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Abstract
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AIMS AND OBJECTIVES: To study the correlation between the epidemiological factors (age, sex, occupation, mode of injury), risk factors, clinical indicators (GCS), requirement of mechanical ventilation, and mortality rate with the cranial computed tomographic findings in patients with traumatic brain injury.
Materials and Methods: A prospective, clinical observational study was developed with 203 patients at department of EMERGENCY medicine, Government medical college and new civil hospital, Surat, Gujarat, India. Eligible patients were given a Glasgow coma score and submitted to computed tomography within the first 12 hours following injury.
Results: The maximum number of cases was within the age group of 21 - 30 years (38%). The minimum age of the patient in our series was 18 year and the maximum age was 72 year. The mean age was 34 year, with prevalence of male patients (86%). Maximum number of patients were labourers (35%) followed by farmers (20%). Road traffic accident was the most common mechanism of injury (55%), followed by pedestrian struck by vehicle (20%), fall from height (13%), and assault (12%). Blast injury or firearm related traumatic brain injury was not reported in our study. Road traffic accident was the most common mechanism of injury (66%) in young age group. Most common risk factor related to trauma found in our study was unconsciousness (67%). Most common risk factor which is not related to trauma found in our study was Alcohol intake/smoking habit (24%). 51% patients presented with scalp laceration. 49% patients presented with had mild TBI, 25% patients presented with moderate TBI and 26% patients with severe TBI while in patients above 50 years of age, 53% patients had severe head injury, 31% patients had mild head injury and 16% patients had moderate head injury. Out of 203 patients, 31% patients had no abnormality on CT scan. All patients with severe TBI had abnormal findings on CT scan. 60% patients with mild TBI and 6% of patients with moderate TBI had normal CT scan findings. Over all Most common CT findings are skull fractures (36%), subarachnoid haemorrhage (31%), brain contusions (30%), brain oedema (28%), and subdural haemorrhage (18%). Out of all skull fractures, linear fractures were more common. Only 17% of patients below 50 years of age had 3 or more findings on CT scan as compared to about 71% of patients above 50 years of age. Requirement of mechanical ventilation was found in 3% of patients with mild TBI, 20% patients with moderate TBI and 70% patients with severe TBI. 92% patients were managed conservatively and 8% patients required operative management. 72% patients showed improvement and were discharged, 21% patients were expired during the course of treatment. Follow up was not possible for 7% of patients.
Conclusion: Statistical significance was observed in the correlation between the Glasgow Coma Scale, Age > 50 years (p = 0.0001), Need for mechanical ventilation (p = 0.0001), CT findings and mortality rate (p = 0.001).
Keywords: Traumatic Brain Injury; Glasgow Coma Scale; Epidemiology; Computed Tomography
Language: en |