Agonies and nuances of geriatric head injury: experience of a tertiary care institute of Western India

Background: Traumatic brain injury (TBI) is the most common cause of mortality and morbidity in emergency surgical department. The basic aim of the present study is to analyze the clinical profile, prognostic factors, impact of comorbidities on outcome and complications of traumatic brain injury in elderly patients.Methods: The study is retrospective analysis of hospital records of all admitted patients of head injury above 60 years of age over last five years at a tertiary care institute of India.Results: There were 94 males and 61 females in our study with male to female ratio of 1.54:1. The average age of male patients were 68.55 years and female patients were 64.50 years. Fall was the most common cause of head injury (59.3%) followed by road traffic accidents (36.8%) and assault was the least common (3.9%). Mortality was more in moderate and severe head injury groups with more propensity among females with comorbidities.Conclusions: Our study highlights that geriatric TBI carries a significant morbidity and mortality in India despite of advances in trauma care.

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Outcome of diffuse axonal injury in moderate and severe traumatic brain injury

Surgical Neurology International ◽

10.25259/sni_573_2020 ◽

2021 ◽

Vol 12 ◽

pp. 384

Author(s):

Farrukh Javeed ◽

Lal Rehman ◽

Ali Afzal ◽

Asad Abbas

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Road Traffic ◽

Axonal Injury ◽

Tertiary Care ◽

Diffuse Axonal Injury ◽

Average Hospital ◽

Satisfactory Outcome ◽

Moderate Traumatic Brain Injury

Background: Diffuse axonal injury (DAI) is a common presentation in neurotrauma. Prognosis is variable but can be dependent on the initial presentation of the patient. In our study, we evaluated the outcome of diffuse axonal injury. Methods: This study was conducted at a tertiary care center from September 2018 to December 2019 and included 133 adult patients with moderate or severe head injury (GCS ≤ 12) diagnosed to have the DAI on the basis of MRI. At 3 months, the result was assessed using the Extended Glasgow Outcome Scale (GOS-E). Results: There were a total of 97 (72.9%) males and 36 (27.1%) females with an average age of 32.4 ± 10 years with a mean GCS of 9 at admission. The most common mode of head trauma was road traffic accidents (RTAs) in 51.9% of patients followed by fall from height in 27.1%. Most patients were admitted with moderate traumatic brain injury (64.7%) and suffered Grade I diffuse axonal injury (41.4%). The average hospital stay was 9 days but majority of patients stayed in hospital for ≤ 11 days. At 3 months, mortality rate was 25.6% and satisfactory outcome observed in 48.1% of patients. The highest mortality was observed in the Grade III DAI. Conclusion: We conclude that the severity of the traumatic head injury and the grade of the DAI impact the outcome. Survivors require long-term hospitalization and rehabilitation to improve their chances of recovery.

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Clinical spectrum of paediatric head injury

Romanian Neurosurgery ◽

10.33962/roneuro-2020-033 ◽

2020 ◽

pp. 220-225

Author(s):

Krishna Govind Lodha ◽

Tarun Kumar Gupta ◽

Gaurav Jaiswal ◽

Yogendra Singh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Road Traffic ◽

Radiological Finding ◽

Paediatric Population ◽

Major Health Problem ◽

Female Ratio ◽

Paediatric Head Injury ◽

Fall From Height

Introduction: Traumatic Brain injury is considered as a major health problem which causes frequent deaths and disabilities in paediatric population with special concern to tribal regions of developing countries like India where etiology of traumatic brain injury in the paediatric population fall from height dominant over the road traffic accident as a major. Aim and objective: The aim is to analyse the epidemiology, mechanism, clinical presentation, severity and outcome of paediatric head injury in the tribal region of northern India that could help to make preventive policies to improve their care. Material methods: It is a prospective observational study of 345 children of up to 18 years of age admitted under Department of Neurosurgery from October 2017 to April 2019. Results: The study population comprised of 345 paediatric patients. Mean age was 9.25 years.36.81% patients were in 1-6-year age group and male to female ratio was 2.45. The most common cause for trauma was fall from height in 179(52%) cases followed by RTA in 141(41%) cases. The most common radiological finding was depressed skull fractures in 97(50%) cases. There was 35% mortality in severe head injury patients. Conclusion: This study through some light on the different scenario of head injury in Tribal regions of Developing country and will help to formulate effective strategies for prevention and better care of the patients.

