05 March 2005	Saturday	23 Muharram 1426

KARACHI, March 4: The ratio of per vehicle fatality in Karachi, which is 11.3 deaths per 10,000 road traffic accidents, is alarmingly higher then in most major cities of the world. This is in comparison with 1.4 deaths per 10,000 accidents in Tokyo, 2.8 in Manchester, and 10 in Bangkok.

Only in 2003, a total of 2,184 people were injured in road accidents in Karachi. Some 1,222 of them died. While out of 500 head injury patients admitted to hospitals, 54 per cent had suffered injuries road accidents.

This was stated by Dr Amir Saghir of the Department of Neurosurgery, Liaquat National Hospital Karachi, at the hands-on workshop on "Acute head injury management' held on Thursday. During the workshop, doctors were trained in the "Burr-hole model" technique to make a hole in the head to pick up a clot.

Talking on "overview of head injuries in Karachi", he further said pedestrians, passengers of public transport and cyclists were the ones most affected during road accidents.

Poor enforcement of traffic safety regulations, inadequate resources, administrative problems and corruption, and inadequacy of public health infrastructure in providing treatment for traffic injuries were the major causes of accidents, he added.

Consultant neurosurgeon Dr Salman Sharif gave talk on "red flags" and said 66 per cent of all multiple-injured patients suffered from head injury, which mostly had a lethal outcome.

In depressed skull fractures, he said elevation should be done if the depression was greater than the thickness of the skull. "CT shows degree of depression, intracranial haematoma or contusion," he added.

"Doing surgical measurement in scalp wounds, hair around the wound should be cleaned, shaved. Wounds over the superior sagittal sinus or other major venous sinuses should be treated by a neurosurgeon," he opined.

"Adequate oxygenation should be ensured and blood pressure be maintained to perfuse the brain. Identification of a mass lesion should be made through CT scan and early treatment must be started," he told.

Talking about emergency burr holes, he said majority of patients did not have haematomas, and 2 cm from a haematoma might not locate it. "Haematomas cannot be adequately evacuated through a burr hole as blood is often clotted; that may cause brain damage or haemorrhage," he added.

He described the danger in head injury patients and the ways to reduce death and disability by detecting high risk patients. "Mortality and morbidity can be halved if these patients are managed according to guidelines set by the neurosurgical society," he said, stressing the use of helmets and seatbelts while driving.

Consultant neurosurgeon Dr Rafay Zafar described various presentations of head injuries and ways to handle them at the acute phase. "History of a patient including period of loss of consciousness, period of post-traumatic amnesia, cause and circumstances of injury and presence of headache and vomiting can be helpful in assessing of head injuries," he added.

"If a CT is available, time should not be wasted with an X-ray of the skull. Indications for doing a CT scan include history of loss of consciousness or impaired consciousness at the time of examination," he noted.

For comatose patients with unstable systemic state, a CT scan done locally may prevent a hazardous transfer to a neurosurgical unit, he added. Dr Ejaz Aslam showed a video and described the technique of making an emergency burr hole for brain clot. He showed various means of making burr holes.

Earlier, Director Skills Lab Dr Mabroor Bhatti delivered the welcome address and introduced its aims and objectives. In the workshop, burr-hole models were used for the first time in Pakistan to train surgeons to improve their expertise in managing acute head injury patients. -PPI