excluded for incomplete records. The average age was 13.1 months. The age group of 28 days-1 year was the most observed. The sex ratio was 1.3. Pregnancies were poorly followed in 72.2% of cases. Malformative neurosurgical pathologies accounted for 63.5% of cases. Hydrocephalus was the most observed in 71.2%. Of the 115 children, 71 received surgical treatment, a rate of 61.7% and the overall mortality rate was 6.1%. In the group of children with congenital malformation, 8.2% had not been treated, the mortality rate was 8.2%. Short-term complications were dominated by infections. Conclusion. Neurosurgical pathologies are frequent in our context. Immediate care remains essential, therefore requiring a cutting-edge technical platform to improve the short-term or even medium- and long-term evolution of these conditions.

Evaluation dosimétrique des tomodensitométries adultes auTogo / Dosimetric evaluation of adult CT scans in Togo

Objectif: Evaluer les doses délivrées aux patients adultes lors des examens TDM en vue de l'établissement des niveaux de référence diagnostiques tomodensitométriques au Togo.Matériel et méthodes: Etude transversale réalisée du 6 Mars au 30 Juillet 2018 dans 5 structures sanitaires disposant d'une unité tomodensitométrique au Togo ayant inclus les TDM cranio-encéphaliques, abdomino-pelviennes, thoraciques, thoraco-abdomino-pelviennes, rachidiennes cervicales et lombaires des patients d'au moins 15 ans.Résultats: Les 1155 TDM adultes inclus étaient dominées par les TDM cranio-encéphaliques et abdomino-pelviens avec respectivement 34,2% et 15,15%. La sex-ratio était de 1,42. Les appareils de marque GE dans 80%, étaient de 6 et 16 barrettes et 60% installés 2010. L'IDSvol de la TDM cérébrale était le plus élevé par rapport à l'IDSvol des autres types d'examen. La dispersion des PDL par acquisition et pour un examen complet inter et intra structure sanitaire était significative. Les NRD (75e percentile du PDL) par acquisition était de 1199,14mGy.cm (cérébral non traumatique), 1596,45mGy.cm (cérébral-traumatique), 635,63mGy.cm (cervical), 401,98mGy.cm (thorax), 594,42mGy.cm (abdomino-pelvien), 675,73mGy.cm (thoraco-abdomino-pelvien) et 681,35mGy.cm (lombaire). Les doses efficaces moyennes associées auxdifférents types d'examens étaient comprises entre 2-3mSv pour l'exposition de la tête et le cou et de 24mSv pour la TDM abdomino-pelvienne.

Objective: To evaluate the doses delivered to adult patients during CT scans in order to establish CT-scans diagnostic reference levels (DRL) in Togo.Material and methods: Cross-sectional study carried out from 6 March to 30 July 2018 in 5 health facilities with a CT-scans unit in Togo that included cranio-encephalic, abdominal-pelvic, thoracic, thoraco-abdominal-pelvic, cervical and lumbar spines CT-scans in patients at least 15 years of age. Results: The 1155 adult CT-scans included were dominated by cranio-encephalic and abdominal-pelvic CTs with 34.2% and 15.15% respectively. The sex-ratio was 1.42. GE brand devices in 80%, were 6 and 16 bars and 60% installed 2010. The brain CT IDSvol was the highest compared to the CTDIvol of other types of exams. The dispersion of the DLP by acquisition and for a complete inter and intra-structure examination was significant. DRLs (75th percentile of DLP) per acquisition were 1199.14mGy.cm (non-traumatic cerebral), 1596.45mGy.cm (traumatic cerebral), 635.63mGy.cm (cervical), 401.98mGy.cm (thorax),594.42mGy.cm (abdominal-pelvic), 675.73mGy.cm (thoracic-abdominal-pelvic) and 681.35mGy.cm (lumbar). The average effective doses associated with the different types of exams ranged from 2-3mSv for head and neck exposure and 24mSv for abdominal-pelvic CT. Conclusion : The high dispersion of dose delivered during CT-scan in Togo requires a process of homogenization of procedures and optimization from DRLs thus determined.(abdominal-pelvic), 675.73mGy.cm (thoracic-abdominal-pelvic) and 681.35mGy.cm (lumbar). The average effective doses associated with the different types of exams ranged from 2-3mSv for head and neck exposure and 24mSv for abdominal-pelvic CT.Conclusion: The high dispersion of dose delivered during CT-scan in Togo requires a process of homogenization of procedures and optimization from DRLs thus determined.

