الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 102 |  |  |
| | | from | 102 | | |
Abstract
Road traffic injuries account for 2.1% of global mortality. The developing countries bear a large share of burden and account for about 85% of the deaths and about 90% of the total disability due to road traffic injuries (1,2)
The Middle East region ranks second highest in terms of road fatalities, according to the WHO, with Egypt alone suffering more than 7,000 deaths annually (4)
The aim of this work is to study patterns of head injuries as regards incidence, types of injury, diagnosis, hospital stay and outcome related to different lines of management among patients admitted to Alexandria Main University Hospital.
The study included patients with head injuries due to road traffic accidents admitted to the emergency department at the Alexandria Main University hospital in a period of 6 months from 1 January 2011 to 30 June 2011.
Data collected about every patient in the current study included: Personal data, history of road traffic accident, clinical assessment: General examination, neurological evaluation including measurement of the level of consciousness using the Glasgow coma score, Computed tomography (CT) brain, surgical procedure done, duration of hospital stay and place of admission, complications occurred during hospitalization, outcome assessment using Glasgow outcome scale (GOS) score. (13)
Total number of patients admitted per year in the surgical emergency department in Alexandria main university hospital was 5820, 44.3 % had head injuries and 44.5% of head injuries were due to road traffic accidents.
The most significantly affected age group in both sexes was 20 – 30 years of age, representing 28.7% of all cases. Males represented 78% of the cases while the females represented 22 % of the cases. The most common time interval for admission of cases was from 6:00 pm till 12:00 am. According to the Glasgow coma score, severe head injuries represented 14% of the cases, moderate head injuries represented 6% of the cases and mild head injuries represented 80% of all cases admitted to the hospital.
Cases with identified pathology in their CT brains represented 32.1% of all CT brains done. The most common CT findings were fissure fractures and brain edema 31.3% followed by extradural hematoma 30 %.
Conservative management was done in 61.3% of all cases with positive CT finding, while surgical management was required in 23% of those cases and discharge against medical advise represented 15.7%. In 14.5% of surgically managed cases the first decision taken after the initial CT was to be managed conservatively, then the decision was changed to surgical management after the first or second follow up CT. Not all of cases with moderate and severe head injuries were admitted to the intensive care unit (ICU) due to the limited available places. The critical care physicians did triaging of all critical care patients involving the neurotrauma patients for ICU admission.
In this study evacuation of EDH represented 58% of all procedures done for head injuries after an RTA. Subdural hematoma evacuation represented 27.6% of all procedures done to these patients, of which, 26.1% subdural hematoma evacuation was done alone and in 1.5% there was an associated intracerebral hematoma evacuation. All procedures included, wide craniotomy, extension duroplasty and temporal decompressive craniectomy in all patients. Elevation of depressed fracture alone was done in 11.6% of all patients and evacuation of traumatic intracerebral hematoma was required in 5.8% of the cases.
Full recovery (Glasgow outcome score - GOS 5) was achieved in 65.8% of all cases with identified pathologies in the CT brain. Death (GOS 1) occurred in 16.3% of all cases. Moderate disability was found in 13.4% of the cases on discharge, severe disability in 2.3% and 0.8% of the patients were discharged in the vegetative state.
Due to the huge range of hospital stay in the collected data (1- 297 days) the median was used to evaluate the central tendency and Kruskal Wallis test was used to measure the significance. It was significantly found that the median of the stay in cases with moderate head injuries was 6 in comparison with 4 days in severe head injuries and 2 days in cases with mild head injures, the however, the mean was greater in severe head injuries due to the huge range 1 – 297 days in comparison with the moderate head injuries 1- 76 days.
The most common complications in both conservatively managed and surgically managed cases were both persistent neurological deficit (17.1%) and behavioral changes (17.9%), followed by pulmonary complications (9.5%) in the form of atelectases, acute respiratory distress syndrome and nosocomial pneumonia, deep vein thrombosis (DVT) (12.2%) and bedsores (10.2%) due to prolonged hospital stay. Other recorded complications were: spasticity in 4.1% of the patients that were mainly admitted with moderate to severe head injuries for prolonged period of time and infection. Infection was in the form of meningitis in 2.4% of all admitted cases, 4 of the cases developed hydrocephalus and required external drain or ventriculo-subgaleal shunt insertion. In addition, 9.5% of the surgically operated cases were complicated by deep wound infection and osteomyelitis.