Head Injury Patients Research Articles

Patterns and Impact of Traumatic Brain Injury at King Abdulaziz Medical City in Jeddah, Saudi Arabia: A Retrospective Cohort Study.

ObjectivesThe objectives of this study are to explore the most common causes, patterns, and severities of head traumas, to evaluate the outcomes of traumatic head injury (TBI) patients followed in the clinic, and to calculate the prevalence of admitted cases.MethodsIn our retrospective cohort study, we included all the cases of adults above 18 years old diagnosed with head traumas (171 patients). The inclusion criteria were patients who presented to the emergency department at National Guard Health Affairs (NGHA), Jeddah, Saudi Arabia from 2016 to 2020. Patients were categorized according to their Glasgow Coma Scale (GCS) score upon admission.ResultsOf the 171 patients in this study, 151 (88.3%) were males and 20 (11.7%) were females. The median age of our patients was 31 years. Most of the cases had no medical illnesses 124 (72.5%). The most common mechanism of injury was motor vehicle accidents (MVAs) in the majority of our cases (105, 61.4%), followed by falls from heights (34, 19.9%). The commonest computed tomography (CT) finding was subdural hematoma (47, 27.4%). The majority of the associated injuries were thoracic cases (43, 25.1%), followed by spinal (40, 23.4%). Most of the patients were admitted to NGHA (120, 70.2%), while the rest (51, 29.8%) were transferred from other hospitals. Of the total of 171 patients, 134 (78.4%) were treated conservatively. There were no associations between mortality nor length of stay and patients’ demographics, except for GCS on admission showed a significant p-value (<0.005).ConclusionIn this study, it was found that the most common causes of TBI are MVAs followed by falls from heights. Therefore, preventive measures such as traffic safety rules need to be addressed.

Ponticulus posticus upon routine evaluation of cervical spine x-ray in head injury patient: Case reports

Introduction: Ponticulus posticus or known as foramen arcuate is an anatomic variation of the first cervical vertebra origin from calcification of the posterior atlantooccipital membrane. The vertebral artery passes through this canal. This canal can be complete or incomplete and can also be unilateral or bilateral. Often related to symptoms of headaches, vertebrobasilar insufficiency, or acute hearing loss. Whereas, imaging studies show the presence of a partial osseous bridge on the upper surface of the atlas. This study aimed to present two cases of ponticulus posticus in head injury patients.Case presentation: We reported 2 cases of ponticulus posticus found incidentally in head injury patients at our institution. The patients were managed conservatively for 5 days and sent home with no neurological deficit and complication.Conclusion: Ponticulus posticus is often ruled out in pre-admission screening. Neurosurgeons should consider this to predict the neurological deficit.Keywords: foramen arcuate, head injury, ponticulus posticus, posterior atlantooccipital membrane

A Clinical Study of ENT Manifestations in Cases of Head Injury Patients Coming to Tertiary Care Centre of South Gujarat.

Head injury is the leading cause of morbidity, mortality and disability in India. Many such cases present with ENT injuries. ENT manifestations are often associated with varying degree of physical and functional damage. The aim of the study is to determine proportion of ear, nose and throat manifestations in head injury patients and its impact on Quality of Life (QOL). This is an observational prospective study of 98 patients with head injury. Most commonly involved site of injury is nose (38.8%). In ear most commonly affected site is external ear (16.3%). Facial palsy is observed in 5.1% patients. The most common type of injury is abrasion (29.6%). The most commonly fractured facial bone is maxilla (13.3%). At 1month post injury, 6.5% patients feel their routine activity is limited while 54.4% patients feel depressed. 41.3% patients feel their external appearance has changed and 6.5% patients reported limitations in doing heavy activity. After 3months limitation in routine activity, feeling of depression and feeling of change in external appearance of face has improved in most patients. Limitation of doing heavy activity has persisted even after 3months in 6.5% cases. Young male adults are most commonly involved in head injury with nose being the most common site involved and maxilla is the most common bone fractured in ENT manifestations. QOL is affected in almost 50% cases as reported at the end of 1month which improve in many by 3rd month.

Assessing the effectiveness of the full outline of unresponsiveness scale and the Glasgow coma scale in patients of traumatic head injury

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients.