Retrospective review of the patient cases at a major trauma center in Nairobi, Kenya and implications for emergency care development

Introduction:Low- and middle-income countries (LMICs) are continuing to experience a "triple burden" of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya's largest public tertiary care hospital.Methods:This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial and emergency centre triage records along with admission and mortality logbooks. Chief complaints and discharge diagnoses collected by specially trained research assistants were manually converted to standardised diagnoses using International Classification of Disease 10 (ICD-10) codes. ICD-10 codes were categorised into groups based on the ICD-10 classification system for presentation.Results:A total of 23,941 patients presented to the emergency centre during the study period for an estimated annual census of 71,823. The majority of patients were aged 18-64 years (58%) with 50% of patients being male and only 3% of unknown sex. The majority of patients (61%) were treated in the emergency centre, observed, and discharged home. Admission was the next most common disposition (33%) followed by death (6%). Head injury was the overall most common diagnosis (11%) associated with admission. Conclusions:Trends toward NCDs and traumatic diseases have been described by this study and merit further investigation in both the urban and rural setting. Specifically, the significance of head injury on healthcare cost, utilisation, and patient death and disability points to the growing need of additional resources at Kenyatta National Hospital for acute care. It further demonstrates the mounting impact of trauma in Kenya and throughout the developing world

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

Traumatismes crâniens de l'enfant: aspects épidémiologiques et prise en charge au Centre Hospitalier Universitaire de Brazzaville

Introduction. Le but de cette étude était d'évaluer les conditions de prise en charge des traumatismes crâniens de l'enfant au Centre Hospitalier Universitaire (CHU) de Brazzaville. Méthodologie. Nous avons revu les dossiers des enfants âgés d'un mois à 17 ans, hospitalisés dans le service de chirurgie polyvalente du CHU de Brazzaville entre janvier 2014 et décembre 2015, et avons retenu ceux qui l'étaient pour un traumatisme crânien. Les paramètres épidémiologiques, diagnostiques, thérapeutiques et évolutifs ont été analysés. Résultats. sur 66 enfant hospitalisés, 48 (72,72%) ont été admis pour un traumatisme crânien et parmi eux 45 (68,18%) enfants ont été inclus dont 33 garçons et 12 filles. Leur âge moyen était de 9,73 ans. Le traumatisme était consécutif à un accident de la voie publique dans 36 cas (80%), à une chute dans 6 cas (13,33%), et à une agression dans 3 cas (6,66%). Le score de Glasgow était inférieur ou égal à huit dans 12 cas (26,66%), compris entre 9 et 12 dans 25 cas (55,55%) et entre 13 et 15 dans 8 cas (17,77%). Le scanner crânio-encéphalique était réalisé en moyenne quatre jours après le traumatisme. Quatre enfants (8,88%) ont été opérés. L'évolution après 12 mois était favorable pour 26 enfants (78,79%) et 12 enfants ont été perdus de vue. Conclusion. la fréquence élevée des traumatismes crâniens chez l'enfant est liée aux accidents de la voie publique. Une prise en charge adéquate nécessite la disponibilité d'un scanner cranioencéphalique en urgence. Nous préconisons un renforcement de l'éducation et la communication s'agissant les accidents de la voie publique et la facilitation de l'accès à l'imagerie

Is computed tomography of the head justified in patients with minor head trauma presenting with Glasgow Coma Scale 15/15?

