FACTORS INFLUENCING THE OUTCOME OF SEVERE HEAD INJURY AT KENYATTA NATlONAL HOSPITAL

Abstract

Objective: To study the Factors influencing the outcome of severe head injury.
Design: A retrospective study.
Setting: Kenvatpa National Hospital, Nairobi, Kenya.
Subjects: Six hundred and seventy seven patients with severe head injuries who were seen st
Kenyatta National Hospital between January 1992 and Dccernber 1996.
Results: Six hundred and srventy seven patients wilh severe head irljuries were treated at
Kenyatta National Hospital betwen January 1992 and December 1996. Three hundred and
eighty one patients died while undergoing trc-ent, 56.2 "0 overall mortality. Age specific
mortality was 35.7% in patient% betaw 13 years, 44% i11 age group 14-25 years. 56% in age
group 26-45 years. The admiwion CSlasgow coma scale (GCS) was recorded in 637 patients.
l'atitnts with admission I;CS of 3-4 had a morinlity of 88 %, those with GCS 5-6 had a
mortality uf 60% and those with admission Gt'S 7-8 had a mortality of52%. h'inety per cemt
of the patients who had bilaterally dilated pupils nut reacting to light unadmission died and
66 G/r of the paticnts with bilaterally constricted pupils at the time of admission died. Only
20% of patients with severe head injury who had nnrmal pupillary rcactio~t t w light at the
tirne uf admission died. Eighty five per cent of the patients with systolic BP of less than 90
mmHg on admission died while 605 of those with systolic BP greater than 120 mmilg died.
Conclusion: In this study. Factors associated with poor outcome in severe head injury patients
at Kenyatta National Hospital were age,admission GCS, admission blood pressure (systolic),
presence of other associated injuries and pupillary reaction to light.