Audit of the Management and Outcome of Severe Head Injury in Patients Admitted to Queen Elizabeth Central Hospital, Malawi
PD Kamalo

Abstract: A retrospective audit was carried out of the management and outcome of severe head injury (GCS 8 or less) in patients admitted to Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi in 2004. The aim was to look at the determinants of mortality and evaluate if improvements could be made in the management in order to reduce the mortality rate.

A total of 79 patients were admitted over this period. The overall mortality was 75% (59 patients). Of those who died 37% did so within 24 hours of admission. Over 50% of the patient who died had been admitted for at least 24 hours but died within 7 days of admission.

Probably the single most important observation related to the deaths occurring after 24 hours of admission was that most of the patients were not monitored closely.

Based on this audit were are:

1. Implementing the use of a Critical Care Pathway (CCP) to improve head injury patient monitoring.

2. Developing management protocols for head injuries in the resource constrained environment.

The audit results, CCP and the management protocols will be presented. The early results of a prospective study of the use of the CCP in head injury will be demonstrated.

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