title: Head injury triage in a sub Saharan African urban population.
abstract: BACKGROUND
  Injuries are the ninth leading cause of death in the world and disproportionately affect low- and middle-income countries. Head injury is the leading cause of trauma death. This study examines the epidemiology and outcomes of traumatic head injury presenting to a tertiary hospital in Malawi, in order to determine effective triage in a resource limited setting.
  
  
  METHODS
  The study was conducted at Kamuzu Central Hospital (KCH) in Lilongwe Malawi during a three-month period. Vital signs and Glasgow Coma Score (GCS) were prospectively collected for all patients that presented to the casualty department secondary to head injury. All head injury admissions were followed until death or discharge.
  
  
  RESULTS
  During the three-month study period, 4411 patients presented to KCH secondary to trauma and 841 (19%) had a head injury. A multivariate logistic regression model revealed that GCS and heart rate changes correlated strongly with mortality. There is a four-fold increase in the odds of mortality in moderate versus mild head injury based on GCS.
  
  
  CONCLUSIONS
  In a resource limited setting, basic trauma tools such as GCS and heart rate can effectively triage head injury patients, who comprise the most critically ill trauma patients. Improvements in head injury outcome require multifaceted efforts including the development of a trauma system to improve pre-hospital care.
authors: Department of Surgery, University of North Carolina, Chapel Hill, NC 27599-7050, USA. jsquresh@gmail.com
authors: Javeria S
authors: JS
authors: Qureshi
authors: Rebecka
authors: R
authors: Ohm
authors: Henrik
authors: H
authors: Rajala
authors: Charles
authors: C
authors: Mabedi
authors: Omid
authors: O
authors: Sadr-Azodi
authors: Åke
authors: Å
authors: Andrén-Sandberg
authors: Anthony G
authors: AG
authors: Charles
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D014218:Triage / Q000379:methods*; D014505:Urban Population / Q000706:statistics & numerical data*