Factors influencing the outcome of severe head injury at Kenyatta National Hospital

Objective: To study the factors influencing the outcome of severe head injury. Design: A retrospective study. Setting: Kenyatta National Hospital, Nairobi, Kenya. Subjects: Six hundred and seventy seven patients with severe head injuries who were seen at Kenyatta National Hospital between January 1992 and December 1996. Results: Six hundred and seventy seven patients with severe head injuries were treated at Kenyatta National Hospital, between January 1992 and December 1996. Three hundred and eighty one patients died while undergoing treatment, 56.2% overall mortality. Age specific mortality was 35.7% in patients below 13 years, 44% in age group 14-25 years, 56% in age group 26-45 years. The admission Glasgow coma scale (GCS) was recorded in 637 patients. Patients with admission GCS of 3-4 had a mortality of 88%, those with GCS 5-6 had a mortality of 60% and those with admission GCS 7-8 had a mortality of 52%. Ninety per cent of the patients who had bilaterally dilated pupils not reacting to light on admission died and 66% of the patients with bilaterally constricted pupils at the time of admission died. Only 20% of patients with severe head injury who had normal pupillary reaction to light at the time of admission died. Eighty five per cent of the patients with systolic BP of less than 90 mmHg on admission died while 60% of those with systolic BP greater than 120 mmHg 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.