Characteristics of patients who died from traumatic brain injury in two rural hospital emergency departments in Maharashtra, India, 2007-2009 (original) (raw)
Related papers
A Retrospective Study of Traumatic Brain Injuries at a Tertiary Care Hospital in AP
IOSR Journals , 2019
Introduction: Traumatic brain injury (TBI) is one of the most devastating types of injury. It affects all ages; however majority of road traffic injuries (RTI) occurs in young adults of productive age group. As per report by the ministry of road transport, Government of India (2007) 1.4 lakhs road accident happened in 2007 with 40,612 people killed and 1.5 lakhs people injured. Hence, India is leading the world in fatalities due to road accidents. TBI is also associated with significant socioeconomic losses in India as well as in other developing countries. Materials and Methods: The prospective study was conducted over a period of 24 months from July 2016 to June 2018 in Department of Neurosurgery, Kurnool medical College and Govt general hospital, Kurnool, AP. A total of 1378 patients presenting with head injury to our major trauma referral center were included in the study. All patients were subjected to detailed primary head-to-toe clinical survey to rule out involvement of other organ systems, following initial stabilization. During the post-resuscitative period an accurate history was taken from the family and/or eyewitnesses along with meticulous neurological and systemic examination including Glasgow Coma Score (GCS). This was followed by neuroimaging along with imaging of other relevant systems. Results: Over the two-year study period, 1378 patients were includedin the study. Out of which 1057 (76.7%) were males and 321(23.3%) were females. The mean age at presentation was 29.2 years (3 months-72 years). The most common age groupwas 21-30 years with 470 (34.1%) patients, followed by 331(24.02%) patients between 31-40 years (Table I).Majority (58.3% n=803) of patients arrived at the A & Edepartment between 2-6 hours following trauma. Only 17.2%(n=237) patients were brought at the A & E within 2 hourswhile 338 (24.5%) patients reached A & E more than 6 hoursafter injury. Conclusion: By improving our system with better reporting and documentation of cases, we will be able to make a better plan to decrease the incidence of TBI and their timely appropriate multimodality approaches to achieve better outcome of these cases within our limited resources.
An Epidemiologic Study of Traumatic Brain Injuries in Emergency Department
SBMU publishing, 2015
Introduction: Traumatic brain injuries (TBI) are one of the most important causes of death in patients under the age of 25 years and is responsible for one third of total deaths caused by trauma. Therefore, knowing its epidemiologic pattern in different populations seems vital. Therefore, this study aims to examine the epidemiologic pattern of TBI in emergency department. Methods: In this cross-sectional study, the profiles of 1000 patients affected by TBI were selected using simple random sampling. The examined variables in this study included demographic, season, mechanism of injury, accompanying injuries, level of consciousness, hospitalization duration, computed tomography (CT) scan results, needing surgery, admission to intensive care unit, and outcome of the patient. In the end, independent risk factors for the death of patients were determined. Results: 1000 patients suffering from were studied (81.8% male; mean age 38.5±21.7 years). The frequency of their referral to hospital in spring (31.4%) was more (p<0.01). 45.9% of the patients had a level of consciousness less than 9 based on the Glasgow Coma Scale (GCS). Subdural (45.9%) and epidural bleeding (23.7%) were the most common findings in CT scans in this study (p<0.001). Finally, 233 (23.3%) of the patients were dead. Over 60 years of age, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and the need to be admitted to intensive care unit were independent risk factors of death in TBI. Conclusion: Age Over 60 years, falling and motorcycle accidents, intracranial hemorrhage accompanied by brain contusion, subdural bleeding, a GCS of less than 9, and need to be admitted to intensive care unit were independent risk factors for the death in TBI patients.
journal of medical science and clinical research, 2017
Background: Traumatic brain injury (TBI) has been called the "Silent Epidemic". It is defined as sudden injury due to an external force that affects the functioning of brain. It may be either caused by sudden blow or impact (closed head injury) or by an object penetrating the skull (Penetrating injury). The common causes of traumatic brain injury include road traffic accidents, fall from height and assault. The mortality from traumatic brain injury is reported to be between 1-2% of death from all the causes. Not only it is one of the major causes of death in young adults but also may cause permanent disability in survivors. The importance of TBI as a public health problem cannot be overstated and the forensic pathologist plays a major role in identifying the specific brain injuries resulting from each circumstance. Aims and objectives: To study the cause, survival time and type of injuries in victims of traumatic head injury brought to the mortuary. Results: This study included all the cases of death secondary to head injuries due to blunt force trauma brought to mortuary. Out of 50 cases 40 (80%) were males and 10 (20%) were females with a M:F ratio of 1:0.25. The most common age group involved was 21-40 years (32%) followed by 61-80 years (28%) and 41-60 years (18%). The most common cause of TBI was found to be road traffic accidents (68%) followed by fall from height (16%). Following TBI majority of the patients succumbed to death between 16-24 hours (34%) while spot death was seen in 12% of the cases.39 (78%) patients were found to be having skull fracture majority of which involved vault alone (48.72%) while in 18 (46.15%) patients the fracture involved both vault and the base of skull. Contusion was present in 28 (56%) patients. Most common type of intracranial hemorrhage was found to subarachnoid hemorrhage which was found in 41 (82%) patients followed by subdural and intra-cerebral hemorrhages which were seen in 38 (76%) and 22 (44%) patients respectively. Conclusion: The most common cause of traumatic brain injury in our study was found to be road traffic accidents. Thus it can be inferred that morbidity and mortality from traumatic brain injuries can be reduced by taking steps to prevent road traffic accidents.