The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries.

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.

Traumatic Brain Injury in the Elderly is common but is not as Bad as we Think! Exercise, not rest, can ensure faster recovery from post-concussion syndromes “Autobiographical case report”

Head injuries, medically known as Traumatic Brain Injuries (TBI) are a leading cause of seeking emergency medical care, hospitalization, long hospital stays, disabilities, rehabilitation services, case fatalities and socioeconomic losses in India. Head trauma is one of the common injuries in the old due to trivial falls, and its consequences need not be grievous always. As many of the elderly are on medication for hypertension, diabetes, and heart ailments and due to sudden rising from the bed, or even from the commode or Indian style of squatting plate develop giddiness and fall. Incidence of head injuries is rising all over the world but fortunately more than half of them is either mild or moderate amenable to management with good outcomes. They can sometimes be serious and fatal when left untreated. The epidemiology of TBI is still an enigma in the medical world due to inconsistency in the definition and classification and discrepancies in data collection. Glasgow Coma Scale (GCS) is a well-accepted tool to assess the seriousness at the first visit to stratify, monitor the prognosis, and recovery of brain functions in patients with traumatic brain injury. Seniors over the age of 60 years with head injury are generally considered to have a poor outcome. However, a recent large multicentric China epidemiologic study of minor head injury patients (GCS 13–15) reported over 90 % survival, few with minor consequences. Another large-scale retrospective study at a level II trauma centre in Florida from 2005 to 2008, too indicated that the outcome of elderly over 65 years old had a survival rate of over 80 %. I report my own autobiographical case of a closed head injury, with good outcome due to timely care and early initiation of aerobic exercise (waking &amp; tread meal) for recovery from concussion injury due to fall in washroom, with no major post-concussive symptoms.

Incidence of Benign Paroxysmal Positional Vertigo in Head Injury Patients

Background: Traumatic brain injury is a common secondary cause of Benign Paroxysmal Positional Vertigo(BPPV).&#x0D; Objective: To determine the incidence and clinical profile of patients with BPPV in mild and moderate head injury.&#x0D; Materials and Methods: A prospective observational study done in patients admitted with mild and moderate head injury who developed BPPV from January 2020 to March 2020 in a tertiary care hospital of South India. Demographic and clinical parameters were noted and were treated with canalith repositioning procedures.&#x0D; Results: Among 42 patients admitted with mild and moderate head injury, 9(21.4%) were diagnosed with BPPV in the follow up. The male female ratio was 2.5:1. The mean age was 44 ±21.4years.Two wheeler accidents contributed to nearly half of (55.6%) traumatic BPPV. Posterior canal was commonly involved in 7(77.8%) followed by horizontal in 2 (22.2%).The type of head injury was mild in 7 (77.8%) and moderate in 2 (22.2%) in traumatic BPPV patients. 5 (55.6%) patients with BPPV had abnormal findings in neuroimaging. 4 (44.4%) patients developed recurrent BPPV in our cohort.&#x0D; Conclusion: The incidence of traumatic BPPV was 21.4% in our study. Road traffic accidents due to two wheeler accidents were the common mode of head trauma. Posterior canal was commonly involved in three fourth of cases. Recurrence of vertigo was documented in 4 (44.4%).

Cervical Spine and Spinal Cord Injury:Keys for Diagnosis and Treatment

Spinal cord injuries are not rare in neurosurgical practice. As cervical spine injuries are frequently associated with head injuries, neurosurgeons have critical roles of immediate evaluation and treatment in an emergency room in Japan. It is crucial to make a correct initial diagnosis and provide appropriate treatment for cervical spine injuries because missed injuries or delayed diagnosis might result in unwarranted neurological sequelae. This paper focuses on tips regarding 1)screening for cervical spine injury in head injury patients, 2)diagnosis and treatment of cranio-vertebral junction injuries, and 3)diagnosis and treatment of acute traumatic central cord syndrome because these conditions are most likely encountered by neurosurgery residents and fellows in their practice.

