Intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia

Neurotrauma, encompassing injuries to the brain, spinal cord, and peripheral nerves, is a significant public health concern in Ethiopia and sub-Saharan Africa. It is a major cause of death, disability, and socioeconomic burden, disproportionately affecting young individuals and their families.
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Patterns and management outcomes of intracranial extra-axial hematomas in low-resource setup: a 6-month prospective observational study at Jimma University Medical Center, Ethiopia - Egyptian Journal of Neurosurgery

Introduction Intracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomy and hematoma evacuations. No prior study was conducted in our setup. Hence, this study aimed to assess the patterns and management outcomes of intracranial hematomas in low-resource setting and tailored our management approach at Jimma University Medical center. Methods An institution-based prospective observational study was conducted at Jimma University Medical Center, Ethiopia, for six consecutive months from June to December 2020. Different data sources and interview methods were used and analyzed using SPSS version 24. A bivariate and multivariate logistic regression was conducted to determine the association between the variables. Results A total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 h. Upon presentation, there were loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%) and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed at 30 days after discharge and re-assessed, 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died. Conclusion Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Introduction

Intracranial hematoma is the collection of blood in various intracranial spaces. Knowledge of patterns, origins, causes, and outcomes of ICH conditions is important for decision-making for urgent surgical interventions such as craniotomies and hematoma evacuations.

Results

A total of 91 eligible patients were recruited during the study period, with a mean age of 34 years. The majority of patients were males [73 (80.2%)] and more common in reproductive age groups (62.6%), from rural areas (50.5%). About 93.4% of patients reported a history of trauma, and road traffic accidents & fighting account for 63.8% of the trauma cases. Sixty-five percent of patients arrive in the hospital within 24 hours. Upon presentation, there was loss of consciousness (48.4%), convulsion (11%), aspiration (9.9%), and increased ICP (12%). The majority (49.5%) of the patients had a mild head injury. The focal neurologic deficits were hemiparesis (29.7%) and hemiplegia (5.5%). Acute epidural hematoma (68.1%) was a common finding, followed by sub-acute subdural hematoma. Of the total study participants, 11% had died. All the surviving patients were accessed 30 days after discharge and re-assessed, of which 66 patients had good neurologic recovery (62 upper and 4 lower good recovery), 11 patients had moderate disability (7 lower and 4 upper-moderate disabilities), two patients had a severe disability, and two patients (among those with severe disability) had died. Conclusion Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration, and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

Conclusion

Trauma was invariably the cause of intracranial hematoma, and patients with low GCS, papillary abnormalities, aspiration, and increased ICP had an increased risk of dying from their illness. It is good to formulate policies to enhance injury prevention and bring about health-oriented behavioral change.

The full text is available at https://doi.org/10.1186/s41984-024-00272-x

Key points about neurotrauma in Ethiopia and sub-Saharan Africa:  

High burden: The incidence of neurotrauma is estimated to be several times higher than in high-income countries, due to factors like:

  • Road traffic accidents: A leading cause, often involving motorcycles, pedestrians, and inadequate infrastructure.
  • Violence and conflict: Unfortunately common in many regions, leading to gunshot wounds, head injuries, and spinal cord injuries.
  • Falls: Especially among children and older adults, due to unsafe environments and a lack of proper care.

Limited resources: Access to quality neurosurgical care is scarce, with a significant shortage of trained personnel, specialized equipment, and rehabilitation facilities. 

Delayed diagnosis and treatment: increase the risk of complications and long-term disabilities.

High mortality rates: particularly for severe injuries due to inadequate medical interventions. Socioeconomic challenges: Families of victims often face financial hardship due to lost productivity, medical bills, and long-term care needs.

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