Pattern of Referrals of Head Injury to the University College Hospital, Ibadan

BACKGROUND Although there are now many neurosurgical units in Nigeria, cases of head injury (HI) continue to present in the University College Hospital, UCH, Ibadan, from hospitals all over the country. OBJECTIVE This report aims to highlight the contemporary patterns of referrals of cases of head injury for neurosurgery in Ibadan. METHOD The study emanated from an analysis of registry of cases of head injury managed in our practice covering a 7-year period at the UCH Ibadan. The clinical/ trauma-demography of cases of head injury referred were analyzed quantitatively and then compared with head injury cases that presented primarily to UCH Ibadan during the same period. An alpha value of <0.05 was considered significant for associations for pattern of referrals. RESULTS Of the 1034 cases of head injuries in the registry, 23.6% presented primarily to UCH, Ibadan; 423 (40.1%) were from outside Ibadan/Oyo state. Most of the cases were earlier seen in other health facilities in four out of Nigeria's six geopolitical zones including other teaching hospitals with practicing neurosurgeons. The reasons for these inter-hospital, inter-state referrals included absence of neurosurgical expertise (67%) or lack of other logistics like neuroimaging, bed space and intensive care unit services. Head Injury was caused by road accidents in more than 85% of the cases. The patients referred inter-state had more severe injuries, more delayed attainment of critical milestones in their trauma care, and higher frequency of neurosurgical operative interventions. They also had worse in-hospital outcome and longer length of stay. CONCLUSION The University College Hospital, Ibadan continues to play a pivotal role in the management of head injury in Nigeria. The results support an urgent need for stakeholders in the health sector to provide all that is required to uphold the status of the Hospital as a center of excellence in neurosurgery and neurosciences.