Assessment of the prognostic value of Helsinki computer tomography score in severe traumatic brain injury patients at Kenyatta National Hospital.
Abstract
Background: Head injury is usually considered as a silent epidemic and continues to exist as
an everlasting consternation conferring high mortality and disability worldwide. In the early
assessment of patients with injury to the head, the computer tomography(CT) is of utmost
importance and millions of CT scans are conducted yearly. These CT scans contain
information which can be used to determine the patient's prognosis and to form a baseline in
identifying risk in clinical trials. The Helsinki computer tomography scoring classification
was created in 2014 as a tool for determining outcomes in those patients with TBI. In Kenya,
severe TBI accounts for 10.3% of all brain injuries seen at the Kenyatta National Hospital
and 14.3% of all adults admitted at the Critical Care Unit. The Helsinki computer
tomography score being the latest in the armamentarium of outcome predictors and having
outperformed previous CT scoring system in the European and Asian subcontinent, it will be
necessary to assess its capacity to predict outcome in the African subcontinent on severe
traumatic brain injury patients and hence guide clinical decision making.
Objectives: This study assessed the prognostic value of the Helsinki Computer Tomography
score among patients with severe traumatic brain injury.
Methodology: Following ethical approval, a prospective observational study involving forty
two patients above 18 years of age with severe TBI were recruited by convenience sampling
at the Kenyatta National Hospital Accident and Emergency Department and Critical care
units over a period of four months(October 2019- January 2020). Clinical parameters of
blood pressure, pupillary reactivity, random blood glucose, age, GCS and Helsinki computer
tomography(CT) score were evaluated at admission and subsequent follow up done at 6
weeks for Glasgow outcome scoring. Data was collected using a structured questionnaire and
recorded in excel sheets and analysis done using Statistical Package for Social Sciences
version 23.0.
Results: A total of 42 patients were recruited with 90% males and mean age of 33 years old.
Overall mortality was 64.3%. RTA was the commonest mode of injury at 64% followed by
assault at 26% and falls at 10%. Patients with non reactive pupil had mortality of 67% while
slow reacting pupil had 63%. Patients with systolic BP > 90 mmHg comprises 95% of the
study population with a resultant mortality at 67.5%. The most common random blood
glucose level was < 10 mmol/l at 80% with a mortality of 58.8%. Patients with GCS of 3-4
had the highest mortality of 100% while GCS of 7-8 lowest mortality of 60.9%. GCS of 3-4
had no favourable outcome at 6 weeks while GCS 7-8 had favourable outcome in 30.4%. The
Helsinki CT score of 4 had mortality of 33.3% while Helsinki CT score of 11 had mortality
of 100%. Patients with contusions and intracerebral hematomas had mortality of 80% while
in ASDH and EDH the mortality were 53.8% and 44.4% respectively. In correlation analysis
the Helsinki score was significantly associated with GOS at 6 weeks(p=0.004), and
death(p=0.009). Age was significantly correlated with 6 weeks GOS(p=0.03) and
mortality(p=0.02). Systolic BP was only associated with mortality at p value of 0.043. The
other clinical parameters did not show any statistical significance with both 6 weeks GOS and
mortality. The specificity, sensitivity and accuracy for Helsinki CT score for mortality were
88.9%, 53.3% and 71% respectively; and for an unfavourable outcome, these values were
81.8%, 55.6% and 69% respectively. After performing logistic regression analysis to
determine the predictors of outcome, we found that the odds ratio(OR) for the Helsinki CT
score to predict mortality to be 9.1(95% CI 1.9-44) and unfavourable outcome at 5.6(95% CI
1.2-27.4).
Conclusion: Severe TBI carries a high mortality and disability in Kenya. The age of patient,
the systolic blood pressure on admission and the initial Helsinki CT score were significant
predictors of outcome(p < 0.05). The Helsinki CT score correlated well with the clinical
parameters at predicting outcome.
Recommendations: A change to new computer tomography scoring system may be
warranted and the Helsinki CT score can be used as a predictor of outcome in Kenyan
hospitals and in our African population. Future studies comparing the different computer
tomography scores available in correlation with clinical parameters on predicting outcome
should be done as a multi-center study.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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