Background: In keeping with radiology departments in tertiary referral hospitals in developing countries offering computed tomography (CT) head scan services, the radiology department at Groote Schuur Hospital (GSH) in the Western Cape of South Africa undertakes several such scans annually. Of these scans, many are undertaken for post-trauma patients with minor head injury (MHI). While there is agreement that MHI patients with Glasgow Coma Scale (GCS)scores of 13­14/15 may well benefit, there is doubt as to the clinical utility of routine CT head scanning in MHI patients with GCS scores of 15/15.Objectives: This retrospective descriptive study of patient records was undertaken to determine the frequency and clinical significance of any abnormalities found on CT head scans of 460 patients with MHI and GCS scores of 15/15, scanned at GSH between 2012 and 2014.Method: Ethical clearance was obtained and the records of 460 MHI patients with GCS scores of 15/15, loss of consciousness (LOC) and amnesia who underwent CT head scanning at GSH between 2012 and 2014 were then retrieved from the Philips picture archiving and communication system (PACS). Patient records, containing illegible referral forms or technically inadequate CT head scans, were excluded from the study. Patients' biographical, clinical and CT head scan data were entered into sequentially numbered data collection forms. These data were tabulated and summed as percentage distributions. Patients' CT head scan findings were reviewed and classified as either showing normal or abnormal features. Abnormalities detected on CT head scans were classified as being either clinically significant or clinically non-significant. Results: Referral forms and CT scan reports were obtained for 460 MHI patients from a sample of 497 patients, calculated by using the equation for estimating a single proportion from a large sample (precision 1.5%). The sample obtained yielded an acceptable response rate of 460/497 (92.6%). Of 460 (100%) scan reports, 320 (69.6%) showed no abnormality, while 140(30.4%) showed abnormality. Of the 140 abnormal scans, 107 (23.3%) showed clinically non-significant abnormality, while 33 (7.2%) revealed clinically significant abnormality. Twenty-two (4.8%) of these clinically significant scans showed brain contusion and 11(2.4%) showed skull fracture. No subdural or extradural haematoma, shift or herniation were reported and none of the 33 patients whose CT scans showed clinically significant abnormality underwent urgent neurosurgical intervention. Conclusion: Of the 460 CT head scans performed at GSH for MHI with LOC but normal GCS between 2012 and 2014, none required urgent neurosurgical intervention. This is in accordance with the 2012 Kimberley Hospital Rule (KHR), a management protocol which indicates that CT head scanning in patients with MHI and GCS scores of 15/15 can safely be delayed for 8 h. An audit of the records of patients excluded from this study coupled with an analysis of data from other Western Cape hospital CT head scan databases could help ensure that this scarce resource is used cost-beneficially for all head-injured patients in the Western Cape catchment area

Profil épidémiologique des traumatismes crânio-encéphaliques au Centre Hospitalier et Universitaire de Bouaké

Introduction : Les traumatismes crânio-encéphaliques représentent une des principales causes de mortalité dans le monde. L'étude de leur épidémiologie permet d'identifier les facteurs de risque pour mieux cibler les actions de prévention. Patients et méthodes : Il s'agissait d'une étude rétrospective descriptive réalisée au service de réanimation polyvalente du CHU de Bouaké de janvier 2013 à décembre 2014. Elle concernait les patients admis en réanimation pour un traumatisme crânio-encéphalique avec un score de Glasgow inférieur à 14. Les paramètres étudiés étaient : le sexe, l'âge, la profession, les circonstances de survenue les modalités de transport, le délai d'admission à l'hôpital et la durée d'hospitalisation. Résultats : Au total 1244 patients ont été hospitalisés durant la période d'étude, dont 92 pour un traumatisme crânio-encéphalique, soit une prévalence hospitalière de 7,39%. Il y avait 86 hommes et 6 femmes. L'âge moyen était de 32,6 ans ± 17,03 (extrêmes 2 à 76 ans). Les conducteurs de mototaxi et les élèves étaient concernés dans respectivement 49% et 24% des cas. Les étiologies étaient dominées par les accidents de la voie publique (87%) qui impliquaient les engins à deux roues motorisés dans 40% des cas. Le transfert des patients a été effectuée par le groupement des sapeurs-pompiers militaires dans 48,9% des cas. L'admission des patients s'est faite dans 61% des cas avant la 6e heure suivant le traumatisme et le délai moyen d'admission était de 3 heures. La durée moyenne de séjour était de 4,37 ± 4,23 jours (extrêmes 1 à 21 jours). La mortalité globale était de 66%. Conclusion : Les traumatismes crânio-encéphaliques sont fréquents à Bouaké et font suite à un accident de la voie publique impliquant un engin motorisé à deux roues dans la majorité des cas. La prévention repose sur la sensibilisation au respect du code de la route

