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

Apport de l'imagerie médicale dans le bilan des traumatismes crâniens au Niger : à propos de 311 cas à l'Hopital National de Niamey (Niger)

But : Décrire les aspects épidémiologiques et cliniques et évaluer l'apport de l'imagerie médicale en particulier le scanner dans la prise en charge des traumatismes crâniens.Patients et méthodes : Il s'agissait d'une étude prospective de 24 mois (Décembre 2005-Décembre 2007) portantsur 311 patients (270 hommes et 41 femmes, sexe ratio=6,5) âgés de 4 mois à 79 ans, admis à l'hôpital nationalde Niamey pour traumatisme crânien avec notion de perte de connaissance initiale et amnésie post traumatiqueou coma. L'âge moyen était de 27 ans. Les étiologies étaient dominées par les accidents de la voie publique(A.V.P.) (75,24 %). Ces patients ont bénéficié d'un examen tomodensitométrique (T.D.M. ou scanner) et/oud'examens radiographiques complémentaires. Résultats : Lebilan radiologique mettait en évidence une prédominance des lésions parenchymateuses avec 38,28 %. Leslésions osseuses isolées représentaient 14,85 % des cas. Conclusion : lestraumatismes crâniens sont fréquents et particulièrement graves au Niger.L'imagerie médicale et la T.D.M. enparticulier, trouvent une place de choix dans la prise en charge adéquate de ces patients