Towards integration of transcranial Doppler in the management of severe TBI in LICs and LMICs: A Cohort Retrospective study

Abstract Background: Decompressing craniectomy (DC) is an important method for the management of severe traumatic brain injury (TBI). Objective: To analyze the effect of prophylactic DC within 24 hours after head trauma TBI. Methods: Seventy-two patients undergoing prophylactic DC for severe TBI were included in this retrospective study. Both of the early and late outcomes were studied and the prognostic factors were analyzed. Results: In this series, cumulative death in the first 30 days after DC was 26%, and 28 (53%) of 53 survivors in the first month had a good outcomes. The factors including Glasgow Coma Score (GCS) score at admission, whether the patient had an abnormal pupil response and whether the midline shift was greater than 5 mm were most important prognostic factors for the prediction of death in the first 30 days and the final outcome at 6 months after DC. Conclusion: Prophylactic DC plays an important role in the management of highly elevated ICP, especially when other methods of reduction of ICP are unavailable.

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Remaining unconscious: The burden of traumatic brain injuries in India

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.165394 ◽

2015 ◽

Vol 06 (04) ◽

pp. 520-522 ◽

Cited By ~ 1

Author(s):

Deepak Agrawal ◽

P. K. Singh ◽

S. Sinha ◽

D. K. Gupta ◽

G. D. Satyarthee ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Retrospective Study ◽

Motor Response ◽

Brain Injuries ◽

Traumatic Brain Injuries ◽

Trauma Centre ◽

Motor Score ◽

Single Centre ◽

Severe Tbi

ABSTRACT Introduction: It is well-known that severe traumatic brain injuries (TBI) have a poor outcome. However, what is not well-known is the outcome for those who survive but remain unconscious at the time of discharge from the hospital. Aims and Objectives: To assess the outcome of severe TBI patients who have a motor response of M5 or lower on the Glasgow coma score (GCS) at discharge from a single centre in India. Materials and Methods: In this retrospective study carried at one trauma centre in India, a prospectively maintained neurotrauma registry was queried from May 2010 to February 2013 for patients who had severe traumatic brain injury (GCS ≤ 8) at admission and had a motor response of M5 or lower on the GCS at discharge. Demographic and clinical data were analyzed, and outcome Glasgow outcome scale (GOS) assessed at 6 months using a telephonic questionnaire. Observations and Results: There were a total of 1525 patients with severe TBI in the study period. Of these 166 (10.9%) were unconscious (motor response M5 or lower on the GCS) at discharge from the hospital. 139 were males and 27 females with a mean age of 33.9 years. After a mean hospital stay of 24.31 days, the discharge motor score was M5 in 32 (19.3%), M4 in 44 (26.5%), M3 in 59 (35.5%), M2 in 44 (26.5%), and M1 in 9 (5.4%). Telephonic follow-up was available in 102 (61.4%) of the patients. 54 (52.9%) patients had died and 32 (31.4%) remained unconscious (vegetative) at 6 months. Only 16 patients (15.7%) had a good outcome (GOS 1–2) at 6 months following an injury. Conclusions: This is the only study of its kind on patients who remain unconscious at discharge following severe TBI and reveals that around 50% will die and another 30% remains vegetative at 6 months of discharge. Only a small percentage (15% in our study) will become conscious and partially integrated in the society.

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Surgical Outcome Following Early Decompressive Hemicraniectomy in Patients of Severe Traumatic Brain Injury: A Retrospective Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49046.15147 ◽

2021 ◽

Author(s):

Srikanta Das ◽

Acharya Suryakant Pattajoshi ◽

Pratyusha Ranjan Bishi ◽

Kulwant Lakra ◽

Biswajeet Bedbak ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Retrospective Study ◽

Brain Injury ◽

Surgical Outcome ◽

Road Traffic ◽

Secondary Brain Injury ◽

Basal Cistern ◽

Decompressive Hemicraniectomy ◽

Novel Technique ◽

Severe Tbi

Introduction: Traumatic Brain Injury (TBI) has become an epidemic and remains the leading cause of death and disability in people of 2nd to 4th decade. Road Traffic Accidents (RTA) are responsible for the majority of cases. Primary brain injury sustained on impact and secondary brain injury that develops in following hours and days contribute together to overall injury and decides ultimate outcome. The goal of management in any TBI patient aims to prevent secondary brain injury. Understanding the importance of Intracranial Pressure (ICP) is key to minimise secondary injury. Decompressive hemicraniectomy is a novel technique of reducing ICP in patients of severe brain injury. It’s judicious and timely performance not only saves life but also prevents the dreaded consequences of raised ICP. Aim: To evaluate the role of early decompressive hemicraniectomy in improving the survival rate among patients of severe TBI and analysing the important factors (glasgow coma scale, airway status, timing of surgery) affecting the surgical outcome. Materials and Methods: It was a retrospective study conducted at the Department of Neurosurgery, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India between September 2016 to March 2020. Case records of 60 patients of TBI who had undergone unilateral Decompressive Craniectomy (DECRA) were analysed. The decision for decompressive hemicraniectomy was purely based upon Glasgow Coma Scale GCS) and Computed Topography (CT) findings. The presence of an evacuable mass lesion, diffuse oedema and obliteration of basal cistern in CT was considered to be the most important criteria for the early decompressive procedure. Patients were assessed until their discharge from ward. Statistical analysis was performed by statistical package for science version 12. Results: A total of 60 patients with severe TBI, who underwent DECRA were analysed. Road Traffic Accident (RTA) was the predominant mechanism of injury. All had presence of a surgically evacuable mass lesion along with compression/obliteration of the basal cistern. The majority of mass lesions (n=42) were frontotemporal contusions (70%). Forty patients of total achieved good surgical outcome (66.67%) and rest 20 patients (33.33%) had poor outcomes. Overall incidence of complications was around 40%. The most important factors associated with good outcomes were GCS of 7 and and above, patent airway, and early surgery. Conclusion: Decompressive hemicraniectomy is a novel technique of reducing ICP which acts by directly breaking the rigid box phenomenon of Monro-Kellie doctrine. However patient selection, prompt decision, earliest intervention, adoption of standard technique of DECRA and post operative critical care management are important aspects behind the successful outcome.

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