Impact of intracranial pressure monitoring on mortality in severe head injury at The Aga Khan University Hospital and The Nairobi Hospital
Date of Award
Master of Medicine (MMed)
General Surgery (East Africa)
Background: Traumatic brain injury is a major public health problem both in developed and developing nations. It is a particular challenge and a strain on the economy of the developing nations because of the high rates of road traffic accidents, affecting mainly the economically productive age group.
World-wide mortalities from severe head injuries range between 39-52% and in our country is estimated at 60%, although it might actually be higher.
Patients with severe head injury (defined by a Glasgow Coma Score from 3 to 8) are at highest risk of developing raised intracranial pressure and therefore, are more likely to benefit from an intervention that aims to control intracranial pressure. In the developed world, with organized trauma care systems, studies have shown that intracranial pressure monitoring has shown a significant decrease in mortality from severe head injury, and intracranial pressure monitoring has thus become the standard of care.
Though intracranial pressure monitoring started in 1960 in the developed world, it has only become available at the Aga Khan University Hospital in 2009. Its routine use in traumatic brain injury has not been fully embraced and there are no clear guidelines on its use in trauma. Its utility has thus not been validated. It is believed that due to the delays in referral and intervention, intracranial pressure monitoring might not be of benefit in traumatic brain injury in our country.
Objectives: The purpose of the present study was to determine the impact of introducing intracranial pressure monitoring and drainage on the mortality from severe head injury and comparing mortality from the period before monitoring intracranial pressure(pre-2009)with mortality after instituting intracranial pressure monitoring and drainage(2010 and after).
Study question: With the challenges in trauma care and referral, does intracranial pressure monitoring actually improve mortality in severe head injury?
Design: A before and after study comparing a retrospective period before 2010 with a prospective period from 2010-2012 for patients admitted with severe head injury (Glasgow Coma Scale score of 3-8) at the Aga Khan University Hospital, Nairobi and the Nairobi Hospital.
Methods: Retrospective data was analyzed from 42 patients with severe head injury (Glasgow Coma Score of 8 or less) admitted between 2007 and 2010, who did not have intracranial pressure monitoring, and their mortality was compared with the outcomes of 31 patients admitted between 2010 and 2012 with severe head injury who did receive intracranial pressure monitoring as part of their treatment.
Analysis: Data was analyzed by chi square for comparison for categorical variables and analysis of variance (ANOVA) for continuous variables. Statistical analysis was done by STATA version 10 for windows.
Results: The present study revealed an overall mortality of 49% from severe head injury. The mortality in the group that had intracranial pressure monitoring was 32.5% and in the group that didn’t have intracranial pressure monitoring it was 60%.Seventy one per cent (71%) of the overall mortality was in the group that didn’t have intracranial pressure monitoring, as opposed to 28% in the group that had monitoring. The present study showed a statistically significant reduction in mortality with the use of intracranial pressure monitoring in the management of severe head injuries. The following variables significantly affected outcome (P<0.05): Glasgow Coma Score of 3-5, intracranial pressure monitoring and receiving surgical intervention.
Conclusion: Intracranial pressure monitoring and aggressive management reduces mortality in severe head injuries, particularly in the patients with Glasgow Coma Score of 3-5.
Mohamed, A. N. (2012). Impact of intracranial pressure monitoring on mortality in severe head injury at The Aga Khan University Hospital and The Nairobi Hospital (Unpublished master's dissertation). .
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