Mortality in childhood head injury in Ibadan.

The clinical records of patients who were 15 years and younger and who attended our casualty department between July 1989 and June 1990 because of head injury were retrospectively analysed in order to determine the mortality rate and evaluate the management of the patients prior to death. One hundred and sixty such patients were identified. They comprised 5.7% of the 2,812 children and 2% of all patients seen during this period. There were 20 deaths in this group, giving a mortality of 12.5%. This rate was greater than that for all patients in this age group (1.3%) and all age groups (1.2%) of patients attending the casualty department during this period. Whereas, children with head injury comprised 2% (160/8,192) of all patients, the deaths in this group comprised 19% (10/107) of all deaths in casualty during this period. Of the 12 patients for whom case records were available, 8 were seen elsewhere before referral. Four patients talked prior to death, suggesting the existence of a treatable mass lesion, while 8 patients were in coma from the onset of head injury to the time of death. Airway management was inadequate in all the patients. The interval to death was less than 2 hours in 7 patients. Only 4 of the patients were evaluated by the neurosurgical service prior to death. These observations suggest that: (1) head injury is a cause of high mortality among children attending our casualty department; (2) there are preventable factors contributing to death.