Outcome of severe head injuries in Central Africa

Two hundred and fourteen patients admitted to the intensive care unit (ICU) over a 2-year period were studied. Computerized tomography (CT) scanning, intracranial pressure (ICP) monitoring and blood gas analysis were not available. There was no neurosurgeon in Zambia during the study. Road traffic accidents accounted for 63.5% of admissions and assault 30.8%. The hospital mortality was 52% (111 patients), 15 patients dying in the ward. Mean ICU stay was 3.8 days for survivors and 1.8 days for those who died. Mean ward stay was 21.3 days for survivors and 16.1 days for those who died. The Glasgow Coma Scale (GCS) on admission significantly predicted outcome (χ2 = 59.05; P < 0.0001) as did intracranial pathology. The mortality for patients with GCS 3-5, 6-8 and ≥ 9 was 91.5%, 19% and 20% respectively. The percentage of patients who died with extradural haematoma, subdural haematoma and brain contusion was 20%, 67% and 89% respectively. The results are compared with series from developed countries where CT scanning, ICP monitoring and neurosurgical skills are available.