Impact de la loi portant sur l'obligation du port du casque à Cotonou sur les traumatismes crânio-encéphaliques

Le 2 août 2014, la loi sur le port obligatoire du casque pour les motocyclistes est entrée en application dans sa phase répressive à Cotonou. Ce travail a pour but d'évaluer l'impact de cette loi sur la fréquence, la morbidité, la mortalité et le coût de la prise en charge des Traumatisés Crânio-Encéphaliques au Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU/HKM) de Cotonou.Une étude prospective sur les facteurs socioéconomiques des TCE avait été initiée du 1er au 31 décembre 2014. C'est durant cette enquête, que la loi sur le port obligatoire du casque par les motocyclistes est entrée en application dans sa phase répressive. Nous avons déduit de cette enquête cette étude comparative, entre le 1er janvier et le 31 juillet 2014 puis entre le 2 août 2014 et le 31 décembre 2014. Parmi les 461 cas d'accidents de la voie publique, 347 (75,27%) étaient des accidents de moto dont 283 (81,55%) touchaient des conducteurs et 63 (18,15%) des passagers. La fréquence du port du casque, parmi les victimes de Traumatismes Crâniens Encéphaliques (TCE), a significativement augmenté de 2,3% à 34,5%. Après l'entrée en vigueur de la loi, On a observé une diminution de la fréquence des TCE de 55,54% mais la fréquence de la gravité et de la mortalité était comparable.Les accidents de moto étaient la cause majeure des TCE admis aux CNHU/HKM. La loi sur le port du casque par les motocyclistes a permis de réduire de façon significative la fréquence des TCE. Mais l'impact sur la mortalité des TCE reste faible

Civilian penetrating gunshot injury to the neurocranium in Enugu

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004­2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Conclusions: Admitting GCS and bullet trajectory were predictive of outcome

Injury Patterns and Mortality Rates of Motorcycle-Related Head Injuries in Kenya

Background: Motorcycles are an emerging means of public transportation in many developing countries and has a poor safety record when compared to other road users. Subsequently; motorcycle injuries have been on the rise and head injuries are the leading cause of death; severe injury and disability globally.Objectives: To determine the injury patterns and mortality rate of motorcycle-related head injuries. Design: A retrospective descriptive study. Setting: Moi Teaching and Referral Hospital Subjects: All motorcycle-related head injuries from the year 2010 to 2013. Results: One hundred and fourteen files were reviewed. The study sample was predominantly male (n=106; 93%) with a mean age of 30.2 years (SD=14.01). More than half of the patients sustained skull fractures and intra-cranial haemorrhage (n=68; 59.6%). About 9.6% (n=11) of the patients succumbed to their injuries out of which 63.6% (n=7) sustained severe head injuries. There was a significant association between helmet use and the mortality rate of patients (?2=5.684; p=0.017). The use of helmets also had an influence on the type of injury sustained (p=0.004) as patients not wearing helmets sustained more serious injuries such as skull fractures; intra-cranial bleeding; cerebral oedema and diffuse axonal injuries.Conclusion: There is a relationship between helmet use; the type of injury sustained and the mortality rate of the patients. Hence; the need for public education programmes on motorcycle safety and helmet use to curb the negative impact of motorcycle-related injuries on the society and economy

Interêt du scanner dans le diagnostic précoce d'une plaie traumatique du Sinus sagittal supérieur: à propos d'un cas à Cotonou

