Outcome of Nonoperative Management of Selected Cases of Acute Traumatic Intracranial Hematomas in a Rural Neurosurgical Service of a Developing Country

Abstract

In resource-limited settings, the standard of care prescribed in developed countries for either operative or non-operative management of traumatic intracranial haematomas (TICHs) frequently has to be adapted to the economic and infrastructural realities. This study aims to present the outcome of selected cases of TICHs managed non-operatively without routine intensive care unit (ICU) admission, repeated cranial computed tomography (CT) scan or intracranial pressure (ICP) monitoring at a rural neurosurgical service in a developing country. This was a retrospective analysis of a cohort of our patients with cranial CT-confirmed TICHs selected for non-operative treatment from our prospective head injury (HI) register over a 42-month period. There were 67 patients (51 males) in this study with a mean age of 38.6 (SD,17.6) years, having mild HI in >half, (55.2%, 37/67) and anisocoria in 22.4% (15/67). Road traffic accident was the most common (50/67, 74.7%) trauma aetiology. Isolated acute- subdural haematoma, intracerebral haemorrhage, and epidural haematoma occurred in 29.9%, 25.4%, and 22.4% of the patients respectively. Only 2 of 8 patients in whom ICU admission was deemed necessary could afford admission. Repeat cranial CT scan was requested in 8 patients (8/67, 11.9%); only 5 of these could afford the investigation. The outcome of care was good in 82.1% patients (55/67). Increasing severity of the HI (p< 0.01) and presence of pupillary abnormality (p= 0.03) were significant predictors of poor outcome. In a Nigerian rural neurosurgery practice, non-operative management of a well-selected cohort of TICHs was attended by acceptable level of favourable outcome.