Out come in Head Injured patients : Experience at a level 1 Trauma Centre

Abstract

Traumatic brain injury (TBI) is the leading cause of death. Evidence-based guidelines for TBI care have been widely discussed, but in-hospital treatment of these patients has been highly variable. We carried out this study to evaluate outcome in patients with head injuries in relation to post-resuscitation GCS score, at a Level 1 trauma centre. A secondary objective was to look for epidemiological factors responsible for these head injuries. In this retro-prospective study, all patients with head injury who were admitted in the department of neurosurgery at JPNATC in last 15 months period were enrolled. Post-resuscitation GCS was considered as baseline and outcome was assessed at discharge using GOS. All patients were managed as per laid down departmental protocols. Total 2068 patients of head injury were enrolled during the study period. Age ranged from 1 – 80 yrs, 71.4% was male and 28.6% were female. The most commonly involved age group was 20–40 yrs (43%) and the most common mode of injury was road traffic accidents (64%). 53% of the patients had severe head injury (GCSd″8), 18% had moderate head injury (GCS 9 to d″13) and 29% had minor head injuries (GCS e″14). 17 patients had penetrating head injury, and 13% had compound head injury. The mean hospital stay was 14 days (range 1 – 62 days). Overall in-hospital mortality was 22% (454 cases), of these 38% were children. Amongst all, 2% of minor head injury, 12% of moderate head injured and 36% of severely head injured patients were expired; 28% of compound and 29% of penetrating injury patients died. Of the patients who expired, 39% died within 48 hrs of injury. Amongst those who survived, 28% had good outcome and 19% remained in vegetative state. Our outcome rates for head injured patients compare favorably with international data. This is the first study of its kind from India, which shows mortality rates and outcome in patients with head injuries.

Keywords

head injury - mortality

• References

• 1 Jennett Brian, Teasdale G, Braakman R. et al Predicting outcome in individual patients after severe head injury. Lancet 01 1976; 1031-1034
• 2 Gómez PA, Lobato RD, Boto GR. et al Age and outcome after severe head injury. Acta Neurochir 142 2000; 373-381
• 3 Lanzino G, Kassell NF, Germanson TP. et al Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?. J Neurosurg 85 1996; 410-418
• 4 Vollmer DG, Torner JC, Jane JA. et al Age and outcome following traumatic coma: why do older patients fare worse?. J Neurosurg 75 Suppl 1991; S37-S49
• 5 Kagan RJ, Baker RJ. The impact of the volume of neurotrauma experience on mortality after head injury. Am Surg 60 1994; 394-400
• 6 Fakhry SM, Trask AL, Waller MA, Watts DD. Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma 56 2004; 492-499