Morbidity Audit of 704 Traumatic Brain Injury Cases in a Dedicated South Indian Trauma Center
Asian journal of neurosurgery
In the era of evidence-based health care, protocol of intervention in traumatic brain injury (TBI) cases help decide more easily and safely about patients and prevent unnecessary transfer of patients to other centers. The objective of this study is to provide protocol-based intervention and evaluate the epidemiological, clinical characteristics of TBI cases. This prospective study was conducted on 704 patients who were suspected of TBI at the Department of Neurosurgery, Narayana Medical College and Hospital, followed by protocol-based intervention assessed and reassessed repeatedly. Overall, TBI involved 569 (80.82%) adults in the productive age groups (21-60 years); among males 81.47%. Among males, highest (23.15%) cases were in the age group of 31-40 years while in females, majority (27.04%) was among 41-50 years. Road traffic accidents were the most common (54.12%) mechanism of injury followed by fall (21.31%) and two-wheelers (15.20%). More than half sustained mild TBI (51.42%) ...
Epidemiological study of traumatic brain injury in a tertiary care centre in South India
International Surgery Journal, 2020
Background: This study investigated the epidemiological pattern of traumatic brain injury (TBI) in our hospital, so as to juxtapose with available statistics and formulate recommendations for patient betterment.Methods: The Government Medical College, Thiruvananthapuram was the setting of this cross-sectional longitudinal study and included all patients admitted with clinical/radiological evidence of TBI over a period of three months (October 2019 to December 2019). Details regarding mechanism of injury and the socioeconomic background of the subjects were collected during the stay in hospital, by means of a semi structured questionnaire. SPSS software was used to analyze the data collected.Results: Out of 658 patients included in the study, majority of the subjects belonged to the age group 30-60 years. About 80% of subjects were males. 63% were manual laborers. Majority of the patients had about 10-15 days’ stay in the hospital. Road traffic accidents were the most common mechanis...
Journal of Evidence Based Medicine and Healthcare, 2015
BACKGROUND Trauma is one of the leading causes of death and disability in the Indian Population. OBJECTIVE To evaluate and describe the epidemiological and clinical characteristics of patients with traumatic brain injury and their clinical outcomes following admission to a rural tertiary care teaching hospital in India. STUDY DESIGN Retrospective, cross-sectional, hospital based analysis of 1713 patients of Traumatic Brain Injury [TBI] admitted to the Department of Neurosurgery in a tertiary health centre in Jaipur from January 2014 to August 2015. METHOD The medical records of all eligible patients were reviewed and data collected on age, sex, mechanism of injury, severity of injury Glasgow Coma Scale (GCS) and Outcome (GOS) score, Computed Tomography (CT) scan results, modality of management and type of surgical intervention and outcome. RESULTS Among the 1713 patients admitted, age of patients varied >1 year to 92 years (mean age 21 years), majority of TBI's were reported in the age group 20-29 years (34.38%), followed by 30-39 years (26.97%), 40-49 years (16.70%), p value <0.05. Most of the patients were male (63.46%), mostly unmarried. Majority lived in suburban areas (51.26%) followed by rural (26.85%) and urban (21.89%). Patients were mostly from middle class (46.58%) and poor socioeconomic background (42.62%), upper class only accounted for 10.8% of the cases. In terms of occupation, servicemen and farmers accounted for the majority (54.73%). Patients were brought to the hospital mainly by known persons (68%) and rest by bystanders and policemen. The most common mechanism of injury was road traffic accidents (RTA) 1199 (69.99%), followed by assault 251 (14.65%), 15.35% accounted for fall from height and fall of object on head. Mean hospital stay was 7.6±9.3 days (range <1 day to 87 days). In our study, patients were classified by GCS as mild TBI in 983(57.38%) patients; moderate in 488 (28.48%) and severe in 242 (14.12). 1481 (86.46%) patients experienced loss of consciousness; 788 (46%) had one or more episodes of vomiting; 312 (18.21%) patients presented with bleeding from ear, nose or throat, seizures were noted in 282 (16.46%) patients and vertigo in 411 (23.99%). Clinical examination also revealed abnormal pupils in 208 (12.14%) patients, abnormal motor response in 211 (12.32%) patients, only 3-5% patients showed cranial nerve deficit, racoon eyes or battle's sign. CT scan revealed contusions (42.50%) and fractures (35.14%) were the most common findings followed by sub dural hematoma (32.87%), extradural hematoma (18.21%). 85% patients were managed conservatively and 27% managed surgically. The overall mortality was 149 (8.69%). In a 6 month follow-up, 54 patients were persistently vegetative, 37 were severely disabled (dependent for day to day activities). 1452 patients recovered to be healthy. CONCLUSION Traumatic brain injury is a serious challenge to the community. With rapid modernization, growth in the country has been sporadic, boosting only segments of the population. Presently, there is no adequate consensus on the magnitude of TBI. A multidisciplinary and multi-modal approach is necessary. Development of a computerized system, better reporting and documentation is essential to understand the true incidence of
