Pediatric traumatic brain injury in chad: about 256 cases

Abstract Purpose Pediatric traumatic brain injury (PTBI) is a frequent pathology in the pediatric environment and remains a public health concern in the world. PTBI is the leading cause of death and severe disability in children in countries with limited pediatric trauma legislation. The objective is to report the experience of the management of PTBI in children in Chad. Methods This report is a prospective study of 256 patients admitted for PTBI over a year period. Result The incidence was 19.09%. The mean age was 6.2 years with extremes of 1 day and 15 years. The male represented 68.8% with a ratio of 2.2. The transport of the injured patients to health facilities using other means than ambulances in 87.5%. Initial loss of consciousness (IOL) accounted for 79.1% and coma seizures for 34.37%. Public road accidents accounted for 64.5% of causes. Severe traumatic brain injury (TBI) accounted for 24.2%. The cerebral scanner was performed in 37.9% of cases and had shown the association of craniocerebral lesions in 10.1% of cases. Craniocerebral wound trimming was the most common surgical procedure performed in 21.8% of cases, followed by removal of the depressed fracture of skull in 6.2% of cases. Mortality rate was 9% and sequelae 5.4%. Conclusion PTBI is a frequent neurosurgical pathology in the pediatric setting in Chad. The absence of health insurance in our context makes access to care and radiological examinations very difficult. The prognosis was conditioned by the rapidity of the management and the initial loss of consciousness

Particularities of ballistic spinal injuries and management in an African context (Chad): Study of 27 cases

The frequency of ballistic spinal injuries is rising in developing nations around the globe. These injuries lead to a functional prognosis linked to disabling sequelae and vitals in patients, which often results in serious complications and death.This study describes the epidemiological, diagnostic, therapeutic, evolutionary characteristics of Ballistic Medullar-Vertebral trauma (BMVT). It presents the particularities of management in the sub-Saharan African country of Chad.This is a prospective descriptive study of 27 ballistic spinal injury patients conducted over an 18-month period.Ballistic Medullar-Vertebral injuries (BMVI) represented 12.9 % of spinal trauma. The average age of the patients was 31.8, and 40.7 % were between 31 and 40 years of age. Military personnel represented 78 % of the patients. 44.4 % of cases came from the Lake Chad region. 59.3 % of injuries were caused by Kalashnikov’s (AK 47) firearms. 74.1 % of cases were admitted to the emergency department within 12 to 24 h. The diameter of the wounds that corresponded to the entry orifice of the bullet was between 1 and 2 cm in 59.25 % of the cases. A Dural breach was found in 14.8 %. 48.1 % had ASIA C score and none of them met the criteria for spinal cord injury collection and immobilization. The lumbosacral location was reported in 55.6 %, and the type I Roy Camille fracture was found in 70.37 %. Surgical management was performed in 88.9 % cases. Multidisciplinary management of the associated lesions was performed in 25.9 %. 7.4 % of patients with cervical trauma died due to septic shock.Delayed emergency department admissions and limited access to medicalized transportation are main factors to BMVI in Chad. Lesion is predominantly located in the lumbosacral region. Lesions and spinal cord involvement were factors of poor vital and functional prognosis. Surgery plays an important role in management. Socio-professional reintegration remains problematic