Intracranial findings in head injury patients who died at the University Teaching Hospital Lusaka,Zambia

The purpose of this study was to determine the missed diagnosis of potentially treatable intracranial lesions in patients who died of head injury.
Two hundred and fifty three patients were admitted to the University Teaching Hospital with head injury in 1996,of these eighty (31.6%) died. Fifty four (67.5%) had autopsy and the incidence of intracranial haemorrhage was forty eight (88.9%). Of the 54 deaths, where autopsy was done, 10(19%) had favourable prognostic factors such as a glascow coma scale of 6-14 and minor body injuries and were therefore salvagable by aggressive, investigation and management facilities. Intracranial lesions are easily detected by diagnostic radiology such as Carotid Angiography and Computerised Tomography scanning which are lacking at this hospital.
Only seven of the eighty patients who died had localising signs on admission and two had exploratory burr hole surgery. In the remaining five cases surgery was not done due to indequate evaluation.
In a major referral hospital such as the University Teaching Hospital, it is important that the services provided are backed by proper diagnostic facilities if patient care is to improve.