Head injury management in a resource limited setting – a prospective analysis of head injury patients and their outcomes in a provincial hospital in Papua New Guinea

Head injury continues to be a common cause of morbidity and mortality worldwide in the 21st century despite advances in medical science and technology. The nations who continue to suffer the most are low to middle income countries with a heavy burden of trauma and limited availability of health resources. This prospective observational study was undertaken to investigate the demography and the management outcomes of patients who were managed in a limited resource setting in Papua New Guinea (PNG). Alotau Provincial Hospital was chosen as the provincial hospital in this study. A total of 67 patients were recruited into the study: 79% (n = 53) were males and 21% (n = 14) were females. The mean age was 20 years (s.d. = 15). Blunt injuries represented 84% (n = 56) of injuries while 16% (n = 11) were penetrating injuries. The causes of trauma were assault (39%, n = 26), accidental falls (33%, n = 22), falling objects (18%, n = 12), and motor vehicle accidents (10%, n = 7). Upon admission, the types of traumatic brain injuries (TBI) as measured by Glasgow Coma Scale (GCS) were mild TBI (76%, n = 51), moderate TBI (15%, n = 10), and severe TBI (9% n = 6). Out of the 67 cases, 45% (n = 30) had surgery while 55% (n = 37) had conservative management. The outcomes upon discharge were a disability rate of 5% (n = 3), with a mean length of hospital stay of 11 days. Fatalities were confined to patients with severe TBI with a case fatality rate for that group of 33% (n = 2). When comparing the other variables to the outcomes, GCS upon admission and operative versus conservative management had significance influence over the outcomes upon discharge. We conclude that severe head injury continues to be a cause of high mortality in PNG due to primary injury to the brain parenchyma, with resource limitations in the provincial hospitals in PNG compromising the effective management of these patients.