Journal of Neurosciences in Rural Practice, 2016
Traumatic brain injury (TBI), a significant public health problem, is a leading cause of disability and mortality in all regions of the globe despite advancement in prevention and treatments. Its global incidence is rising, and it is predicted to surpass many diseases as a major cause of death and disability by the year 2020. [1] TBI is the main cause of one-third to one-half of all trauma deaths and the leading cause of disability in people under forty, severely disabling 15-20/100,000 populations per year. [2] The World Health Organization estimates that almost 90% of deaths due to injuries occur in low-and middle-income countries (LAMICs), where 85% of population live, and this situation will continue to represent an important global health problem in the upcoming years. [3,4] TBI is a leading cause of mortality, morbidity, disability, and socioeconomic losses in India as well. It is estimated that nearly 1.5-2 million persons are injured, and 1 million die every year in India. [5] India and other developing countries are facing the major challenges of prevention, prehospital care, and rehabilitation in their
Indian Journal of Neurosurgery, 2021
Introduction The purpose of this study is to compare the current clinical management practices and decision guidelines of the Brain Trauma Foundation (BTF) for mild traumatic brain insult with line of treatment followed at our center to identify the clinically significant treatment outcome in pediatric to elderly patients. Materials and Methods This is a questionnaire-based prospective observational study at the emergency department of neurosurgery in Dr. Ram Manohar Lohia (RML) Hospital, New Delhi. A registry questionnaire was administered to all the eligible subjects by the neurosurgery resident in emergency department (ED) to correlate clinical status, severity of traumatic brain injury (TBI) and associated comorbid conditions and its outcome after management. Results Out of 154 mild TBI cases attending ED, 115 (74.7%) were males and 39 (25.3%) were females, with average age of 27 years. Of the patients with mild TBI, road traffic accidents (RTA) were the main cause (50.6%), foll...
2021
Objective: Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality in both adults and children. As with other severe injuries, the outcome of TBIs is also gravely related to the quality of emergency care. Effective emergency care significantly contributes to reduced morbidity and mortality. This study was ensued to evaluate the characteristics of TBIs in Pakistan and their outcomes in the emergency department (ED). Material and Methods: This cross-sectional study included records of TBI patients seen in the Neurosurgical ED of Jinnah Postgraduate Medical Centre, Karachi, Pakistan. All patients of any age with TBI were included in the study. The outcome was assessed at the end of ED treatment. Results: During the study period, 5,546 patients with TBI were seen in the ED; an estimated 56.5 patients per day. There were 73.1% male patients and 26% were of age < 10 years. The most common culprit of TBI was road traffic accidents (RTAs) (39%) followed by accid...
A Survey of Traumatic Brain Injuries from Road Traffic Collisions in a Lower Middle-Income Country
Cureus
The burden of traumatic brain injury (TBI) from road traffic collisions (RTCs) is great in low-and middleincome countries (LMICs) due to shortfalls in preventative measures, and the lack of relevant, accurate data collection. To address this gap, we sought to study the epidemiology of TBI from RTCs in two LMIC neurosurgical centres in order to identify factors amenable to preventative strategies. A prospective survey of all adult and paediatric cases of TBI from RTCs admitted to Northwest General Hospital (NWGH) and Hayatabad Medical Complex (HMC) over a four-week period was carried out. Data on patient demographics, risk factors, injury details, pre-hospitalisation details, admission details and post-acute care was collected and analysed. A total of 68 patients were included in the study. 18 (26%) of the patients were male and in the 30 to 39 age group. Fifty-two percent were two-wheeler riders and/or passengers. 51 (75%) of the RTCs occurred between 12 noon and 12 midnight and in rural areas (66.2%). The most commonly documented risk factor that led to the RTC was speeding (35.3%). Pre-hospital care was either absent or undocumented. Up to two-thirds of patients were not direct transfers, and most were transported in private vehicles (48.5%) arriving later than an hour after injury (94.1%). Less than half with documented disabilities were referred for rehabilitation (38.5%). There are still gaps in the prevention of TBI from RTCs and in relevant data collection. Data collection systems must be strengthened, and further exploratory research carried out in order to improve the prevention of TBI from RTCs.