AUDIT OF MANAGEMENT OF HEAD TRAUMA

IN SLEMANI TEACHING HOSPITAL 2001 – 2002

DR. HIWA OMER AHMED

MB.CHB. C.A.B.S

CONSULTANT SURGEON STH

ASSISTANT PROFESSOR – COLLEGE OF MEDICINE – UNIVERSITY

OF SLEMANI

SUMMARY:

Background

;

Trauma remains the leading killer of children and youngadults, specially head trauma injuries of different types from fall from height (FFH) inchildren to road traffic accident (RTA) and quarrelling in adolescence and young adults.

Every day many victims with head trauma will arrive the Surgical CasualtyDepartment of STH, managed first by house officer and senior house officers in generalSurgery.

Aim:

to compare a study group with controle group to evaluate the role of different lines and grugs in the management of head injured patients.

Patients, Methods and Materials:

A retrospective review was undertaken of 160 patients admitted with headinjuries over a period of years from 1

April 2003 to 1

April2004 ,in Sulemani Teaching Hospital. Demographic data obtained from the patients files ,studyhas been designed that may predict theoutcome of these two types of managements. Eiety patients (Group- A) managed in theauthors surgical unit and the rest (Group B) managed by a colleague surgeons in anothersurgical unit.Comparative analysis between the two groups through multiple variables wasdone to identify any different between them in the aspect of management and outcome.

Results:

Most of the patients in both groups were males , most of theinjuries were mild. The most common type of trauma was fall from height, there was noany correlation between # skull and physical findings as most of the patients withphysical findings.Differnt unneccessory drugs and lines of managements were used in thecontrolled group , which add no any benefit to the patients, but increase thecomplications.

Conclusion:

we need a uniform standard revised updated schedulefor management of head injured patients in our casualty, aiming in saving lives and timeof the physician, nursing and radiological Staffs

Key words: Head injury, Glasgow coma scale, Audit

INTRODUCTLON

Trauma in general is the most common cause of death in children, adolescenceand young adults. Minor head injury is common in modern society

(1)

. Care of the headinjured patients begins with assessment of severity and protection of the brain fromfurther insult. Outcome depends on recognition, severity and treatment of twofundamentally distinct types of head injury: diffuse and focal.To achieve correct management of this common problem, we need accuratemedical data recording and detailed and repeated neurosurgical examinations; includingrecords of repeated evaluation of the level of consciousness by Glasgow Coma Scale(GCS), to assess the severity of the injury, diagnosing the life threatening conditions, toprotect the brain from second trauma. This recognition needs precise clinical evaluationand imaging to differentiate the type of the injury: is it focal or diffuse, which needdifferent methods of treatment.

On the other hand (GCS) will help in classifying the head injury into minor(13,14,15 scores), moderate (9,10,11,12 Scores) and severe (8 or less scores)

(2)

, whichhave different outcome & may need different levels of care and treatment. The objectiveof scoring is to provide a uniform way of describing injuries, which can only be achievedby obeying the rules, this still requires practice, as there are many pitfalls for the unwary,clinical outcome in patients with minor head injury, might have been predicted fromhistory & clinical examination alone, and less than (1%) of these patients will develop anintracranial complication.The aim of this study is to audit two different methods of management of headtrauma patients in two surgical unites, to assess methods, which may improve theoutcome.

PATIENTS AND METHODS:

A retrospective review was undertaken of 160 patients admitted with headinjuries over aperiod of years from 1

April 2003 to 1

April 2004 ,in Sulemani Teaching Hospital.Demographic data obtained from the patients files ,study has been designed that may predictthe outcome of these two types of managements. Eiety patients (Group- A) managed in theauthors surgical unit and the rest (Group B) managed by a colleague surgeons in anothersurgical unit.Demographic details were extracted from action taken on basis of the finding wasnoted Comparative analysis between the two groups through multiple variables was doneto identify any different between them in the aspect of management and outcome