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