Head Injury Patients Research Articles

Head injuries in prehospital and Emergency Department settings: a prospective multicenter cross-sectional study in France

BackgroundHead injuries are the leading cause of trauma in Emergency Departments (EDs). Recent studies have shown epidemiological changes in patients consulting ED for head injuries. The main objective of this study was to describe the profile of head injury patients consulting in the EDs in France and assess i) head injury severity across age groups; ii) the delay between the occurrence of head injury and ED arrival; iii) factors associated with traumatic intracranial hemorrhage (ICH).MethodsThis cross-sectional study collected patient data over a three-day period in March 2023. All adult patients (≥ 18 years old) admitted to the ED with a head injury (defined as a trauma to the head) were included. TBI severity was classified according to patients’ initial Glasgow Coma Scale score in the ED: severe (3–8); moderate (9 -12); mild (13–15); and simple head trauma in the absence of transient or persistent neurological symptoms.ResultsAmong the 71 participating EDs, 26,008 patients visited EDs and a total of 1070 patients (4.1%, IC 95 3.9—4.4) presented a head injury were included in the study, with a median age of 68.5 [37–85] years old. Most of the patients (66.7%) were referred to ED after a call to the Emergency Medical Dispatcher (EMD). The median time from head injury to ED visit was 2 h [1.0 – 5.5]. Ground-level falls were the leading cause of head injury (60.3%). Most of patient presented a simple head trauma (n = 715, 66.8%) followed by mild TBI (n = 337, 31.5%). CT head scans were performed for 636 patients (59.6%), of which 58 were positive. Traumatic ICH prevalence was 5.4% (95% CI: 4.1–6.9) and three patients (0.3%) required an urgent neurosurgical intervention. Neither preinjury anticoagulant (p = 0.97) nor antiplatelet (p = 0.93) use was associated with an increased risk of traumatic ICH.ConclusionsOne head injury patient out of two presenting in the ED is aged over 65 years. Patients referred by EMD were more likely to visit ED promptly. The majority of older patients underwent a head CT scan and preinjury anticoagulant use was not associated with increased risk of traumatic ICH.

Serum Glial Fibrillary Acidic Protein and S100B Profiles in Severity and Outcome Assessment of Moderate and Severe Head Injury Patients in India

Abstract Background: Traumatic brain injury (TBI) is a significant global health issue, with India witnessing approximately 150,000 deaths and 50,000 TBI-related fatalities annually. Severity is classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS). Imaging and blood biomarkers such as serum glial fibrillary acidic protein (GFAP) and S100B aid in diagnosis and outcome prediction, yet imaging facilities are scarce in India. This highlights the necessity for dependable biomarkers. GFAP indicates astroglial injury, while S100B suggests neuronal injury, both in TBI patients’ blood. However, their associations and utility in the Indian population require further exploration. Our study addresses this gap by examining serum GFAP and S100B levels in moderate and severe TBI patients, correlating them with radiological findings and clinical outcomes. Methodology: This prospective observational study was conducted in a tertiary care hospital on 212 patients (106 each for moderate and severely injured groups). Initial disease severity was assessed by GCS score. Outcome assessments were required of surgical intervention and mortality within 5 days. Results: S100B superseded GFAP in assessing disease severity. Receiver operating characteristic analysis showed that S100B was successful with 66% sensitivity and specificity for a cutoff value of 78.77 pg/ml. For early mortality prediction, sensitivity (S100B = 81%–87%, GFAP = 64.1%–78.6%), specificity (S100B = 60.2%–99.2%, GFAP = 54.5%–74.6%), and area under the curve-wise (S100B = 0.721–0.909, GFAP = 0.614–0.763) S100B model performed better than the GFAP model for all corresponding cutoffs (ranged S100B = 86.53–118.56 pg/ml, GFAP = 30.87–34.5 ng/ml). Conclusion: Taken together, our study provides strong evidence that S100B is a better marker of severity and outcome assessment than GFAP.

A Study of Skeletal Survey Disparity in Pediatric Head Injury in the Emergency Department.

