The pattern and early outcome of paediatric cranial-cerebral injuries managed at Kenyatta National Hospital

Abstract

This is a prospective study of children below 13 years with head injuries, seen at the Kenyatta National hospital over a period of five months from October 2004 to February 2005. A total of 101 children were managed 64 males and 36 females (Male: to female ratio was 1:7: 1). Their mean age was 4.9 years (range 3months-12years). The commonest cause of head injury was fall from a height (65.3%) followed by road traffic accident (26.7%) and assaults (7.9%). Most of the falls were from balconies (57.6%). The mean time interval between trauma and admission into hospital was 7 hours. Most of the patients were admitted with mild head injuries (83.2%) while 8.9% had severe injuries. Skull radiographs were done in 95% of the cases and were positive for skull fractures in half of them. Computerized tomography (CT) scan of the head was done in only 24% of the patients. The clinical indicators for a CT were good predictors of intracranial injury (ICI). 6 patients with ICI had no skull fracture. 21 patients had cranial surgery 10 of who had a surgical toilet. 5 patients had extra cranial surgery. Factors that were associated with poor outcome in the first 24 hours of admission were admission Glasgow coma score, papillary signs, focal neurological signs and CT signs of brain injury. The average duration of hospital stay was 7.2 days. There was a 1% overall mortality and a 13 % poor functional outcome at discharge.