EP.FRI.828 Accidental Placement of Nasogastric Tube into the brain

Abstract The nasogastric tube (NGT) plays a very vital role in the early resuscitation of head injury patients for various reasons. Though considered a simple procedure, it can be associated with multiple dreadful complications. Our patient was a 44-year-old male, referred from a peripheral health center for further management of severe head and faciomaxillary injuries following a motor vehicular accident. On arrival at the hospital, the endotracheal tube and NGT were in situ. A computed tomography scan of the brain revealed the NGT piercing through the cribriform plate of ethmoid and coiling into the cranial cavity with pneumocephalus. The NGT was retrieved under C-arm guidance and his injuries were managed respectively. The patient was discharged after prolong hospitalization with an acceptable outcome. With this case report, we want to remind emergency health care providers to avoid this catastrophic complication of NGT insertion in a faciomaxillary trauma patient by doing it transorally. We report a novel method of safely removing NGT which has not been reported in the past.

Post-traumatic cerebral venous sinus thrombosis – Institutional study and literature review

BackgroundPost-traumatic cerebral venous sinus thrombosis (CVST) – incidence is rising during the last two decades, partly due to advanced imaging technologiesand partly due to accidents caused by high-velocity vehicles. Case seriesDuring a period from January 2020 to September 2020, we had 264 cases of head injury patients. On average, we receive 30 head injury cases per month, among which 50% would be severe head injury cases. We documented ten CVST cases among them. Diagnosis and managementIn severe head injuries with suspicion, CT brain with contrast done immediately to diagnose CVST. After 48 h of admission, worsening of GCS, increased severity of headache despite adequate management, worsening of CT findings as an increase in edema, and hemorrhagic transformation are all indications for repeat CTbrain with contrast. Management of CVST patients done with enoxaparin 40 mg twice a day/1.5 mg per kg in a day, for a duration of ten to fourteen days. Anticoagulants started only after 48 h of trauma. ConclusionEarly diagnosis of CVST in severe head injury patients and treatment started early (after 48 h of trauma) will help to prevent morbidity and mortality.

All body region injuries are not equal: Differences in pediatric discharge functional status based on Abbreviated Injury Scale (AIS) body regions and severity scores

PurposeFunctional outcomes have been proposed for assessing quality of pediatric trauma care. Outcomes assessments often rely on Abbreviated Injury Scale (AIS) severity scores to adjust for injury characteristics, but the relationship between AIS severity and functional impairment is unknown. This study's primary aim was to quantify functional impairment associated with increasing AIS severity scores within body regions. The secondary aim was to assess differences in impairment between body regions based on AIS severity. MethodsChildren with serious (AIS≥ 3) isolated body region injuries enrolled in a multicenter prospective study were analyzed. The primary outcome was functional status at discharge measured using the Functional Status Scale (FSS). Discharge FSS was compared (1) within each body region across increasing AIS severity scores, and (2) between body regions for injuries with matching AIS scores. ResultsThe study included 266 children, with 16% having abnormal FSS at discharge. Worse FSS was associated with increasing AIS severity only for spine injuries. Abnormal FSS was observed in a greater proportion of head injury patients with a severely impaired initial Glasgow Coma Scale (GCS) (GCS< 9) compared to those with a higher GCS score (43% versus 9%; p < 0.01). Patients with AIS 3 extremity and severe head injuries had a higher proportion of abnormal FSS at discharge than AIS 3 abdomen or non-severe head injuries. ConclusionsAIS severity does not account for variability in discharge functional impairment within or between body regions. Benchmarking based on functional status assessment requires clinical factors in addition to AIS severity for appropriate risk adjustment. Level of evidence1 (Prognostic and Epidemiological).

Analysis of factors influencing outcome in head injury patients: A study of 200 cases

Background: A clear Understanding of injury patterns, causes and outcome of patients of head injury is essential for establishment of preventive strategies as well as treatment protocols. Such data is lacking in our environment as no local study has been done. The objective of this study is to determine age and sex distribution of head injury cases, etiological factors, indications of surgical interventions, various complications and their management, morbidity and mortality of head injury patients and the risk factors associated with morbidity and mortality. So as to improve management of head injury patients. Methods: This was a prospective study carried out at Dept. of surgery at us tertiary care center over a period of two years from October 2015 to September 2017. Patients who were admitted in wards and ICU of all age groups and of both sexes having head injury were selected for analysis. Results and conclusion: incidence of head injury was more in younger age males, rural population, evening and night time. Adverse outcomes were associated with Alcoholism, poor GCS presence of comorbidities.