The objective of this study was to evaluate disparities in skeletal survey (SS) use for pediatric. head injury patients in the emergency department (ED). This was a multi-site retrospective. cohort study of children <24months with concern for head injury and injury on head CT from. 7/1/12 - 1/1/22. We determined adjusted associations between SS completion and race, ethnicity, language for care, insurance type, and income, with sub-analysis of children <6months and with complex injury. We evaluated occult fracture prevalence. Two-hundred seventy children met criteria and 88 had SS. No statistical association was found between skeletal survey completion and race or ethnicity, language for care, private insurance, median census tract income, or in sub-analyses. Two of 88 (2.3%) patients had occult fracture; both had risk factors for NAT. In conclusion, no statistical association was found between SS completion and demographics. Occult fracture was uncommon. SS use can likely be decreased in lower risk patients.

Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Patients with Traumatic Head Injury: A Prospective Observational Study

Introduction: The early detection of elevated intracranial pressure is crucial for guiding interventions and improving patient outcomes in head injury patients. The intracranial pressure assessment with invasive intracranial devices is the gold standard. These devices however has a risk of infection, bleeding and dislodgement. Optic nerve sheath diameter measurement using ultrasonography has emerged as a promising method for indirect intracranial pressure estimation. Aims: To observe the changes in optic nerve sheath diameter over period of time, and to correlate the optic nerve sheath diameter with computed tomography findings of raised intracranial pressure in traumatic head injury. Methods: A prospective cross-sectional time series study was conducted at Nepalgunj Medical College to assess the utility of ultrasonography measurement of optic nerve sheath diameter in patients with head injuries from August 2023 to January 2024. Forty-nine patients with head injuries were included in the study. The ultrasonographic optic nerve sheath diameter measurements were obtained at admission, 48 hours post-admission, and 1 month post-head injury. The clinical parameters including Glasgow Coma Scale and radiological findings from Computed Tomography head were recorded. Results: Forty nine patients were enrolled in the study. Among them, 44.90% (27) were male and 55.10% (22) were female. Age ranged from 5 to 66 years, with a mean of 33.94 ± 15.27 years. The mean optic nerve sheath diameter was 5.24±0.86 mm at admission which decreased to 4.31±0.62 mm at 48 hours and 4.02±0.47 mm at 1 month. Our study showed significant reduction in optic nerve sheath diameter after conservative or surgical treatment in patients with head injury (F = 27.017; P =0.002) Conclusion: The ultrasonographic measurement of optic nerve sheath diameter proved to be a valuable tool in monitoring intracranial pressure in patients with head injuries.

Evaluation of the effectiveness of road safety measures and their impact on the pattern and distribution of extracranial and intracranial hemorrhages in fatal head injury cases in Uttar Pradesh, India

Introduction: In Uttar Pradesh, India, there are many fatal head injuries as a result of road traffic accidents (RTAs). Studying the pattern and distribution of intracranial hemorrhages, a frequent complication of severe head trauma might provide vital information on the efficacy of traffic safety regulations. To improve road safety tactics and lower fatal head injuries in Uttar Pradesh, this study intends to assess the effect of road safety measures on the frequency and distribution of intracranial hemorrhages in fatal head injury patients. Aim: This study’s objective is to assess the influence of current road safety initiatives on intracranial bleeding distribution and patterns in fatal head injury cases in Uttar Pradesh. Methodology: The 604 RTA cases with head injuries that were brought to the mortuary of the S.R.N. Hospital in Prayagraj for a medical-legal postmortem assessment over the course of a year, from April 2021 to March 2022, make up the entirety of this prospective study. Following receiving institutional ethical approval and informed consent, structured interviews with attendees utilizing a questionnaire were done to gather the data. Result: The results show that certain traffic safety measures have reduced the frequency of fatal head injuries in RTAs. A decreased incidence of intracranial hemorrhages was linked to improved traffic infrastructure, including well-planned junctions, pedestrian crossings, and distinct bicycle lanes. Similar results were shown in serious head injuries when traffic restrictions including speed limits, seat belt use, and helmet legislation were strictly enforced. Conclusion: There are still issues with fatal brain injuries from car accidents, despite some encouraging results. Safety legislation violations, a lack of public knowledge, and inadequate enforcement all contribute to the issue. Disadvantaged groups like walkers and users on two-wheelers continue to be especially susceptible. The results of this investigation offer important new understandings of the efficiency of traffic safety measures and their influence on the distribution and pattern of cerebral hemorrhages in Uttar Pradesh, India. The results point to the necessity of improved public education efforts and traffic safety laws. More research and focused interventions are required to address specific risk factors among various road user groups. This will result in a safer driving environment and a decline in catastrophic brain injuries.

