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Abstract
Some authorities in the world's industrialized nations now believe that the care of
patients with mild (and even some moderate) head injury (MiHI) in general is an unnecessary
additional burden on their already over-tasked neurosurgical workforce. There is a
high rate of inter-hospital transfer for neurosurgical evaluation of cases of MiHI
in Nigeria, an African developing country. This may be needless in many cases. We
therefore conducted a prospective in-hospital cohort study of cases of MiHI managed
in a new neurosurgical service in a Nigerian university teaching hospital over an
8-month period. Clinical and in-hospital outcome characteristics of the cases were
analysed and presented in descriptive statistics. Subgroup analysis was then carried
out between cases presenting directly post-trauma in our unit and those referred to
us for neurosurgical management from other health facilities. Inferences were made
based on the chi-squared test and the 2-tailed t-test, and the significant level was
set at p < 0.05. Eighty-four cases of MiHI were analysed, 72 males, 12 females. The
causative trauma was road traffic related in 65.5%, and 25.0% had other extracranial
injuries. The admission GCS was 14 or 15 in 93%. Seventy percent of the cases were
referred from other (including tertiary) medical facilities. With mean length of stay
of 6.15 days, the over-all inhospital good vs poor outcome rates were 97.6 vs 2.4%
on the dichotomised GOS. There was no significant difference (p > 0.10) between the
two subgroups with respect to either the post treatment in-hospital outcome variables,
or in their clinical determinants.
Majority of the cases of mild head injury that were so treated in this study population
did not need the inter-hospital transfer for neurosurgical management. Large studies
are needed to determine the clinicopathologic indices predictive of the few cases
that may be an exception to this assumption.
Keywords
developing country - mild head injury - neurosurgical referral