EPIDEMIOLOGY OF HEAD INJURY- LEVEL 1 TAEI CENTRE STUDY

Introduction: Head injury affects over 60 million people every year which causes mortality and morbidity. Of all the injuries, head injury accounts for most cases of death and disability. Sixty-nine million individuals worldwide sufferred from head injury in 2018. As the time progresses there is observable increase in rates of Head injuries. Hence this study focuses on this aspect of injuries in a level 1 TAEI centre. Research studies from TAEI centre are sparse as of now and this study will be a helpful tool for illumination of further research and development which will be useful in reducing public health burden. TAEI (Tamilnadu Accident and Emergency Care Initiative) : Tamilnadu Government have initiated TAEI centres along the National and major State highways. This is in co-ordination with 108 free ambulance service, Government hospitals and CMCHIS schemed private hospitals. It provides immediate and free treatment to the trauma patients. Aim : To study the Epidemiology of Head Injury in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. Materials And Methods: This study is a prospective study covering all head injury cases admitted from November 2020 - January 2021 in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. The treatment is initiated upon arrival in Zero delay ward and they are triaged by TAEI team. These patients are treated according to the protocol of Department of Neurosurgery. This study covers the management, discharge and follow up of these patients. Results: The admitted head injury patients in TAEI ward are 1319 cases out of 1750 trauma cases. Among them RTA tops head injury mortality and morbidity. Among RTA, Two wheeler associated injuries were most common. Drunken drive, not wearing helmets and protective gears played a vital role in head injuries. Conclusion : The primary prevention can be the key to reduce the national burden of head injuries.

Prospective Observational Study of Early Tracheostomy Role in Operated Severe Head Injury Patients at A Level 1 Trauma Center.

Objective:To evaluate the impact of the early tracheostomy on operated patients with severe head injury.Methods:This prospective observational study was conducted at a level 1 trauma center and medical college over one-year period. The study included all surgically managed severe head injury patients without any other life-threatening major injuries. Patients who underwent tracheostomy within 7 days were classified as early tracheostomy. Results:The patient’s mean age of this cohort study was 43.4±14.5 years. Motor-vehicle accidents were being the most common cause of severe head injury. Operated patients were undergoing early tracheostomy on an average of 2.9 days. We were observed that the patients spent on a mechanical ventilation on an average 3.67±2.26 days. This was significantly lower than previous four published studies (p<0.05) which had a range of mean 9.8-15.7 days. Conclusion:We have shown that it is possible to decrease mechanical ventilation (MV) time, intensive care unit (ICU) stay and total hospital stay by doing early tracheostomy in operated severe head injury patients.

EPIDEMIOLOGY OF HEAD INJURY - A LEVEL 1 TAEI CENTRE STUDY

Head injury affects over 60 million people every year which causes mortality and morbidity. Of all the injuries, head injury accounts for most cases of death and disability. Sixty-nine million individuals worldwide suffered from head injury in 2018. As the time progresses there is observable increase in rates of Head injuries. Hence this study focuses on this aspect of injuries in a level 1 TAEI centre. Research studies from TAEI centre are sparse as of now and this study will be a helpful tool for illumination of further research and development which will be useful in reducing public health burden. TAEI ( Tamilnadu Accident and Emergency Care Initiative ) : Tamilnadu Government have initiated TAEI centres along the National and major State highways. This is in co-ordination with 108 free ambulance service, Government hospitals and CMCHIS schemed private hospitals. It provides immediate and free treatment to the trauma patients. Aim : To study the Epidemiology of Head Injury in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. Materials and Methods : This study is a prospective study covering all head injury cases admitted from November 2020 - January 2021 in level 1 TAEI centre, Coimbatore medical college and hospital, Coimbatore. The treatment is initiated upon arrival in Zero delay ward and they are triaged by TAEI team. These patients are treated according to the protocol of Department of Neurosurgery. This study covers the management, discharge and follow up of these patients. Results : The admitted head injury patients in TAEI ward are 1319 cases out of 1750 trauma cases. Among them RTA tops head injury mortality and morbidity. Among RTA, Two wheeler associated injuries weremost common. Drunken drive, not wearing helmets and protective gears played a vital role in head injuries. CONCLUSION : The primary prevention can be the key to reduce the national burden of head injuries.