Computed Tomographic Scan for Head Injury Patients: Any Justification for Adapting Routine Cranio-Cervical Examination Irrespective of Clinical Severity?

This study aimed to assess the prevalence of concomitant cervical spine and head injury at our University Teaching Hospital in Nigeria and attempted to justify examining patients' head and cervical spine using computed tomography (CT) scan at presentation irrespective of the head injury severity by clinical assessment using Glasgow Coma Scale (GCS). All eligible patients, 1-80 years of age who presented with head injuries in the accident and emergency (A&E) unit during the study period, were included if they satisfied the inclusion criteria. Post-resuscitation GCS was assessed clinically, and head and cervical spine injury (CSI) were observed radiologically on cranio-cervical CT scan for all patients. The presence of cervical spine fractures, subluxation or dislocation was considered a confirmation of CSI. There were 143 patients with head injuries studied; 90.2% of them were males. The mean age of the patients was 28.87 ± 15.93 years. The most common cause of injury was road traffic accidents in 110 (76.90%). The prevalence of CSI was 11.2%. Majority of the patients with CSI in this study (56.25%) had a mild head injury, 25% had a moderate head injury, and 18.75% had a severe head injury. The lower cervical spine was the most frequently injured segment in this study, involving 10 patients. Multi-level cervical vertebral body fractures of C3 to C6 were the most common form of CSI in this segment. The prevalence of concomitant cervical spine and head injury was significant in this study. This was confirmed among study subjects with a clinical diagnosis of mild-to-moderate head injury as compared with moderate-to-severe head injury. Therefore, all patients who sustained a head injury irrespective of severity are required to have a complete and rapid evaluation of the cervical spine.

994 Enhancing Compliance with BOAST Guidelines: A Closed-Loop Audit on Cervical Clearance in Head Injury Patients

994 Enhancing Compliance with BOAST Guidelines: A Closed-Loop Audit on Cervical Clearance in Head Injury Patients

Racial difference in receiving computed tomography for head injury patients in emergency departments

Study objectivePrior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries. MethodsPatients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics. ResultsAmong 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06–2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment. ConclusionsAsian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference.

Outcome and Management of Occipitofrontal Contrecoup Head Injury.

Contrecoup brain injury refers to the classical opposite of the primary impact. Tamil Nadu has the highest rate of road traffic accident in India. Madurai has peak mortality due to accidents in India. Previous studies done on contrecoup head injury had shown patterns of injuries and mechanism of injury. Outcome and management of only occipitofrontal contrecoup head injury has been taken in this study. Mortality in this specific group is very high. Seventy-six patients of this specific head injury were admitted at Government Rajaji Hospital, Madurai. Patients were assessed for Glasgow coma scale (GCS), age, sex, progression of volume, mortality, traumatic brain injury-induced coagulopathy, and pillion rider outcome. Fourteen patients were surgically treated by decompressive craniectomy. Conservative management was done by antiepileptic and antiedema measures. Mostly affected were males ( n = 54) followed by females ( n = 22). GCS on admission mean value 9. In our study, mortality was 32% with sudden death of three patients due to hypothalamic compression. Hospital stay of the patient was significantly increased with progression of lesion with mean 9 days and p -value less than 0.01. Pillion riders ( n = 18) were also affected in our study. Traumatic brain injury-induced coagulopathy ( n = 12) was also detected, which was treated by injection tranexamic acid and injection vitamin K, thereby not leading to any death due to coagulopathy with significant p -value less than 0.01. We recommend helmet for both main and pillion rider with strict speeding regulations.

