Correlations of computerized topographic severity with clinical severity and outcome of head injury patients at Tikur anbessa specialized referral and teaching hospital, Addis Abeba, Ethiopia
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Date
2017-08
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Addis Ababa University
Abstract
Background: Polytrauma due to road traffic accidents (RTA) is the leading cause of head
injury in all age groups especially in young adults. More than half of the cases of head trauma
are caused by RTA, leading to 70% of all deaths due to brain injury.
OBJECTIVE: To correlate the computed tomographic (CT) severity of head injury patients
with their clinical severity score (GCS) and outcomes.
MATERIALS AND METHODS: An institutional based prospective cross sectional study was
conducted among 131head injury patients over a period of 6 months (from March to August
2017). The patients’ levels of consciousness (GCS) were determined and non-contrast head CT
scans were performed from vertex to base of the head. The causes for head injury were recorded.
The outcomes of patients were also documented from direct telephone communications and chart
retrieval and document reviews using patients’ medical record numbers.
RESULTS: The age range of patients was 6months to 80 years. The mean age of patients was
30.9 with male to female ratio being 5:1.The most common causes for head injury were
RTA(46.6%),fighting(32.1%) and falling down injury(19.1%),The most common CT findings
were skull fractures(51.9%),soft tissue swelling(34.4%),brain contusions(32.8%),brain
herniation(29.8%),brain edema(29.0%),SDH(22.9),SAH(18.3%),%),EDH(16.0%)and
IVH(6.9).There were a total of 6(6.6%) deaths which were resulted from fall down (3cases),
RTA (2cases) and fighting (1case). Most patients had Rotterdam CT severity score of 2 and GCS
of 13 and above. Loss of consciousness and vomiting were the commonest clinical features in
head injury patients brought to emergency department.
CONCLUSION: The Rotterdam CT scores of most of the patients in this study was
2.Significant correlation (P-value <0.001) was found between the Rotterdam CT severity scores
and clinical severity scores (GCS). The CT severity scores showed inverse correlation with
clinical severity scores (GCS) of patients and found to be strong predictor of outcome. The CT severity score was also found to have positive correlation with mechanism of injury (Pvalue=0.044). It was also shown that significant association was found between the outcome of study subjects and Rotterdam CT severity scores (P- value =0.02).The most severe clinical and CT severity scores were found in road traffic accident cases.
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Keywords
head injury