Citation

Alexis RJ, Jagdish S, Sukumar S, Pandit VR, Palnivel C, Antony MJ. J. Emerg. Trauma Shock 2018; 11(3): 205-210.

Affiliation

Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, (JIPMER), Puducherry, India.

Copyright

(Copyright © 2018, INDO-US Emergency and Trauma Collaborative, Publisher Medknow Publications)

DOI

10.4103/JETS.JETS_127_17

PMID

30429629

PMCID

PMC6182969

Abstract

AIMS: This study aims to correlate the autopsy findings with the clinical picture and imaging report in fatal head injury patients. SETTINGS AND DESIGN: A descriptive study conducted at tertiary care hospital in South India from July 2015 to December 2016.

PATIENTS AND METHODS: All patients with head injuries who were admitted to our Emergency and Trauma Centre and underwent autopsy were included in the study. A structured pro forma was used for collecting information. Autopsy findings were considered as a gold standard to correlate with antemortem findings in fatal head injury. The data were analyzed with EpiData and OpenEpi statistical analyzing software.

RESULTS: Of the 303 fatal head injury patients, a majority were males and age group between 21 and 40 years. Eighty-eight percent (267/303) of fatal head injuries were due to road traffic accidents. Twenty-five of the 303 patients reached our center within 1 h (golden hour) of trauma. Of the 303 fatal head injuries, 153 (50.5%) died within 24 h of reaching our center. The most common autopsy finding in this study was subarachnoid hemorrhage (SAH) (247/303, 81.3%). Diagnostic accuracy of Epi dural hemorrhage (EDH) antemortem had the highest value (98.35%). SAH had least diagnostic accuracy value (45.72). subdural hemorrhage (SDH) had highest sensitivity (57.02%). EDH had higher specificity (100%). Significant SDH, SAH, and brain contusions were not detected during antemortem evaluation.

CONCLUSIONS: Our study revealed that among fatal head injury patients, half of them died within first 24 h after reaching to tertiary care center. Diagnostic accuracy to detect extradural hemorrhage antemortem had the highest value and SAH had least diagnostic accuracy value. Significant subdural hemorrhage, subarachniod hemorrhage, and brain contusion were not detected during antemortem evaluation. Expertise in interpretation of imaging, adequate clinical examination, proper documentation, and early resuscitation may reduce the chances of missed injuries in head injury patients.

Language: en

Keywords

Antemortem; autopsy; head injury; postmortem; traumatic brain injury