Factors Affecting Outcome of Traumatic Brain Injury in Alcohol Dependence in the Absence of Intoxication: A Study from Goa

Abstract Background Alcohol dependence is common in certain parts of the world and it contributes to increased incidence of head injury. The effect of alcohol dependence on head injury outcome separate from intoxication has not received much attention. Aims We evaluate the factors affecting outcome in head injury patients with a history of alcohol dependence. Materials and Methods A prospective study of alcohol-dependent patients with head injury was conducted. The patients were treated using standard head injury protocols and information regarding duration of alcohol use was assessed with investigations relating to alcoholic liver disease. The outcome was measured up to 1 month and analyzed with respect to the factors measured. Results The Extended Glasgow Outcome Score at 1 month was lower in patients with increasing duration of alcohol use. Increased duration of alcohol use also led to increased incidence of liver disease and coagulopathy, which independently affected the outcome negatively. Higher duration of alcohol use also resulted in increased risk of seizures and infection. Conclusion Alcohol dependence negatively affects head injury outcome at 1 month. In addition, increased duration of alcohol use shows a linear trend with poor outcome. Although the exact mechanisms for this are not clear, detection and management of complications like coagulopathy may improve outcome.

Variations of Tentorial Notch Anatomy in Autopsy and NCCT of Head Injury Patients to Correlate Its Impact over Brainstem—An Observational Study

Abstract Background Tentorium cerebelli divide cranial cavity into supratentorial and infratentorial compartment. Tentorial notch is a gap in tentorium cerebelli located centrally and anteriorly, related to upper brainstem, first six cranial nerves, cerebrum, and cerebellum. The aim of this study was to analyze morphometric variation in tentorial notch anatomy in autopsy and computed tomography (CT) of head injury patients and to find out correlation between tentorial notch anatomy and uncal herniation and changes over brainstem surface in case of uncal herniation. Materials and Methods Autopsy examination of head injury patients was done between July 1, 2021, and Jan 31, 2023. Skull was opened in a standard manner and midbrain sectioned at the level of tentorial edge. Tentorial notch parameters (anterior notch width, maximum notch width, notch length, posterior tentorial length, apicotectal distance, interpedunculoclival distance) were measured using geometry compass and vernier caliper. These parameters were also measured on noncontrast computed tomography (NCCT) head of same patients. Evidence of uncal herniation was sought for in both NCCT head and autopsy examination. Impact of uncal herniation over brainstem in form of indentation over lateral surface of midbrain and macroscopic brainstem hemorrhage was noted. Results In 65 autopsy cases, there were 56 male and 9 female specimens; their mean age was 40.63 ± 16.78 years (range: 7–86 years). The most frequent type of tentorial notch observed in our study was typical type (32.30%). Relative frequency of uncal herniation was present predominantly (75%) in large type of tentorial notch and least (20%) in small type of tentorial notch. A significant correlation (p-value &lt; 0.01) was found between uncal herniation and indentation over lateral surface of midbrain, while no significant correlation (p-value &gt; 0.05) was found between uncal herniation and macroscopic brainstem hemorrhage in autopsy specimens. Conclusion The results of our study provide a baseline data about tentorial notch anatomy and it may facilitate neurosurgical decision making as well as help in deciding the best trajectory for lesions approaching in the vicinity of the tentorial notch

A Glimpse into the Prognostic Factors of Outcomes for Isolated, Operated Severe Traumatic Head Injury Patients in a Resource Constrained Trauma Center Setup

