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Prognostic Indicators Influencing Short Term Outcomes among Operated Head Injury Patients at Kilimanjaro Christian Medical Center Northern Zone Tanzania.
Ayesiga, H M; Chilonga, K S & Msuya, D
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
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