Traumatic Head Injury Patients Research Articles

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 < 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 < 0.0001, respectively), low GCS (p = 0.011), midline shift > 5 mm (p < 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 < 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.

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.

Plasma interleukin 6 as an outcome predictor of traumatic brain injury patients.

Traumatic brain injury is one of the leading causes of death and disability in young adults. Previous studies have suggested that neuroinflammatory process involves the overexpression of interleukin 6 (IL-6); however, data on the predictive ability of IL-6 is limited and conflicting in traumatic head injury patients. The aim of this study was to assess the ability of plasma IL-6 as a predictor of outcome in head injury patients. A cross-sectional study was conducted between June and December 2020 among traumatic head injury patients admitted to Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia. Demographic, clinical data, and IL-6 level were collected and measured on admission. The outcome was assessed by the Glasgow outcome scale extended (GOSE) in the first- and third-month of post-injury. A total of 50 traumatic brain injury patients were recruited of which 54% were male, 64% had mild head injury, 82% had leukocytosis, and 60% had non-bleeding head CT scan. The mean of IL-6 level was 79.32 pg/mL while the GOSE scores ranged from 1 (death) to 8 (upper good recovery). Early IL-6 level (<24 hours post-injury) was significantly correlated with worse outcome in traumatic head injury, though the correlation strength was moderate (p<0.001; r=-0.42). As a predictor, IL-6 yielded the area under curve (AUC) value of 93.5% (p<0.001) and a cut-off point of 46.33 pg/mL. The sensitivity and specificity of this predictor were 87.5% and 95.24%, respectively. In conclusion, early IL-6 level can be used as a predictor for traumatic head injury. Nevertheless, further multi-center study with a bigger sample size is needed to confirm this finding.

Comparative analysis between GCS (Glasgow coma scale) and FOUR (Full Outline of Unresponsiveness) score in preliminary assessment and prognostication of traumatic brain injury

Introduction: Head injury is one of the most critical conditions and has a serious neurological outcome if not treated promptly. Effective initial assessment and timely intervention ensures a favourable outcome. To achieve this, many assessment scoring systems have been devised over the years of which Glasgow coma scale (GCS) is the most widely used but it does have a few drawbacks. A newer coma scale, the FOUR score (Full Outline of UnResponsiveness) evaluates four components. The aim of the present study is to compare the GCS and FOUR score in traumatic head injury patients in predicting the better outcome. The outcome scoring is done by GCOS (Glasgow Coma Outcome Scale). Methods and Materials: One twenty-five patients with traumatic head injury were recruited between September 2019 to September 2021 in a tertiary health care centre. For all these cases, GCS and FOUR score on the day of arrival in emergency department (ED) was calculated by residents attending the case in ED and the outcome was scored using GCOS. The correlation between all three scores was then calculated. Results: The present study revealed the major cause of traumatic head injury as road traffic accidents and most of them being males. A significant strong positive correlation was found in FOUR score when compared with GCS in the prediction of outcome in traumatic brain injury patients. Conclusion: It was concluded that the FOUR score is more beneficial to that of GCS and can be used in outcome assessment in traumatic head injury and intubated patients. Thus, FOUR score is a better tool for prognostication.

Chronic Anterior Pituitary Dysfunction Following Traumatic Head Injury: Prospective Study in Hospital Sultanah Aminah Johor Bahru, Malaysia.

