Computerized tomography in acute head injury the Nairobi experience

Abstract

Head Injury is a common problem in Kenya. CT Scanning is known to be a useful imaging modality for the evaluation of this problem. It provides a more informative way of investigating this condition than plain films of the skull, and is less traumatic than care;tid angiography. One hundred and sixty patients, who presented for CT Scan of the head after Acute Head Trauma, were studied prospectively at a private CT Scanning facility in Nairobi, Kenya. The study was carried out over a one year period between October 1, 1990 and September 30, 1991. The types of trauma, modes of presentation, delay in scanning and patterns of pathology encountered were studied. In addition, correlation between level of consciousness, using the Glasgow Coma Scale, and CT findings, use of surgery and mortality was attempted. Road Traffic Accident accounted for the majority of trauma (52.5 %), followed by assault (28.1 %) and falls (10.6%). Only 18.8% of patients were scanned within 48 hours of Ole trauma. This was felt to pose a significant problem to patient care. Decreased level of consciousness (39.3 %), headache (25 %) and con fusion (24.3 %) were the commonest presenting symptoms. 68.8% of patients had no evidence or lateralising signs on examination. 25% of all scans were normal. Intracranial haemorrhages were common findings. Contusion injuries and generalised brain oedema were also frequently seen. Midline shift, compression of the basal cisterns and sub arachnoid haemorrhage were all found to be more frequent in patients with severe coma. 9 Significant intracranial pathology, was often associated with the absence or a skull vault fracture, and this emphasises the superiority of CT over plain skull films. Patients with severe coma were found to be more likely to undergo surgery and to have a fatal outcome. CT was found to have an overall accuracy of 96% when compared with surgical findings. CT was found to be a useful, accurate diagnostic tool ill evaluation of Acute Head injury. Its introduction at the Kenyatta National Hospital, will aid the management of these patients. The severity of coma, assessed by use of the Glasgow Coma Scale,is or use in predicting severity of injury, necessity for surgery and mortality. Its continued use is thus recommended. ..