Adeleye A O, Olowookere K G, Olayemi O O
Division of Neurosurgery, Department of Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
Neuroepidemiology. 2009;32(2):136-41. doi: 10.1159/000182821. Epub 2008 Dec 16.
Although head injury (HI) is a major public health problem in Nigeria and other low and middle income countries of the world, there is a paucity of data from these societies. This is largely due to under-reporting. We carried out a prospective study of the clinicoepidemiological profiles and outcomes following the first hospitalization of a cohort of head-injured patients in Ikeja, Nigeria, a metropolitan African city.
In an 8-month period from May until December 2005, data from all HI cases seen in our neurosurgical unit were prospectively recorded for subsequent analysis. These include demographics, mechanism of injury, pre-neurosurgical care received, severity of injury using the Glasgow Coma Scale, presence of hemodynamic instability, pupillary anomalies and associated systemic injuries, cranial computed tomography (CT) findings and the number of surgical interventions, as well as outcomes after the first hospital admission using the Glasgow Outcome Scale. Determinants of outcome were explored using the chi(2) test and the level of significance was put at p = 0.05.
There were 143 cases of HI, which is about one fifth of our total workload, including 122 males and 21 females aged 0.5-85 years (mean age 29.15). The majority (88%) were either school children or low income earners. Road accidents accounted for 75% of the cases; three quarter of the cases had some initial care in other health facilities before the arrival in our unit, at an average of 33 h. Mild, moderate and severe HI accounted for 60, 18 and 22%, respectively. About a quarter of the patients sustained other systemic injuries. Cranial CT scanning was obtainable in 40 patients (28%); 9 of these revealed surgical mass lesions, of whom 5 had life-saving operations. Many well-known determinants of a poor outcome of HI were prevalent in this study group and found to have a significantly adverse effect on patient outcome.
HI is a major public health problem in Nigeria, taking up at least one fifth of the neurosurgical workload. The prehospital emergency medical service is poorly organized. Determinants of a poor outcome of HI are highly prevalent, including poor accessibility to cranial CT scanning, absence or inadequacy of logistics for neurocritical care and an inadequate number of neurosurgeons.
尽管头部损伤（HI）在尼日利亚及世界其他低收入和中等收入国家是一个重大的公共卫生问题，但这些地区的数据却很匮乏。这主要是由于报告不足所致。我们对尼日利亚一个非洲大都市伊凯贾一组头部受伤患者首次住院后的临床流行病学特征及转归进行了一项前瞻性研究。
在2005年5月至12月的8个月期间，前瞻性记录了我们神经外科病房收治的所有HI病例的数据，以供后续分析。这些数据包括人口统计学资料、损伤机制、术前接受的治疗、使用格拉斯哥昏迷量表评估的损伤严重程度、血流动力学不稳定情况、瞳孔异常及相关的全身损伤、头颅计算机断层扫描（CT）结果、手术干预次数，以及首次入院后使用格拉斯哥预后量表评估的转归情况。使用卡方检验探讨转归的决定因素，显著性水平设定为p = 0.05。
共有143例HI病例，约占我们总工作量的五分之一，其中男性122例，女性21例，年龄在0.5至85岁之间（平均年龄29.15岁）。大多数（88%）为学童或低收入者。道路交通事故占病例的75%；四分之三的病例在到达我们科室之前在其他医疗机构接受过一些初始治疗，平均时长为33小时。轻度、中度和重度HI分别占60%、18%和22%。约四分之一的患者伴有其他全身损伤。40例患者（28%）可进行头颅CT扫描；其中9例显示有手术性肿块病变，5例接受了挽救生命的手术。本研究组中许多已知的HI不良转归决定因素普遍存在，并被发现对患者转归有显著不利影响。
HI在尼日利亚是一个重大的公共卫生问题，至少占神经外科工作量的五分之一。院前紧急医疗服务组织不善。HI不良转归的决定因素高度普遍，包括头颅CT扫描难以获得、神经重症监护的后勤保障缺失或不足以及神经外科医生数量不足。