Hypopituitarism following traumatic brain injury (TBI) is not rare however most patients were left undiagnosed and untreated. Association of post TBI hypopituitarism causing neurobehavioural and quality of life impairment. The aim of the study is to determine the incidence of the chronic anterior pituitary deficiency in patients with traumatic brain injury. Subsequently determine the risk factor and the outcome of the patient with chronic anterior pituitary dysfunction. This is single centre cross-sectional study involved 105 traumatic head injury patients under the Neurosurgical Department Hospital Sultanah Aminah, Johor Bahru, Malaysia. The primary investigator will do an interview and the patients will be asked question to complete a questioner from SF-36 (36 questions). Subsequently, consent for participation will be taken and blood sampling will be done. Thirty-three patients were noted to have anterior pituitary dysfunction. The mean age was 36.97 ± 12.96 years old. Twenty-seven patients (32.5%) were male and six patients were female (27.3%). Chronic anterior pituitary dysfunction in patients with a severe traumatic head injury around 47.1% (23 patients), as compared to a moderate head injury (8 patients, 38.1%) and 2 sustained mild head injury (5.6%). The mean duration after the onset of trauma was 10.3 ± 1.79 months. All patient with anterior pituitary dysfunction had positive CT brain findings with 22 had subarachnoid haemorrhage (SAH) at the basal cistern and 27 patients had a base of skull fracture, where 52.1% of the patient underwent surgical intervention, 84.8% involved one axis and another 5 patients had two axes involved. Severity of the head injury (P < 0.001), prolonged duration of hospital stay (P = 0.014), radiological findings of a base of skull fracture (P < 0.001) and presence of SAH at basal cistern (P < 0.001) was significantly associated with pituitary dysfunction. The patient with anterior pituitary dysfunction has the lower 36-item Short Form Survey (SF-36) marks 56.3 ± 10.3. The prevalence of hypopituitarism was 31%. Indicators are increased TBI severity, prolonged hospitalisation and positive finding in radiological assessment. Post-traumatic chronic anterior pituitary dysfunction also related with poor quality of life as showed by low SF-36 marks.

CEREBO®: A Portable Device for Non-invasive Detection of Intracranial Hematomas in Real Time.

Brain injury has become a silent epidemic and has very low survival and recovery rates because of inaccurate triaging, especially in absence of symptoms. Therefore, a clinical assessment tool for quick onsite detection of intracranial hematoma is necessary. This study aims to assess the efficacy of the near infrared-based device CEREBO® for the non-invasive detection of intracranial hematomas in traumatic head injury patients. Observational, prospective, cohort, single-center study. Forty-four patients recruited from the Department of Neurosurgery of Civil Hospital, Ahmedabad, between 3 and 85 years from June 2018 to March 2020 were examined by CEREBO® and computed tomography (CT) scan within 72 h post-injury or first onset of symptoms to measure the desired parameters. SAS 9.4. The device exhibited high sensitivity (94.87%) and specificity (76.19%) for unilateral hematomas with a positive predictive value (PPV) of 93.67% and a negative predictive value (NPV) of 80%. For bilateral hematomas, the device exhibited a sensitivity of 80%, specificity of 77.78%, PPV 83.33%, and NPV 73.68%. This study establishes the efficacy of CEREBO® to be used as a point-of-care medical screening device for detecting brain hematomas in patients who have had a head injury and is therefore recommended as an adjunct to CT scan. In the triaging or diagnosis phase, it allows for early treatment and thus helps to reduce the secondary injury resulting from the existing and delayed hematomas.

Study protocol for a pilot randomised controlled trial evaluating the effectiveness of oral trehalose on inflammatory factors, oxidative stress, nutritional and clinical status in traumatic head injury patients receiving enteral nutrition

IntroductionIn traumatic brain injury (TBI) patients, inflammatory processes and oxidative stress have been linked to the development of neurodegenerative diseases, disability, increased rate of muscle catabolism, malnutrition, hospital stay and...

OCULOMOTOR DEFICIT IN MILD TRAUMATIC HEAD INJURY AN INSTITUTIONAL STUDY

INTRODUCTION: Traumatic head injury can be mild causing a bump, laceration or contusion with or without a disturbance of conciousness. It can be a moderate or severe injury depending upon clinical parameters of Post traumatic Amnesia (PTA) and/or a disturbence of Conciousness and Presenting GCS . Oculomotor decit following mild Head Injury can be Considered in checklist while discharging the Patients, as it is one of the commonest and important symptoms experienced by them. Several Studies have shown in Populations with contusions and neuronal injury that vision and eye movements are closely tied to the functionality of the Brain. In our Study we found 31 patients out of 178 having changes in visuomotor Performances. Optimal management of Patients that is used based on the type of injury and ndings according to institutional Protocol. Most of the oculomotor Symptoms improved with Conservative management via regular follow-up. AIMS AND OBJECTIVES: To Study the frequency and various types of visuomotor decit in mild traumatic head injury, its co-relation and further evaluation on the resolution of visual abnormalities in patients after 3 months. MATERIALS AND METHODS: The study design is prospective and was conducted between January and December 2021 at Gauhati Medical College and Hospital. The data of 178 patients were collected in the mentioned hospital and evaluation was done during the discharge and followup after 3 months. The signicance test was carried out using Pearson's Chi-Square and Fisher's Exact Test were conducted. RESULT: It was found by Pearson's Chi-Square and Fisher's Exact Test that the number of patients having oculomotor abnormalities in mild traumatic head injury is signicant (P&lt;0.005). Moreover, 74.19% of patients showing oculomotor abnormalities had no Extraocular muscle abnormalities during discharge which increased to 93.54% and the rest 6.45% of patients showed partial improvement. No patient was found to have 4th nerve palsy, 83.87% of OM (patients with oculomotor abnormalities) patients had no 3rd nerve palsy during discharge which increased to 93.54%. CONCLUSION: the study concluded that there is a signicant number of mild traumatic head injury patients with visual abnormalities which can be resolved effectively by conservative management within 3 months. It is suggested that more follow-up and research required for more prompt treatments.

