Prise en Charge Initiale des Traumatismes Crâniens de l’Adulte au Service d’Accueil des Urgences d’un Hôpital à Vocation de "Trauma Center" de Libreville

ABSTRACT Introduction. Injuries are the leading cause of death before the age of 45 years and head injuries account for the greatest part of post traumatic mortality and morbidity. The objective of our work was to assess the initial management of head injuries in adults at the accident and emergency service (AES) of the Centre Hospitalier Universitaire d’Owendo (CHUO) which is acting as a "trauma center" in Libreville. Patients and methods. This was a cross-sectional and prospective study carried out from January 1 to March 31, 2017 at the AES of the CHUO. All patients aged 15 years and above who consulted or were admitted in the wards for traumatic brain injury during this period were included. The variables of interest were: epidemiological and clinical data, time delay between injury and arrival at the AES. Management, length of stay in the ward and outcome of the patients were also analyzed. Results. Thirty-three patients were enrolled (26 male and 7 female). Their average age was 31.96 years (SD: 10.28). Road traffic accidents were the most common etiology (51.5%). Five patients (15%) had serious head injuries. Hemodynamic disorders were present in 23 patients (70%). The average time before initiation of care was 2 h 15. The average delay before the performance of CT was 3 hours and 40 minutes. Conclusion. Head injuries affects mainly young males. The main cause is road traffic accident. The management is largely suboptimal and the prognosis is serious. RESUME Introduction. Les traumatismes sont la premiere cause de mortalite avant 45 ans et l’atteinte cerebrale est responsable de la plus grande partie de la mortalite et de la morbidite post traumatique. L’objectif de ce travail etait de decrire la prise en charge initiale des traumatismes crâniens chez l’adulte aux urgences du CHUO. Patients et methodes. Il s’agit d’’une etude transversale descriptive et prospective realisee du 1er Janvier au 31 mars 2017 aux urgences du CHUO. Tous les patients âges de plus de 15 ans ayant consulte ou ayant ete hospitalises pour traumatisme crânien durant cette periode ont ete inclus. Les variables d’etudes etaient : les donnees anamnestiques, epidemiologiques et cliniques, les delais entre l’accident et l’arrivee aux urgences. La prise en charge, le devenir des patients et le delai de sejour aux urgences ont egalement ete releves. Resultats. Trente-trois patients ont ete colliges (26 hommes et 7 femmes). Leur âge moyen etait de 31,96 (ecart type : 10,28 ans). Les accidents de la voie publique etaient l’etiologie la plus frequente (51.5%). Les traumatismes crâniens graves representaient 15% des cas. Les troubles hemodynamiques etaient presents chez 23 patients (70%). Le delai moyen de prise en charge des patients apres la survenue du traumatisme etait de 2 heures 15 minutes. Le delai moyen de realisation de la tomodensitometrie etait de 3 heures 40 minutes. Conclusion. Les traumatismes crâniens affectent surtout l’homme jeune. Les accidents de la voie publique en sont la premiere cause. La prise en charge du traumatisme crânien pose encore d’enormes problemes dans notre contexte et la mortalite est elevee.