A study of correlation of degree of midline shift on computed tomography scan and Glasgow coma scale in patients of acute traumatic head injury

Background: Traumatic brain injury is one of most common cause of death in road traffic accident. Most of these classified as mild injury, with approximately 20% classified as moderate to severe. Approximate 50% of the 150,000 trauma deaths every year are caused by head injury.Methods: A prospective cross-sectional study was conducted on 150 patients with a head injury admitted in the Hamidia hospital, Bhopal. The assessment of the severity of head injury using Glasgow coma scale (GCS) at the time of admission, follow up on 5 days and 15 days respectively. The collected data were transformed into variables, coded and entered in Microsoft excel. Data were analyzed and statistically evaluated using statistical package for the social sciences (SPSS)-PC-21 version.Results: Out of 150, a total of 115 patients had no midline shift while 35 patients were having midline shift. Severe head injury patients (GCS 3-8) were having more morbidity and mortality. Moderate head injury (GCS 9-13) was associated with good prognosis and low mortality. A greater degree of midline shift of (more than 5 mm) is indicated severe head injury and is significantly associated with morbid outcome and higher mortality.Conclusions: In our study, road traffic accidents is the most common cause of head injury, with males being affected more than females. The degree of midline shift on computed tomography (CT) scan head in patients with head injuries was found to be significantly associated with high mortality and morbidity.

Trauma Surgery and War: A Historical Perspective

The aim of this review is to introduce the progress in trauma surgery made during war. In the 16th century, Paré reintroduced ligature of arteries, which had been introduced by Celsus and Galen, instead of cauterization during amputation. Larrey, a surgeon in Napoleon’s military, adapted the “flying artillery” to serve as “flying ambulances” for rapid transport of the wounded. He established rules for the triage of war casualties, treating wounded soldiers according to the seriousness of their injuries and the urgency of medical care. To treat fractures and tuberculosis, Thomas created the “Thomas splint”, which was used to stabilize fractured femurs and prevent infection; in World War I (WWI), use of this splint reduced the mortality of compound femur fractures from 87% to less than 8%. During WWI, Cushing systematized the treatment of head injuries, reducing mortality among head injury patients. Gillies repaired facial injuries, and his experiences became the basis of craniofacial and aesthetic surgery. In WWII, McIndoe discovered that immersion in saline promoted burn healing and improved survival rates, and thus began saline baths and early grafting instead of using tannic acid. A high mortality rate in patients with acute renal failure was noted in WWII and the Korean War. In the Korean War, Teschan used the Kolff-Brigham dialyzer. The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by the US Army in Burma during WWII. As a lotus blooms in the mud, military surgeons have contributed to trauma surgery during wartime.

Clinical and Outcome Analysis in Head Injury Patients with Fahr's Disease.

Context:Fahr's disease (FD) is a rare neurodegenerative disorder. Head injury in patients with FD is an uncommon occurrence.Aim:The aim is to evaluate clinical and outcome characteristics in traumatic head injury patients with FD.Settings and Design:Retrospective cohort study.Materials and Methods:This retrospective cohort study includes 13 patients of FD presenting as head injury in neurosurgical emergency between September 2018 and February 2021. Each patient was evaluated in terms of demographic profile, Glasgow coma scale (GCS) at admission, severity of head injury, type of head injury, preexisting clinical features of FD, radiological findings, Glasgow outcome score (GOS), family history of FD, and biochemical abnormalities. Patients were also evaluated for dichotomized outcome (Good recovery: GOS 5–4 versus Poor recovery: GOS 1–3) and gender differences in FD presentation.Statistical Analysis Used:Fisher's exact test and unpaired t-test were used. P < 0.05 was considered statistically significant.Results:Neurological symptoms (69.2%), neuropsychiatric manifestations (46.1%) and extrapyramidal features (38.5%) were preexisting in these patients. Seizure (61.5%) was the most common neurological manifestation. Depression (23.1%) and anxiety disorder (15.4%) were common psychiatric disorders seen. Akathisia (23.1%) followed by tremor (15.4%) were predominant extrapyramidal presentations. On dichotomized outcome analysis, preexisting neurological, neuropsychiatric, and extrapyramidal manifestations due to FD were not associated significantly with outcome following head injury. GCS at admission, severity of head injury and pupillary changes were significantly associated with outcome (P < 0.05). Neuropsychiatric features (P = 0.0210) were significantly more in females suffering from FD.Conclusions:Neurological features in FD predominate over neuropsychiatric and extrapyramidal symptoms. FD does not affect outcome following head injury.

