Risk Factors Related to Hospital Mortality in Kenyan Patients with Traumatic Intracranial Haematomas

Background: The aim of this study was to investigate the factors which influence mortality of patients with traumatic intracranial hematomas (ICH).
Methods: Following ethical approval, the records of patients admitted to the Kenyatta National Hospital neurosurgical unit between January 2000 and December 2009 and who were diagnosed with traumatic ICH were retrieved and reviewed. The outcome measured was mortality during admission. Analysis was done using Statistical Package for Social Sciences (SPSS) version 12.
Results: During the study period, 608 patients were admitted with a diagnosis of traumatic intracranial haematoma. 89.3% were male and 10.7% female with a mean age was 35.33 years (+/- 17.420). 59.3% of patients with preoperative GCS scores of <8 died, while only 11% and 3% deaths occurred in the patients with moderate and mild head injury respectively. 70.4% of patients with unreactive pupils died as compared to 7.5% of patients with bilaterally symmetrical reactive pupils (p=0.002). There was a statistically significant increase in mortality in patients who did not undergo surgical intervention (26.1%; p=0.000) as compared to those who were operated (15.7%; p=0.000). The mean time from accident to surgery was 3 days. Patients who were operated on more than 4 days after the initial trauma had a mortality of 42.1% as compared to 9.3% for patients operated on within 24 hours.
Conclusion: An increased risk of death was observed in patients who are over 61 years of age, have lower preoperative GCS, the presence of pupillary abnormalities and a long interval between trauma and decompression.