PRISE EN CHARGE ET DEVENIR DES TRAUMATISES CRANIENS HOSPITALISES AU CHU DE TLEMCEN EN 2009 ET 2010

Abstract

In the region of Tlemcen, head injuries are among the major public health problems, it is a brutal event that most often involves young adult men. This work has as objectives to determine the characteristics of hospitalized cases of traumatic brain injury in the CHU Tlemcen, to evaluate the mortality rate and to appreciate the functional, neurobehavioral and socio-occupational outcomes of the survivors. Materials and Methods This is an observational longitudinal clinical and epidemiological descriptive study. The patients included were all admitted to CHU Tlemcen for TBI in 2009 and 2010, whatever were their age, gender or severity of their brain injury. Among this population, 156 patients were evaluated 18 months after their trauma. Results Among the 377 patients enrolled in this study, we have 181 cases of severe head injuries, 53 moderate and 143 mild TBI. The mortality rate is estimated at 44%, and concerns only severe TBI, this rate represents 8 % of the deaths in our hospital. Some unnecessary imaging tests continue to be widely performed, in particular skull’s X-ray (79% of patients). The neurosurgery service is the first one concerned by the management of these patients (80% TC). After 18 months, 50% of severe TBI kept serious motor and cognitive sequelae, while the recovery is considered very good in 85% of mild head injury, but with persistence of subjective posttraumatic syndrome in 25% of them. The relation between the GCS in the admission and functional outcome is significant (P<10-3 ). The professional or school resumption concerns the patients with moderate or mild TBI after 2 months on average. Conclusion The monitoring of this cohort of patients with TBI has helped to give the first figures for head trauma in our region. The importance of this phenomenon and its many repercussions require the use of rigorous protocols and impose to work together to limit their consequences. Keywords Head injury - intensive care - neurosurgery - physiotherapy - outcome - disability - handicap – rehabilitation - Tlemcen