A prospective study of factors that Influence early outcome of severe Traumatic brain injury in different Age groups at the Kenyatta National hospital

Abstract

Four factors influencing short term outcome of sixty seven patients with severe head injury managed at the Kenyatta National Hospital during the months of October and November 2009were analyzed. These were patients with a Glasgow Coma Scale Score (GCS) of 3 to 8 whoseoutcome was reviewed after seventy two hours. Of the total number of patients in the study, 67% were adults and 33% were children. On admission majority of patients in this studywere between 24-34 years (22.4%) and the least number of patients was seen in the 57 years and above at 3%.The 3-5 year age group was the commonest in pediatric age group at 11.9%. Poor outcome was seen in extremities of age, 87.5% in children between 3-5 years as well as with increasing age with 100% poor outcome in patients who were 57 years and above. The most frequent Glasgow Coma Scale Score (GCS) was of 3 (34.3%) while the least frequent score was 8 (4.5%).16 children had a GCS score of 6-8 compared to 25 adults while 6 children had a GCS Score of 3-5 compared to 20 ofthe adults. Patients with a GCS score of 3-5 had poorer outcomes compared to those with GCS Score of 6- 8.Children had fewer poorer outcomes compared to adults with similar GCS Scores. The prognosis in three groups of intracranial pathologies due to head injury was assessed. Brain oedema was the commonest CT scan finding (55.2%) both in children and adults while contusion was the least(l0.5%).41% of patients with brain oedema had poor outcome. Most patients had abnormal pupillary reactions to light (82%) and the most frequent abnormal pupillary reaction was dilated unresponsive pupils at 58.2%.Poor outcome with dilated unresponsive pupils was seen in 52.2% of the total number of patients. Overall poor outcome fifty four subjects (80.6%) compared to thirteen (19.4%) who had good outcome. 22.4% of pediatric subjects had poor outcome compared to 58.2% of the adult. From this study, the Glasgow Coma Scale score and pupillary reaction to light were found to significantly correlate to outcome with low GCS score value and abnormal pupillary reaction predicting poor outcome. Age and CT Scan features were associated with outcome but were not found to be statistically significant.