Incidence of mortality and its predictors among patients with head injury admitted to adult intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia.

Traumatic head injury, referred to as the "silent epidemic", remains a growing public health concern and the leading cause of mortality in young adults, with a disproportionate burden of disability and death occurring in low-income and middle-income countries, including Ethiopia. However, estimates of the traumatic brain injury burden from low and middle-income countries are scarce. The aim of this study was to assess outcome and its associated factors among patients with head injury admitted to the Adult Intensive care unit at AaBET and ALERT hospitals, Addis Ababa, Ethiopia. Institution-based retrospective cohort study was conducted at AaBET and ALERT hospitals from February 01, 2019 to January 30, 2020. All head injury patients' records were reviewed. A structured checklist was used to collect data. Binary logistic regression analysis was used to identify factors associated with death among head injury patients. Out of 205 patients, 178 (86.8%) improved, while 27 (13.2%) died. Road traffic accident was the most common cause of head injury (Adjusted odds ratio (AOR) = 46.3%). Patients with pulse rate admission (AOR = 1.49), NA + level (3.48), type of head injury (AOR = 3.67), mechanical ventilation (AOR = 4.70) were significant predictors of death among patients with head injuries. The incidence of death among head injury patients was 13.2% (27). Road traffic accident was the leading cause of head injury. Pulse rate, plasma sodium level, penetrating head injury, being on a mechanical ventilator were predictors of death among traumatic head injury (THI) patients treated for head injuries. Prevention of road traffic accidents and continuous awareness creation about the consequences of a road traffic accident is recommended.

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.

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.

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.

Impact of implementation of the national institute for health and clinical excellence (NICE) head injury guideline in a tertiary care center emergency department: A pre and post-intervention study.

Head injury, a common presentation to the emergency department (ED), is a substantial problem in developing countries like Nepal. The current national institute for health and clinical excellence (NICE) guideline revised in January 2014 focuses on effective clinical assessment and early management of head injuries according to their severity in all age groups. This study assessed the impact of implementing this guideline on the proportions of computed tomography (CT) head scans, guideline adherence, and confidence level of the attending physicians. We consecutively recruited 139 traumatic head injury (THI) patients in this prospective pre-post interventional study conducted in the ED of a tertiary care center. We implemented the NICE guideline into routine practice using multimodal intervention through physicians' education sessions, information sheets and guideline-dissemination. The pre and post-implementation CT head scan rates were compared. The post-implementation guideline adherence was assessed. Online Google form-questionnaires including 12 validated case scenarios were distributed to the attending physicians at the end of both phases to assess their confidence levels. The implementation resulted in a statistically significant decrease in the proportion of CT head scan rates from 92.0% to 70.0% (p-value = 0.005). Following educational interventions, improved guideline adherence of 20.3 percentage points (p-value = 0.001) was observed. Nine ED attending physicians were enrolled in the study who showed statistically significant improvement in their confidence level following the intervention. The NICE guideline showed a sensitivity and specificity of 93.6% and 76.4% with 82.6% accuracy compared to that of clinical judgment (100%, 34.6%, and 58.1% respectively) in detecting intracranial lesions. The implementation was successful in satisfying the aim of the NICE guideline by decreasing the proportion of CT head scans, improving guideline adherence and increasing the confidence of the attending physicians.

Multidetector Computed Tomography (MDCT) Evaluation of Traumatic Brain Injury in Head Trauma Patients in Tertiary Hospital of Eastern Region of Nepal

Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions.&#x0D; Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury.&#x0D; Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated.&#x0D; Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P&lt;0.05).&#x0D; Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male.

Comparison of Neutrophil Lymphocyte Ratio in Traumatic Head Injury Patients With and Without Intracranial Hemorrhage at Dr. M. Djamil Hospital

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English

BACKGROUND Traumatic head injury is one of the most common causes of mortality all over the world. Substantial initial assessment of head injury and its intensity in these patients is the primary goal for medical treatment. Hence, there is a necessity for a score better than GCS for the assessment of head injury patients. FOUR score, a new coma scale was published by Wijdicks in 2005. It included 4 components, motor response, eye response, brainstem reflex, and respiration. It precisely assesses the neurological activity as it includes the brain stem reflexes and eliminates the verbal component and identifies locked-in syndromes, temporal lobe herniations and third nerve dysfunctions which GCS fails to do so. We wanted to evaluate the correlation between FOUR score and GCS in evaluating the level of consciousness in patients with head injuries and evaluate the interobserver reliability of both the above-mentioned scores. METHODS This is an observational prospective study conducted on 92 patients with isolated traumatic head injury admitted to Department of General Surgery, VIMSAR, Burla, from November 2018 to October 2020. The parameters that were evaluated were clinical examination at the time of admission, were blood pressure (BP), temperature, pulse, and respiratory rate at the time of admission. Assessment of GCS and FOUR score at the time of admission, at 6 th hour, 24th hour and daily assessment till discharge. RESULTS A total of 92 isolated traumatic head injury patients were included in the study. Number of females (19.5 %) were significantly less when compared to males. The Pearson correlation coefficient between FOUR score and GCS was calculated to be 0.945, 0.962 and 0.951 respectively at the time of presentation, after 6 hours and isolated traumatic head injury. After 24 hours in patients with isolated traumatic head injury, Cohen’s weighted Kappa of GCS and FOUR score inter reliability was 0.956 and 0.985 respectively. Area under receiver operating characteristic curve (ROC) for GCS and FOUR score with Modified Rankins Score was 0.951 and 0.951. Area under ROC for mortality for GCS and FOUR score was 0.974 and 0.997 respectively. CONCLUSIONS As per our results, there is an excellent correlation between GCS and FOUR score in head injury patients. The FOUR score aims to overcome these shortcomings with a scale that is both simple to use and comprehensive in its overall neurologic assessment of the isolated traumatic head injury patients. FOUR score might prove to be a better tool to evaluate the consciousness of head injury patients and help in detection and stratification of these patients and in monitoring the efficiency of ongoing treatment. KEYWORDS Four Score, GCS, Head Injury

Incidence of Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury in a Tertiary Care ICU: A Retrospective Cohort Study

Abstract Background Paroxysmal sympathetic hyperactivity (PSH) is an understudied complication of traumatic brain injury (TBI). PSH usually presents with transient rise in sympathetic outflow, leading to increased blood pressure, heart rate, temperature, respiratory rate, sweating, and posturing activity. We retrospectively analyzed the incidence of PSH in TBI using PSH-assessment measure (PSH-AM) scale. Methods This single-center retrospective cohort study was conducted in traumatic head injury patients admitted in the intensive care unit from January 1, 2016 to December 31, 2019 in a tertiary care center. The data was collected from the hospital database after obtaining approval from the hospital ethics committee. Results A total of 287 patients (18–65 years of age) were admitted to intensive care unit (ICU) with TBI out of which 227 patients were analyzed who had ICU stay for more than 14 days. PSH was diagnosed in 70 (30.8%) patients. Mean age of PSH positive patients was 40 ± 18 and 49 ± 11 years for PSH negative patients (p &lt; 0.001). The age group between 40 and 50 years had a higher incidence of PSH. The age and Glasgow coma score (GCS) were significantly associated with the occurrence of PSH. The GCS score demonstrated good accuracy for predicting the occurrence of PSH with AUC 0.83, 95% CI of 0.775 to 0.886, and a p-value of 0.001. Conclusion We observed that the incidence of PSH was 30.8% in the patients with TBI. Age and GCS were found to have a significant association for predicting the occurrence of PSH. The patients who developed PSH had a longer length of hospital stay in ICU.

