Abstract

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

References

1. Injuries-violence-facts-2014-WHO (2014).
2. Ake Grenvik., et al. “Management of Traumatic Brain Injury in the Intensive Care Unit”. Critical Care (2000): 322-326.
3. Agrawal A., et al. “Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India. 2007-2009”. International Journal of Critical Illness and Injury Science 2 (2012): 167- 171.
4. Morgado FL and Rossi LA. “Correlation between the Glasgow Coma Scale and computed tomography imaging findings in patients with traumatic brain injury”. Radiologia Brasileira 1 (2011): 35-41.
5. A Study of Referral System for EmOC in Gujarat. Mona Gupta, Dileep Mavalankar, Poonam Trivedi W.P. No (2009).
6. GH Yattoo and Amin Tabish. “The profile of head injuries and traumatic brain injury deaths in Kashmir”. Journal of Trauma Management and Outcomes 2 (2008): 5.
7. Tien HC., et al. “Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival?” Journal of Trauma 60 (2006): 274-278.
8. Signorini DF., et al. “Predicting survival using clinical variables: a case study in traumatic brain injury”. Journal of Neurology, Neurosurgery, and Psychiatry 66 (1999): 20-25.
9. Schreiber MA., et al. “Determinants of mortality in patients with severe blunt head injury”. The Archives of Surgery 137 (2002): 285-290.
10. Bhatoe HS. “Brain Injury and prehospital care: Reachable goals in India”. Indian Journal of Neurotrauma (IJNT) 6 (2009): 5-10.
11. Knudson P., et al. “Improving the field triage of major trauma victims”. The Journal of Trauma 28 (1988): 602-606.
12. Bhole AM., et al. “Demographic profile, clinical presentation, management options in cranio-cerebral trauma: An experience of a rural hospital in Central India”. Pakistan Journal of Medical Sciences 23 (2007): 724-727.

Citation

Citation: Ritesh Gajjar and Mehul Modi. “The Corelation Between Epidemiology, Glasgow Coma Scale and Computed Tomography Findings in Patient with Traumatic Brain Injury : A Prospective Analysis from A Tertiary Care Centre in A Developing Country”.Acta Scientific Neurology 3.1 (2020): 43-48.

Copyright

Copyright: © 2020 Ritesh Gajjar and Mehul Modi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.