Abstract Background Severe traumatic brain injury (STBI) continues to burden health care in developing countries. This study focuses on STBI patients undergoing surgical intervention to understand the factors affecting their outcomes in a constrained trauma center setup. Aim This aims to study the epidemiological and clinical factors to understand the long-term morbidity, mortality risks, and triaging among STBI patients requiring surgery. Methods A prospective observational study was conducted on 227 isolated STBI patients with Glasgow Coma Scale (GCS) ≤ 8 who underwent surgical evacuation of intracranial lesions. Patients were classified based on their neurological status and lesions on computed tomography head. Postoperative data on complications were collected. At 6-month follow-up, patients with Glasgow (Extended) scores of 7 to 8 were deemed good outcomes, and scores of 1 to 6 were deemed poor. Cox regression analysis was used to identify independent influencing factors, with p &lt; 0.05 as statistically significant. Results The clinicoradiological factors including age (p = 0.02), asymmetric pupillary reaction (p = 0.002), low presenting pulse rate (p = 0.041), and low systolic and diastolic blood pressure (p = 0.016 and p &lt; 0.0001, respectively), low GCS (p = 0.011), midline shift &gt; 5 mm (p &lt; 0.0001), and obliterated basal cisterns were significantly associated with poor outcome. Tracheostomy, respiratory tract infection, bedsore, meningitis, deep vein thrombosis, cerebrospinal fluid leak, and bone flap site infection were significantly associated with survival of the patients (p = 0.036). The most common cause of mortality during home care included respiratory tract infection and was associated with the care of the tracheostomized. GCS (p &lt; 0.0001), age (p = 0.005), and alcohol use (p = 0.034) were independent predictors for the outcome of patients. Conclusion This study helps clinicians predict prognosis, postoperative recovery, manage challenges, counsel caregivers, and predict long-term patient outcomes.

Pengaruh Pemberian Posisi Head Up 30° Terhadap Tingkat Kenyamanan Pasien Cedera Kepala Di Ruang Instalasi Gawat Darurat RSUD Tidar Kota Magelang: Case Report

Background: Head injury is a pathophysiological event that occurs after trauma to the head which can cover every part of the head consisting of the scalp, bones and brain tissue or all the organs in the head. Objective: To determine the effect of providing Head Up 30⁰ position on the comfort level of head injury patients. Method: The method in this research is to use a case report with the nursing intervention of providing a Head Up 30⁰ position to the comfort level of head injured patients, carried out for 4 observations every 15 minutes. Results: From the results of the research, nursing intervention was carried out, namely by providing Head Up 30⁰ position for 4 observations every 15 minutes. The results showed that there was a change in comfort level before and after Head Up 30⁰ position was carried out. Conclusion: Based on the results of research conducted by researchers regarding the effect of providing Head Up 30⁰ position on the comfort level of head injury patients in instalation emergency RSUD Tidar, Magelang City obtained from the results of case study research through intervention, it can be concluded that Head Up 30⁰ therapy has an effect on changes. comfort level of mild to moderate head injury patients with changes in oxygen saturation values increasing, intracranial pressure decreasing, and pain scale decreasing.

Comparison of the efficacy of 0.9% normal saline with balanced crystalloid (Plasmalyte) in maintaining the metabolic profile in head injury patients undergoing evacuation of acute subdural haematoma - A randomised controlled trial.

The choice of intravenous fluids is important in patients with traumatic brain injury (TBI), where large volumes may be required for resuscitation. Our study aimed to compare 0.9% normal saline (NS) with balanced crystalloid (Plasmalyte) in TBI patients in terms of metabolic and coagulation profile, brain relaxation score (BRS) and renal functions using serum urea, creatinine and urinary tissue inhibitor of metalloproteinases-2* insulin-like growth factor binding protein-7, [TIMP-2]*[IGFBP7], value to assess the risk of acute kidney injury. This randomised controlled trial on 90 TBI patients undergoing emergency craniotomy and subdural haematoma evacuation was conducted in a tertiary care institute. The patients were randomised to receive either NS (Group NS) or Plasmalyte (Group P) as the intraoperative maintenance fluid. The primary outcome measures included the potential of hydrogen (pH), base excess (BE) and chloride values from an arterial blood gas. The secondary outcomes were the coagulation profile, BRS and urinary [TIMP-2]*[IGFBP7]. The two groups' metabolic profile differences were analysed using two-way repeated analysis of variance. BRS was analysed using the Mann-Whitney U test. A P value < 0.05 was considered to be statistically significant. The pH and chloride values were significantly higher, and the BE values were significantly lower in Group P compared to Group NS (P < 0.001). Brain relaxation and coagulation profiles were comparable between the two groups. Serum creatinine (P = 0.002) and urinary [TIMP-2]*[IGFBP7] (P = 0.042) were significantly higher in the NS group. Plasmalyte maintains a more favourable metabolic profile than NS in TBI patients without affecting brain relaxation adversely.