Study of Traumatic Head Injuries Using Computed Tomography

The aim of this retrospective research was to study traumatic head injury (THI) using CT scan and to classify the types of head trauma fractures and types of hemorrhages. Methods and Results: The current study included 53 THI patients (43/81.1%) males and 10/18.9% females) with positive and negative CT scan findings. A complete clinical history and patients’ data were taken from CT reports, which included age, gender, type of trauma, associated injury, and CT findings with their percentages. The study was carried out in Taif city in King Abdelaziz Hospital and King Faisal Hospital. The distribution of various etiologies of THI has shown that the most common etiology was road traffic accident (RTA) (45.3%). The typical age for THI was between 21 to 30 years old (26.4%). The distribution of the traumatic causes for each age group is shown in Table 1. The typical age for RTA was the age group of 11-20 years (33.3%), for falls – the age groups of 0-10 years (33.3%) and over 60 years of age (33.3%). The frequency of various CT findings of THI was as follows: intracranial hemorrhage (56.6%), fracture (39.6%), pneumocephalus (22.6%), contusion (22.6%), foreign body (11.3%), and proptosis (3.8%). The distribution of fracture cases, according to their types, was as follows: a linear fracture (76.2%), comminuted fracture (23.8%), basilar fracture (14.3%), and depressed fracture (9.5%). The frontal bone was the most affected site with fractures (30.7%). Conclusion: CT is an appropriate clinical modality used in the management of THI patients in the emergency department. CT has the advantage of being fast, safe, available, sensitive to most acute post-traumatic injuries, accurate in identifying the head abnormalities such as fractures and hemorrhage during the first 24 hours after injury, which is beneficial in the early assessment, therapy planning, monitoring, and long-term patient care.

Ultrasonographic measurement of optic nerve sheath diameter to detect raised intracranial pressure in adult head injury patients in the intensive care unit and its correlation with computed tomography scan findings

Background: Our objective was to evaluate if ultrasonographic measurement of optic nerve sheath diameter can be used for early and accurate diagnosis of raised intracranial pressure as seen in cranial CT scan in patients of traumatic brain injury. Methods: Prospective, observational study. 40 adult traumatic head injury patients with altered sensorium suspected to have elevated intracranial pressure admitted to the ICU. Single optic nerve sheath diameter was measured 3.0 mm behind the globe in each eye, and optic nerve sheath diameter from each eye were averaged to create a binocular optic nerve sheath diameter measurement. A binocular optic nerve sheath diameter or uni-ocular measurement in patients with single eye measurement greater than 5.00 mm was considered abnormal. A CT scan of the head was performed within 2 hrs of USG measurement. The radiologist was blinded to the USG measurement of optic nerve sheath diameter and patient's CT considered to be positive for raised ICP Results: Mean age of the patients was 41.15 years. Mean ONSD recorded was 5.613. Highest ONSD was 6.300 and the lowest was 4.750. CT scan findings of raised ICT were present in 36 patients and mean ONSD was >5.00 mm in all the patients. CT scan finding of raised ICT was not present in 4 patients out of which raised ONSD was present in 1 patient. Hence study showed that USG of ONSD has 100% sensitivity and 75% specificity with a positive predictive value of 97.3% and a negative predictive value of 100%. Conclusions: Bedside ultrasonographic measurement of optic nerve sheath diameter has the potential as a sensitive screening test for elevated intracranial pressure in adult head injury patients in ICU.

The audit of traumatic head injuries in a tertiary care hospital in Mumbai: a retrospective study

Background: Trauma and trauma related deaths are a major health concerns in any country of which half of the deaths are due to head injuries. Yet reliable statistics are difficult to discover from routinely collected data. This study helps to analyse the epidemiology, mortality and morbidity of traumatic head injury patients in a tertiary care hospital in Mumbai.Methods: Retrospective data of one year (1st January 2019 to 31st December 2019) was collected from Medical records department. Demographic data, mode of injury, severity of injury, interventions done, duration of hospital stay, mortality and morbidity were recorded.Results: Of the total 944 cases recorded, 785 (83%) were males. More than half of the patients were below 40 years of age. The leading cause of trauma was RTA (79%) followed by accidental fall (18%). Of all the trauma patients 110 (11%) were found to be under influence of alcohol. 77 patients (8%) on admission had poor GCS (0-3), while 766 (81%) on admission had good GCS (8 and above). 153 patients (16%) underwent neurosurgical intervention. Average length of hospital stay of most patients (545) was 4 to 7 days. Total mortality was 111 (12%). Mortality was high in patients with poor GCS on admission.Conclusions: The above study gives statistics regarding the epidemiology, morbidity and mortality of patients of traumatic head injuries in a tertiary care hospital which can be used for future references in designing management policies to prevent traumatic head injuries.