epidemiologyandoutcomesofheadinjurypaents ... ·...
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Characteris*cs Overall, 204 pa-ents with head injury were enrolled; 53 (26.0%) had mul-system trauma. Most head injuries occurred in 16 -‐30 yrs old (51.0%) and men (86.8%). Road traffic accidents (RTA’s) were responsible for the majority of head injuries (40.2%); pedestrians struck being the most common (overall 24.5%). Other mechanisms included: assault with blunt injury (38.2%) or penetra-ng injury (2.5%) and falls (17.7%). Head Injury Severity and Outcomes Overall head injury severity (as per the Glasgow Coma Scale (GCS)) on presenta-on was: 108 pa-ents had mild injury (GCS 13-‐15; 53.0%), 39 with moderate (GCS 9-‐12; 19.1%), and 51 with severe (GCS 3-‐8; 25.0%). Overall, 21 pa-ents died (10.3%). The majority (62.6%) of deaths occurred within 48 hours of admission to the emergency department. Risk factors associated with mortality are seen in Table 2. These highlight the severity of clinical presenta-on among those pa-ents with mortality – including severe GCS, bilateral fixed pupils and hypoxia.
Epidemiology and outcomes of head injury pa;ents in an urban Ethiopian emergency department
M. Landes1,4,5, R Venugopal1,4,5, S. Berman4,5, A. Azazh3,5
Head injury is a leading cause of mortality from trauma in low to middle income countries. Ethiopia is in the early stages of developing pre-‐hospital, emergency and cri-cal care services • Addis Ababa University’s (AAU) Tikur Anbessa Specialized
Hospital (TASH) is a neurosurgical and trauma referral center and the largest general public hospital in Ethiopia. The Emergency Department treats approximately 80,000 pa-ents per year in a low resourced working environment.
• The first Emergency Medicine residency was started at Addis Ababa University in 2010 and has since graduated the first four emergency medicine doctors in October of 2013.
The objec-ve of this study was to characterize the epidemiology and outcomes of head injury at a large urban academic hospital with a newly ac-ve emergency medicine program in Ethiopia.
1Division of Emergency Medicine, Department of Family and Community Medicine, Toronto, Ontario; 2Division of Emergency Medicine, Department of Medicine, University of Toronto; 3Department of Emergency Medicine, School of Medicine, Addis Ababa University;
4University Health Network, Toronto, Ontario; 5Toronto Addis Ababa Academic Collabora-on in Emergency Medicine
We report a high prevalence of severe clinical presenta-ons and mortality among a prospec-ve cohort of head injured pa-ents in a large urban emergency department in Ethiopia. Road traffic accidents cons-tute a large propor-on of head injuries presen-ng to this emergency department, and reflects the high burden of road traffic related trauma in low-‐resource seengs. Head injury afer trauma represents a significant risk of morbidity and mortality in this seeng in Ethiopia, for which the ongoing development of emergency and surgical services may improve outcomes Appropriate iden-fica-on and services for pa-ents at risk of mortality may guide this con-nued development.
We conducted a prospec-ve cohort of all head injured (including both isolated head injury and mul-system trauma with head injury) pa-ents over 4 months presen-ng to the Emergency Department of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Using a standardized data collec-on form, demographic and clinical informa-on was extracted from the pa-ent’s chart, radiology reports and/or opera-ve reports. Pa-ents were followed un-l they reached one of the following endpoints: discharge, referral to another hospital, death, or 7 days in the hospital. Consent for study par-cipa-on was obtained from the pa-ent or subs-tute decision maker.
Support for this study was from a grant from the University Health Network Emergency Department Prac-ce Plan, the Department of Family and Community Medicine at the University of Toronto and the Interna-onal Development Research Centre (Canada).
*Table 2. Mul;variate analysis of risk factors for mortality
*N=170 includes pa-ents not transferred with known outcomes **Measured on presenta-on
Table 1. Pa;ent Characteris;cs on Presenta;on and Outcomes by Mechanism of Injury
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