Diaphragm ultrasound: A predictor of extubation in head injury patients

Background: Timing is critical when determining if a patient can be successfully extubated. The criteria for obtaining the optimal time for extubation are bare minimum and subject to variability. There are not many studies that are done to use diaphragm function or diaphragm thickness (Tdi) to have any role in extubation outcome as success or failure. Aims and Objectives: The aims and objectives of the study are to apply diaphragmatic ultrasound as a predictor of extubation to reduce morbidity and mortality in these patients. Materials and Methods: This study was conducted as a prospective single-blind study among patients admitted in post-anesthesia care unit and surgical intensive care unit, Department of Anesthesiology at Trauma care Centre during the study period of June 2019–November 2021. The ultrasonographer was informed of the intensivist’s decision to start weaning. Tdi is measured at end expiration and end inspiration. The percent change in Tdi between end expiration and end inspiration (ΔTdi%) was calculated as (Tdi end inspiration–Tdi end expiration/Tdi end expiration) ×100. Results: Mean age was 46.2±15.2 years, ranging from 18 to 66 years. Tdi was above 30 in 64% cases, whereas Tdi% at end of expiration was above 0.17 cm in 62% cases. Weaning was successful in 78% cases whereas weaning failed in 22% cases. Weaning success rate was significantly associated with higher Tdi at end expiration (≥0.17 cm) (P&lt;0.05). Conclusions: Timely weaning off is very important. Delayed weaning may lead to further infection and complications. Diaphragmatic ultrasound plays a vital role in extubating the patient. Ultrasound-guided Tdi and diaphragm motion can be used as a predictor for timely extubation. Diaphragmatic thickness reflects the strength of diaphragm and hence would help us to estimate a successful extubation.

Correlation of Glasgow Coma Scale with Head Computed Tomographic Findings in Patients with Traumatic Brain Injury in a Tertiary Hospital in Nnewi

Background: Traumatic brain injury is an injury that causes anatomical or functional damage to the cranium, meninges and the brain. It is a major health challenge that causes increased mortality among trauma patients. This creates the serious need to find ways of elucidating the seriousness and prognostic possibility of every head injury patients. This study will help classify the patients in such a way as to affect management and also predict outcome early in the treatment of patients with traumatic head injury. Aim of the Study: Aim of this study is to correlate the clinical assessment of head injury patients with Glasgow Coma Scale (GCS) and CT findings as classified with Rotterdam scoring system. Subjects and Methods: This prospective study of 170 patients with head injury presenting for CT scan, was carried out from October, 2017 to September, 2019, in the Radiology department of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. All stable patients that were referred for head CT within this period were included in the study. Prior to the commencement of the study, informed consent, relevant clinical history and necessary physical examination are usually carried out on the patient or obtained from the care giver to ascertain the level of consciousness by Glasgow coma scale. The GCS grading used was as follows; a score of 3 - 8 (severe head injury), 9 - 12 (moderate head injury) and 13 - 15 (mild head injury). Patients were scanned using a 4 slice/gantry rotation capacity CT (General Electric (GE), HANGWEI MEDICAL SYSTEMS CO. LTD. Data obtained from the study pro-forma and the cranial CT findings of subjects, was entered and analysed using IBM SPSS (Statistical Package for Social Sciences), version 20.0. Armonk, NY, U.S.A, 2011. Results: A total of 170 patients were involved in the study which showed a high prevalence of traumatic head injury. More males were involved than females and the predominant age in the study is 21-30. There was a significant correlation between the GCS and the Rotterdam scoring system. Discussion: The findings that more males and the younger age group are more involved and that the Rotterdam scores are good indicators of the outcome are similar to the findings in other studies. Conclusion: This study showed that Rotterdam CT score system is a good prognostic tool in patients with traumatic brain injury.