Incidence and predictors of mortality among patients with head injury admitted to Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia: A retrospective follow-up study.

Head injury is the leading cause of morbidity and mortality throughout the world, especially in resource-limited countries including Ethiopia. However, little is known about the mortality rate and its predictors among these patients in Ethiopia. Thus, the study aims to assess the incidence rate of mortality and its predictors among patients with head injury admitted at Hawassa University Comprehensive Specialized Hospital. Institutional based retrospective follow-up study was conducted among 1220 randomly selected head injury patients admitted from July 2017 to July 2019. Bivariable and multivariable Cox regression models were fitted to identify the predictors of mortality. Proportionality assumption was tested by a global test based on the Schoenfeld residuals test. The incidence of the mortality rate was 2.26 (95%CI: 1.9-2.6) per 100-person day observation. The independent predictors of time to death were age above 65 years (AHR:3.49, 95%CI:1.63, 7.48), severe TBI (AHR: 8.8, 95%CI:5.13, 15.0), moderate TBI (AHR:3, 95%CI:1.73,5.31), hypotension (AHR:1.72, 95%CI: 1.11,2.66), hypoxia (AHR:1.92, 95%CI: 1.33,2.76), hyperthermia (AHR:1.8, 95%CI: 1.23,2.63) and hypoglycemic (AHR:1.94, 95%CI: 1.34, 2.81) positively associated with mortality, while underwent neurosurgery was negatively associated with mortality (AHR: 0.25, 95% CI: 0.11,0.53). The incidence of mortality rate among head injury patients was high. Older age, moderate and severe TBI, hypotension and hypoxia at admission, neurosurgical procedure, and the episode of hyperthermia and hypoglycemia during hospitalization were the independent predictors of mortality among head injury patients. Therefore, intervention to reduce earlier deaths should focus on the prevention of secondary brain insults.

Registry-based pilot epidemiological study of traumatic brain injury in a tertiary trauma care center in Kerala, India - Difficulties encountered during data collection warranting the need for standardized electronic database.

Background: Head injury is referred to as a “silent epidemic” globally. Studies regarding epidemiology of head injury are very few especially in Kerala and most have conflicting reports. Unlike developed countries, there is no well-established system for collecting and managing information on traumatic brain injury (TBI) in India, especially in Kerala. The present study shares the difficulties encountered and the insights acquired by conducting a registry-based epidemiological pilot study for collecting a baseline data of traumatic head injury patients in a tertiary care center in Kerala.Methods: The pilot study was conducted to know the efficiency of present reporting system of a tertiary hospital in Kerala. We tried to collect retrospective data from December 2018 to December 2019 in the department of neurosurgery. As there was no standardized protocol or electronic database for data collection in hospital, we made a sample proforma for data collection. The patient details were obtained from medical records (case sheets), resident doctor’s, and staff nurse’s notes which included demography, clinical details, and radiological findings which were analyzed.Results: We were not able to fill the full details regarding demography, prehospital data, and clinicoetiological details which are important as far as head injury management is considered. The hospital records were grossly inadequate for full retrieval of information. Inadequate case definition and lack of centralized electronic reporting mechanisms were some of the major difficulties we faced obviating the need for collecting, managing, and utilizing epidemiological data using an electronic database.Conclusion: We believe that the present pilot study will give an insight regarding the difficulties encountered in collecting data regarding TBI. This study will be the first of its kind in Kerala highlighting the importance of maintaining a proper head injury electronic registry. The data from this study would definitely guide future experimental operational research on these unexplored areas which will be relevant in head injury policy-making in Kerala as well as in India.