Introduction : Lors des traumatismes crâniens, le scanner permet un bilan exhaustif des collections intracrâniennes et des lésions osseuses et parenchymateuses. Nous rapportons le cas d'une plaie traumatique inhabituelle du sinus sagittal supérieur par embarrure ouverte du vertex.Observation : Patient de 18 ans, sans antécédents particuliers, admis pour une plaie crânio-cérébrale du vertex avec coma d'emblée. A l'admission, l'examen neurologique notait un Glasgow à 5/15 avec des pupilles isocores et réactives. Localement, il existait une large plaie du vertex pariéto-occipital. Le patient fut admis en réanimation. Il a été intubé et sédaté. Le scanner cérébral a été réalisé le jour de son admission et mettait en évidence une embarrure multi-esquilleuse en regard de la portion moyenne du sinus sagittal supérieur. Une craniectomie a été réalisée en urgence. A 18 mois postopératoire,le sujet était sans séquelles neurologiques.Conclusion : La gestion efficiente d'une plaie du sinus sagittal supérieur est facilitée par la réalisation urgente du scanner cérébral

Cout direct de la prise en charge du traumatisme cranio-encepahlique au CHR de Segou au Mali : quel financement pour la PEC au Mali ?

Le traumatisme cranien encephalique (TCE) est la deuxieme cause d'admission aux urgences de l'hopital Nianankoro Fomba de Segou. Il touche l'adulte jeune avec un faible pouvoir d'achat. L'objectif de ce travail etait d'evaluer le cout direct de la prise en charge (PEC) du TCE en reanimation et de proposer les modalites de financement pour sa PEC au Mali. Il s'agissait d'une etude prospective de Septembre 2009 a Decembre 2010 au centre hospitalier Nianankoro Fomba de Segou. Tous les patients admis pour TCE en reanimation pour plus de 24 heures etaient inclus. La tranche d'age 2140 etait predominante. Toutes les couches socioprofessionnelles etaient exposees. Le cout moyen des ordonnances etait de 55.392 CFA. L'evacuation sanitaire etait effectuee dans 15 cas pour un frais de 60.700 francs. Pour manque de moyens; 75% des patients decedes n'etaient pas evacues en 3eme reference. Le cout moyen de la PEC etait de 99.385 Francs (39.115-282.944). Le cout total des prestations s'elevait a 7.269.320 francs CFA. Le cout de la PEC des TCE est eleve et constitue un determinant majeur de la morbimortalite liee a ce fleau

Head injury-a neglected public health problem: a four-month prospective study at Jimma University specialized hospital, Ethiopia

BACKGROUND: Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world's population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middleincome countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury. METHODS: All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study. RESULTS: Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively. CONCLUSION: Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done

Traumatic brain injuries in children: a hospital-based study in Nigeria

The most frequent computed tomography finding was intracerebral haemorrhage. Mean duration of hospitalization was 18 days (median 11 days). Eleven patients died; mortality correlating well with severity and the presence of intracerebral haematoma. Conclusion: Head injuries in children are due to motor vehicle and motor vehicle-related accidents. Hence; rational priorities for prevention of head injuries in children should include prevention of vehicular; especially pedestrian; accidents in developing countries.Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However; there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of paediatric traumatic brain injuries. Setting and Design: This is a prospective analysis of paediatric head trauma at the University of Benin Teaching Hospital; a major referral centre for all traumatic brain injuries in Nigeria between October 2006 and September 2011. Materials and Methods: We studied the demographic; clinical and radiological data and treatment outcomes. Data was analysed using statistical package for the social sciences (SPSS) 16.0. Results: We managed 127 cases of paediatric head injuries; 65 boys and 62 girls representing 13 of all head injuries managed over the 5-year period. They were aged 3 months to 17 years. The mean age was 7.4 years (median 7 years) with peak incidence occurring at 6-8 years i.e. 31 (24.4) cases. Motor vehicle accidents resulted in 67.7; falls 14 and violence 7

Computerised tomographic patterns in patients with head injury at the university of Benin teaching hospital