Profile of Patients Receiving Computed Tomography Scans for Mild Traumatic Brain Injury in a Tertiary Care Hospital in Ethiopia

Traumatic brain injury (TBI) is a leading contributor to emergency department (ED) mortalities in Ethiopia. Mild TBI patients comprise half of all TBI patients presenting for care in Ethiopia and have a high potential for recovery. As such, context-specific care-improving strategies may be highly impactful for this group of patients. This study examines the presentation and disposition of mTBI patients who received a computed tomography scan of the head (CTH) upon arrival at the largest teaching hospital in Ethiopia. A retrospective cohort study was conducted from 2018-2021 including patients >13 years old with a head injury and a Glasgow Coma Score of 13-15 who obtained a computed tomography scan of the head (CTH). Variables were collected from medical charts and single and multi-variable analyses assessed outcomes of clinically important TBI (ciTBI) requiring a neurosurgical procedure or admission. A total of 193 patients were included. They were predominantly young men with no comorbidities, injured in road traffic accidents or by assault, had stable vital signs and were treated in lower-acuity ED areas. A minority demonstrated focal deficits, and 29.5% of patients had ciTBI. Most patients were discharged from the ED, but 13% were taken for operative neurosurgical procedures and 10.4% were admitted to the neurosurgery ward for observation. ED stays ranged from 8 hours to 10 days, as patients waited for CT availability, neurosurgical decision, or transportation. Female sex was independently protective of ciTBI. Self-referral status was independently protective against operative intervention. Female sex and self-referral status were independently protective of a disposition of admission and/or going to the operating room. This study characterizes the mTBI subgroup of head injury patients in Ethiopia's busiest ED: predominantly healthy young men with low-acuity presentations and only a fraction with abnormal neurological examinations. Nonetheless, about one-third had clinically important TBI and a minority were taken for neurosurgical procedures or admission, with female sex and self-referral identified as protective factors. Meanwhile, many patients stayed in the ED for days due to social or other non-medical reasons. As TBI care in Ethiopia continues to improve, optimizing care for the mTBI subgroup is tantamount given their high recovery potential. This care will benefit from efficiently identifying those who need intervention or hospital level of care, and discharging those who do not.

Project to improve the management of the head injury patients presenting to the emergency department

IntroductionAt Sandwell General Hospital, there was no risk stratification tool or pathway for head injury (HI) patients presenting to the emergency department (ED). This resulted in significant delays in the...

Incidence of intraoperative hypotension and its factors among adult traumatic head injury patients in comprehensive specialized hospitals, Northwest Ethiopia: a multicenter observational study

IntroductionTraumatic head injury (THI) poses a significant global public health burden, often contributing to mortality and disability. Intraoperative hypotension (IH) during emergency neurosurgery for THI can adversely affect perioperative outcomes, and understanding associated risk factors is essential for prevention.MethodA multi-center observational study was conducted from February 10 to June 30, 2022. A simple random sampling technique was used to select the study participants. Patient data were analyzed using bivariate and multivariate logistic regression to identify significant factors associated with intraoperative hypotension (IH). Odds ratios with 95% confidence intervals were used to show the strength of association, and P value < 0.05 was considered as statistically significant.ResultThe incidence of intra-operative hypotension was 46.41% with 95%CI (39.2,53.6). The factors were duration of anesthesia ≥ 135 min with AOR: 4.25, 95% CI (1.004,17.98), severe GCS score with AOR: 7.23, 95% CI (1.098,47.67), intracranial hematoma size ≥ 15 mm with AOR: 7.69, 95% CI (1.18,50.05), and no pupillary abnormality with AOR: 0.061, 95% CI (0.005,0.732).Conclusion and recommendationThe incidence of intraoperative hypotension was considerably high. The duration of anesthesia, GCS score, hematoma size, and pupillary abnormalities were associated. The high incidence of IH underscores the need for careful preoperative neurological assessment, utilizing CT findings, vigilance for IH in patients at risk, and proactive management of IH during surgery. Further research should investigate specific mitigation strategies.

Incidence of surgically treated chronic subdural hematoma after head injury with normal initial computed tomography

PurposeThe objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT).MethodsA total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital’s emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39–79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%).ResultsTwo (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma.ConclusionThe extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease.