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Head injuries in Papua New Guinea
O Liko1, P Chalau, J V Rosenfeld
1Department of Clinical Sciences, University of Papua New Guinea, Port Moresby.
Papua and New Guinea Medical Journal
|June 1, 1996
Summary
Head injuries are a major cause of death in Papua New Guinea. Improved airway management by trauma-trained surgeons could reduce fatalities from head trauma.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Public Health
Background:
- Head injuries represent a significant cause of mortality in surgical wards and road accidents in Port Moresby.
- This study analyzes 274 head injury cases admitted to Goroka and Port Moresby over a decade, managed without advanced neuroimaging or monitoring.
Observation:
- The primary causes of head injury were motor vehicle accidents (49%), assaults (32%), and falls (17%).
- The overall case fatality rate was 21%, with higher mortality in patients with lower Glasgow Coma Scores (GCS).
- Specific injuries like subdural hematoma had a high fatality rate (67%).
Findings:
- Fatality rates correlated strongly with GCS scores: 81% for GCS 3-5, 21% for GCS 6-8, and 3% for GCS over 9.
- While most deaths were due to severe primary brain injury, some were avoidable, particularly those related to infection or associated trauma.
- Airway management emerged as a critical factor for improving outcomes.
Implications:
- General surgeons trained in trauma care, including emergency airway management, can effectively manage most head-injured patients in resource-limited settings.
- Enhancing diagnostic speed and quality of care, especially airway management, is crucial for reducing preventable deaths.
- This highlights the need for specialized trauma training for surgeons in regions facing high rates of head injury.