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BACKGROUND: Severe head injury is a major public health threatthat is the main cause of morbidity and mortality in all age groups ofthe world’s populations including Ethiopia. In view of this, this studywas assessed the severity of head injury and its contributing factors.METHODS: A Two-year retrospective study was conducted at DillaUniversity Referral Hospital, from December 2014 to November 2016.All head injury patients admitted to the surgical ward were included.Bivariate and multivariate regression analyses were used to identifyfactors associated with severity of head injury.RESULTS: A total of 106 eligible head injury patient charts werereviewed. The magnitude of severe head injury was 32.1%. Youngpopulations, mainly males, were the highest risk groups, and roadtraffic accident was the main cause of severe head injury. In adjustedanalysis, age interval greater than 45 years (aOR, 5.41; 95% CI:1.05-29.09), alcohol consumption before the trauma (aOR, 4.16, 95%CI:1.18, 14.61), delayed presentation (beyond 24 hours) after injury(aOR, 4.717; 95% CI: 1.02-21.81), and respiratory rate greater than30 breaths per minute (aOR, 7.34; 95% CI: 1.88-28.73) weresignificantly associated with severe head injury.CONCLUSIONS: Severe head injury remains an important publichealth problem. Young adults were the highest risk groups ofpopulations. Prevention of road traffic accidents, continuousawareness creation about the consequences of road traffic accidentand close neurological monitoring offered by neuro-intensive careunit are recommended.