AGE RELATED PATTERN AND OUTCOME OF HEAD INJURY IN INDIGENOUS AFRICA

Background: Most studies of patients with head injury managed outside of indigenous Africa have shown poorer outcome with increasing age, but data on this subject is scanty in this part of the world. Aim: To determine age related pattern and outcome of head injury in an indigenous African setting. Methods: A retrospective analysis of clinical characteristics, mechanism of head injury, associated injury, trauma scores and outcome in patients admitted for head injury at the University Teaching Hospital, Ilorin, Nigeria, between 1989 and 1999. Results: The 648 patients comprised of 39 older subjects (= 60 yrs), 357 adults (17-59 yrs) and 252 children (= 16 yrs). They were aged 1 to 105 years (mean = 37years). Road traffic injury was the commonest cause of trauma to the head. Children were most often injured as pedestrians while adults and older patients were more often victims of passenger vehicular accidents. Older patients had the poorest outcome with a mortality rate of 48.7%. They were more prone to severe head injury (41.0%) and multi-system trauma (51.3%), with higher mean injury severity scores and lower probability of survival than younger patients. Outcome was predictable by age and GCS (p=0.0206 & 0.0000) in all age groups put together and in children while GCS was a predictor in adults (p =0.0000), and none of the variables could predict outcome in the older patients. Conclusion: The study reaffirms that outcome of head injury worsens with advancing age and indicates that severity of head injury and higher frequency of multi-system trauma may contribute to worse outcome in older patients.