Background: Head injuries rank high among morbidities due to trauma. Computerised tomography is an important modality in the investigation of these cases. However; literature on this subject in the south-south geopolitical zone of Nigeria is sparse. This study therefore aimed to document the computerized tomographic features of patients with head injury managed at the University of Benin Teaching Hospital (UBTH). Materials and Methods: A prospective study involving patients with head injury referred for CT scan from the Accident and Emergency Unit of UBTH over a 12-month period. A total of 100 patients were studied; using non-enhanced cranial CT scans. Findings were recorded and data analysis using SPSS done. Results: The age group 21-30 years was most frequently involved. Sex preponderance was 4.3:1 (male: female). Twenty-six patients had normal CT scans. The most common abnormal finding was intracerebral hemorrhage 35 cases (33). This was followed by skull fractures; 23 cases (31); subdural hemorrhage; 16 cases (21); cerebral edema; 11 cases (15). Others included mass effect; nine cases (12). Conclusion: CT plays a very significant role in management of head injuries; as demonstrated in this study; by making such diagnoses that guided eventual patient management. Intracerebral hemorrhage was the most common abnormal finding in this report. Regular use of CT in moderate to severe cases of head injury is advocated

Les plaies traumatiques cervico-faciales a hopital national Donka du CHU de Conakry

Les plaies traumatiques cervico-faciales (PTCF) peuvent entrainer des complications et des sequelles esthetiques et fonctionnelles graves. Les objectifs de l'etude etaient de determiner le profil epidemiologique des PTCF; de decrire les formes cliniques rencontrees et leur prise en charge. Il s'agissait d'une etude prospective realisee de Fevrier a Juillet 2010 a l'hopital National Donka du CHU de Conakry. Elle a porte sur 265 patients presentant des PTCF et ayant beneficie d'une prise en charge. La frequence des PTCF par rapport aux autres plaies traumatiques des autres regions etait de 8;56. Les adultes jeunes de 21-30 ans etaient les plus touches (38;49) et 74;34etaient des hommes contre 25;66de femme soit un sex ratio de 2;90. Les AVP etaient la cause des plaies dans 70;57des cas. Le tableau clinique etait domine par les plaies de type II (49;05) suivis des plaies de type I (48;30) et 2;65de plaies de type III. Le traitement effectue etait medico-chirurgical. L'evolution a ete jugee favorable dans 82;13des cas et defavorable dans 17;85 des cas

Prise en charge neurochirurgicale des traumatismes crâniens à Parakou, Bénin : apport de la radiographie standard

Objectif : Rapporter l'apport de la radiographie standard du crâne dans la prise en charge chirurgicale des traumatismes crânio-encéphaliques (TCE) au bénin. Méthodes : Etude descriptive réalisée à l'unité de neurochirurgie du CHD-Borgou au nord-est du Bénin. Elle concernait 29 cas de TCE tous opérés entre Avril 2008 et Juin 2009 sur des critères cliniques et radiographiques. Résultats : L'âge moyen des patients était de 23,46 ± 14,28 ans avec une prédominance masculine (93,10%). Neuf patients (31%) présentaient un TCE grave, 15 (51,8%) un TCE modéré et 5 (17,2%) un TCE léger. La radiographie du crâne objectivait une embarrure chez 17 (58,6%) patients, une fracture de la voûte chez 7 (24,2%) et aucune lésion dans 5(17,2%) cas. IL a été réalisé une réparation de plaie crânio-cérébrale 3(10,3%) cas, une évacuation d'hématome extra dural 4(13,8%) cas, une trépanation exploratrice 5 (17,2%) cas et un redressement d'embarrure 17 (58,6%) cas auquel était associé 3 évacuations d'hématome extra dural, 3 réparations de brèche ostéoméningée et 4 débridements et duroplasties. Conclusion : La radiographie du crâne ne peut pallier au défaut de scanner cérébral en cas de TCE. Elle peut néanmoins apporter de précieuses informations permettant une prise en charge chirurgicale

Traumatic Brain Injury in the Accident and Emergency Department of a Tertiary Hospital in Nigeria

