Prognostic indicators influencing short term outcomes among operated head injury patients at Kilimanjaro Christian Medical Center Northern Zone Tanzania

Abstract

Background: Head injury causes significant morbidity and mortalityand accounts for about 10 million cases globally. In Tanzaniait’s the most common type of injury contributing about 32% to 50% of all trauma patients. Favorable outcomes for head injury patients depends on initial evaluation and proper timely intervention. This study aimed at determining the prognostic indicators for short term outcomes in operated head injury patients at KCMC.

Method: Operated head injury patients meeting inclusion criteria were enrolled and followed to the point of discharge.Age, cause of injury, time of injury to surgery, indication for surgery,GCS, ISS were recorded on admission. Outcomes of interest(GOS and hospital stay) were recorded ondischarge. The association between age, GCS on admission, ISS and time of injury to surgery and outcomes was done using Chi square test.

Results: A total of 57 patients were enrolled in the study with the median age of 34 years (range 22-44 years). Males accounted for 71.9% of participants. The mean admission GCS 11.9 (+/-3.4) and median ISS of 9(range 4-52). RTA was the leading cause of injuries with 56.1% followed by falls and assaults. The median hospital stay was 5 days (range 1-66) with median GOS of 5 (range 1-5). The overall mortality was 14%.Of those with fatal outcome (n=8), 87.5% had ISS ≥ 16 (P=0.004) and Unfavorable GOS of 84.7% (n=13) (P=0.01). GCS ≤ 8 was associated with mortality of 63% (n=8) (P=0.003), unfavorable GOS in 61.5% (n=13) (P=0.015) and 90% of those who stayed > 8 days had GCS< 13. Time of injury to surgery and social demographic characteristics had no significant association with fatality, GOS and hospital stay.

Conclusion: ISS and GCS were important predictors of outcomes and thus their use in patient assessment should be encouraged. Furthermore GOS may be used as a primary measure of outcomes for patients with head injury.

Keywords: Head injury, outcomes, injury severity score, Glasgow coma score, Glassgow outcome score