Abstract
Traumatic brain injury (TBI) is a common condition presenting in the accident and Emergency Department (AED). Defined as injury to the scalp, skull and brain, no age group is spared. The study aims to highlight the epidemiological pattern associated with head injury patients as seen in the AED of this tertiary institution where the study was carried out. This was a 27 months retrospective study of all head injury patients who met the criteria for traumatic brain injury in the AED. Data was collected from the emergency cards and case notes, then collated and analyzed using the descriptive statistics on SPSS 16, with the p value taken as <0.05. One thousand, three hundred and twenty eight (1328) patients were recorded at the AED during the period under review; 123(9.2%) of them met the inclusion criteria for the study. There were 101 (87.1%) males and 22 (17.9%) female. The mean age incidence 33.5 years was in the 31 - 40 year age group. Civil servants constituted the highest occupational group 40 (32.5%). Most (59.3%) of the cases resulted from motorcycle (MC) accident; then motor vehicle (MV) 22.0%, assaults12.2%,fall 8.1% and domestic injury 2.4%.For severity, 76 (61.8%) of the patients had mild HI, 17.9% had moderate and 20.3% had severe HI. 72.4% were discarded from AED,22.0% were referred or admitted into the wards. There were 2 deaths all males giving a mortality rate of 1.6%.TBI is a common presentation at AED. Civil servants within the age range 21-40 years were mostly implicated and RTA was the commonest etiology factor especially MCA. Improving the state of our roads, licensing road users and compliance to traffic regulations will go a long way in reducing this menace.
Keywords: trauma, brain, injury, aetiology, accident & emergency.
References
- Barr RM, Gean AD, Le TH. Craniofacial trauma. In: Brant WE, Helms CA, editors. Fundamentals of Diagnostic Radiology. 4th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2012; 49–74.
- Onwuchekwa RC, Echem RC. An epidemiologic study of traumatic head injuries in the emergency department of a tertiary health institution. J Med Trop 2018; 20:24-9.
- Bouma GJ, Muizelaar JP, Choi SC, Newlon PG, Young HF. Cerebral circulation and metabolism after severe traumatic brain injury: the elusive role of ischemia. J Neurosurg 1991; 75: 685-93.
- Bouma GJ, Muizelaar JP, Stringer WA, Choi SC, Fatouros P, Young HF. Ultra-early evaluation of regional cerebral blood flow in severely head-injured patients using xenon-enhanced computerized tomography. J Neurosurg 1992; 77: 360-8
- Klauber MR, Barrett-Connor E, Marshall LF, Bowers SA. The epidemiology of head injury: a prospective study of an entire community-San Diego County, California, 1978. Am J Epidemiol 1981 113: 500-9.
- Emejulu JK, Isiguzo CM, Agbasoga CE, Ogbuagu CN. Traumatic brain injury in the accident and emergency department of a tertiary hospital in Nigeria. East Cent Afr J Surg 2010; 15:28–38.
- Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury: prospective cohort study. Br Med J 2000; 320: 1631-5.
- Yates PJ, Williams WH, Harris A, Round A, Jenkins R. An epidemiological study of head injuries in a UK population attending an emergency department, J Neurol Neurosurg Psychiatry, 2006, vol. 77 (pg. 699-701)
- Klauber MR, Marshall LF, Luerssen TG, Frankowski R, Tabaddor K, Eisenberg HM. Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 1989; 24: 31-6.
- Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury: prospective cohort study. Br Med J 2000; 320: 1631-5.
- Brain Trauma Foundation, Management and Prognosis of Severe Traumatic Brain Injury, 2000New YorkBrain Trauma Foundation.
- Hukkelhoven CWPM, Steyerberg EW, Rampen AJJ, et al. Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 2003; 99: 666-73.
- Moppett IK. Traumatic brain injury: assessment, resuscitation and early management. BJA: British Journal of Anaesthesia 2007;1: 18–31
- Chesnut RM, Marshall SB, Piek J, Blunt BA, Klauber MR, Marshall LF. Early and late systemic hypotension as a frequent and fundamental source of cerebral ischemia following severe brain injury in the Traumatic Coma Data Bank. Acta Neurochir Suppl (Wien) 1993; 59:121-5.
- Hartl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma 2006; 60:1250-6.
- Lu J, Marmarou A, Choi S, et al. Mortality from traumatic brain injury. Acta Neurochir Suppl 2005; 95: 281-5.
- Bock-Oruma AA, Odatuwa-Omagbemi DO, Ikubor JE. Pattern of head injury in the emergency department of the Delta state university teaching hospital, Oghara, Nigeria. Br J Med Med Res 2016; 15:1–6.
- Jasper US, Opara MC, Pyiki EB, Akinrolie O. The epidemiology of hospital-referred head injury in Northern Nigeria. J Sci Res Rep 2014; 3:2055–64.
- Boniface R, Lugazia ER, Ntungi AM, Kiloloma O. Management and outcome of traumatic brain injury patients at Muhimbili Orthopaedic Institute Dar es Salaam, Tanzania. Pan Afr Med J 2017; 26:140.
- Thurman D, Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA 1999; 282:954–7.
- Yates PJ, Williams WH, Harris A, Round A, Jenkins R. An epidemiological study of head injuries in a UK population attending an emergency department. J Neurol Neurosurg Psychiatry 2006; 77:699–701.
- Emejulu JK, Isiguzo CM, Agbasoga CE, Ogbuagu CN. Traumatic brain injury in the accident and emergency department of a tertiary hospital in Nigeria. East Cent Afr J Surg 2010; 15:28–38.
- Quayle KS, Powell EC, Mahajan P, Hoyle JD Jr, Nadel FM, Badawy MK et al. Epidemiology of blunt head trauma in children in US emergency departments. N Engl J Med 2014; 371:1945–7.
- Emejulu J.K.C., Isiguzo CM, Agbasoga CE, Ogbuagu CN. Traumatic Brain Injury in the Accident and Emergency Department of a Tertiary Hospital in Nigeria. East and Central African Journal of Surgery 2010;15: 28-38.
- Onwuchekwa RC, Echem RC. An epidemiologic study of traumatic head injuries in the emergency department of a tertiary health institution. J Med Trop 2018;20:24-9
- Thurman D, Janet G (1999); Trends in Hospitalization Associated with Traumatic Brain Injury, Journal of American Medical Association; 282:954 - 957.
- CDC-NCPIC (2008 March), Traumatic Brain Injury; http://www.cdc.gov/ncipc/ factsheets /tbi.htm
- Shivaji T, Lee A, Dougall N, McMillan T, Stark C. The epidemiology of hospital treated traumatic brain injury in Scotland. BMC Neurol 2014;14:2
- Palacios EM, Yuh EL, Chang YS, Yue JK, Schnyer DM, Okonkwo DO et al. Resting-state functional connectivity alterations associated with six-month outcomes in mild traumatic brain injury. J Neurotrauma 2017;34:1546–57.
Corresponding Author
Annongu, Isaac Terkimbi
Department of Radiology, College of Health Sciences, Benue State University, Makurdi
DOI: https://dx.doi.org/10.18535/jmscr/v8i12.32