Background: Traumatic brain injury is a major public health problem in Nigeria; as it could be associated with long term and life long deficits. Unlike other parts of the world; in our country; motorcycles are possibly the main cause of this injury. Unfortunately; we do not have a national epidemiological data base yet. This study was aimed at defining the peculiar demographic and associated risk factors in traumatic brain injury among our patients; as part of a multi-institutional data pool for a future meta-analysis to generate the national data base. Methods: This was a 24-month retrospective study of all head injury patients who met the criteria for traumatic brain injury in the Accident and Emergency Department of a tertiary health institution. Data were collected from the emergency cards and case notes; then collated and analyzed using the descriptive statistics on SPSS 13; with the p value taken as 0.05. Results: A total of 9;444 patients were attended to during the 24 months; 510 (5.4) of them met the inclusion criteria for the study. This translated to a presentation rate of 5.3 cases per week and an incidence rate of 2;710 per 100;000 per year. Males accounted for 404 (79.2) of the cases. The peak age incidence (31.2) was in the 20 - 30 year age group. Traders constituted the highest occupational group 125 (24.5). Most (58.8) of the cases resulted from motorcycle accident. There were 28 deaths giving a mortality rate of 5.5or 148 deaths per 100;000 per year. Conclusion: The risk factors were the male gender; motorcycle riding; illiteracy; trading; extremes of age and active daytime period of 12:01 - 18:00hours. The incidence rate was much higher than in the developed countries; but could reduce with the use of crash helmets; seat belts; speed limits and safety/protective vehicular devices; with better road rehabilitation

Traumatisme cranioencephalique a l'hopital Gabriel Toure

Objectif : etait d'evaluer la morbidite et la mortalite liee au traumatisme cranioencephalique. Patients et methodes : Il s'agissait d'une etude descriptive portant sur des patients admis consecutivement pour traumatisme cranioencephalique aux urgences chirurgicales de l'hopital Gabriel Toure de Bamako de janvier 2004 a aout 2004. Etaient inclus tous les patients victimes de traumatisme cranioencephalique avec ou sans autres lesions associees. Un P 0;05 etait considere comme significatif. Resultats : Sur une periode de huit (8) mois 324 patients ont ete admis pour traumatisme cranioencephalique. Les patients de sexe masculin etaient de 243 soit 75avec un sex-ratio de 3;1. La population scolaire et universitaire representaient 79 des professions soit 24;4. Le traumatisme cranien survenait dans 268 cas soit 82;80des cas dans un contexte d'accident de la voie publique. Ces accidents concernaient les pietons dans 42des cas (auto pietons ou moto pieton). Le taux de morbidite etait de 11.Conclusion : Les lesions intracerebrales sont des lesions majoritairement rencontrees au cours du traumatisme cranioencephalique. Le fait d'etre pieton dans un contexte d'accident semble rendre vulnerable au traumatisme cranioencephalique

Aetiological Patterns and Management Outcome of Paediatric Head Trauma: One-Year Prospective Study

Trauma is themost common cause of paediatric deaths. In75of paediatric trauma deaths; head injury is responsible; and most are from falls. Recent reports from Nigeria; however; appear to indicate a predominance of road traffic accidents; instead of falls. To evaluate the aetiology of paediatric head trauma; management protocols and outcome from our Centre; in order to acquire a baseline data base and recommendmeasures to reduce childhood trauma. Aprospective study of all paediatric head trauma cases presenting toNnamdiAzikiwe University Teaching Hospital; Nnewi; for 12months from April 21; 2006 to April 20; 2007; was done and collated data subsequently analyzed. The paediatric age group was taken as =15years; and grading of head injurywaswith theGlasgowComa Scale (3 15) and themodified scale for non-verbal children;while outcome wasmeasuredwith the Glasgow Outcome Scale (1 5). Out of 334 patients treated within the period of study; 210 were head trauma cases. Of these; 52 were paediatric head trauma; representing 24.8of all head trauma cases; and 19.2(10 of 52) of them were aged 0- 2years. About 62(32 of 52) were males. Falls and RTA were each responsible in 25(48.1) cases. Mild head injury occurred in 31(59.6); and 49(94.2) patients were evaluated by plain radiography. Treatment was conservative in 39(75) cases;with satisfactory outcome in 36(69.2); and amortality rate of 15.4. Road traffic injury; mostly from motorcycles; has become the major cause of morbidity and mortality amongst the paediatric age group; especially the male gender; and outcome from management is mostly satisfactory