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An Epidemiological Study of Traumatic Head Injury in a Tertiary Care Center in Kancheepuram, Tamil Nadu, India

Asian Journal of Medicine and Health ◽

10.9734/ajmah/2019/v16i130136 ◽

2019 ◽

pp. 1-5

Author(s):

K. Myl Kumaran ◽

Pragadeesh Raja ◽

M. Jasmine

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Tamil Nadu ◽

Road Traffic ◽

Tertiary Care ◽

Major Public Health Problem ◽

Traumatic Head Injury ◽

History Of ◽

Traumatic Head

Introduction: Traumatic brain injury is a major public health problem in India. The severity of a traumatic brain injury may range from mild to severe. The increase in economic growth in India coupled with rise in population, motorization and industrialization has contributed to a significant increase in TBI with each advancing year. India having the highest rate of head injury in the world. In India more than 100000 lives are lost every year with over 1 million suffering from serious head injury. Objectives: To assess the risk factors among for head injury cases and assess the outcome of the traumatic brain injury patients. Materials and Methods: A cross sectional Study conducted among all patients with traumatic head injury attending tertiary care centre and those admitted in intensive care unit with the history of traumatic head injury for the duration of one year (August 2016 to July 2017). Data was collected through questionnaire, hospital records and collected from patients. Data Collected was entered in MS office excel and analyzed in SPSS version 21. Results: Totally 295 cases were reported with history of traumatic brain injury, out of which 82.7% were males and 17.3% were females. Road traffic accidents was the most common cause for TBI 86.4%. Most of the patient was between the age group of 21-40 (51.5%). Most of the cases were from rural areas 55.3%. Based on GCS 49.5%, 28.5% and 22.0% patients had mild, moderate and severe injury respectively. 44.7% injuries occurred between the time period 04.00PM to 12.00AM. Conclusion: This study revealed that most traumatic head injury occur due to Road traffic accident stressing the urgent need to create awareness and conduct health education about prevention of traumatic head injury.

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TRAUMATIC BRAIN INJURY: EPIDEMIOLOGY, MODE AND TYPE OF INJURY AND MANAGEMENT. A STUDY OF TERTIARY CARE HOSPITAL IN WESTERN INDIA

10.36106/paripex/5301063 ◽

2019 ◽

pp. 1-2

Author(s):

Meghna Kinjalk ◽

Dilraj Kadlas* ◽

Pooja Agarwal

Keyword(s):

Quality Of Life ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Western India ◽

Care Hospital ◽

Age Group

The morbidity and quality of life after head injury is long and devastating.The symptoms may persist for lifetime and if not, then can be long enough to affect a person's health/the working conditions and definitely the monetary factor for coping up with this comes into a larger picture.It is also one of the leading causes of lifelong disability or death worldwide.The presentation may vary between a conscious patient on arrival to the emergency room to a person with seizures,ear bleed or drowsiness.The various types of presentation go hand in hand with different types of head injury, its management,prognosis and long-term impact on a person's life.Despite various studies and appropriate guidelines, the morbidity after head injury remains high.This study has a purpose to correlate various presentations of head injury, the epidemiology of head injury,types of head injury and its management options in a tertiary acre hospital. OBJECTIVES: a. To study the demographic profile and gender distribution of patients presenting to emergency room in a tertiary care hospital in western India. b. To study the mode and type of head injury,Imaging finding and its management. METHODOLOGY: It was a prospective study of consecutive 200 patients presenting to a tertiary care hospital: Mahatma Gandhi Mission's Medical college and hospital,Kamothe,Navi Mumbai.Institute Ethical committee approval was obtained before the start of study. All the age group was included. There were no exclusion criteria. Result was tabulated and analysed at the end of the study. RESULT:This study enrolled 200 patients in which male were more common than female,young adults more commonly affected.Majority of patients were treated conservatively and improved. CONCLUSION: The most common cause of traumatic brain injury is road traffic accident and relating it with the most common age group ,brings us to the conclusion of importance of safety measures on road amongst young adults.Hence , preventing the wrath of morbidity associated with the debilitating head injury.This also helps in improving the quality of life of the patient and the care giver

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Prospective Analysis of Coagulopathy Associated with Isolated Traumatic Brain Injury and Clinical Outcome

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1728989 ◽

2021 ◽

Author(s):

Gopal Krishna ◽

Varun Aggarwal ◽

Ishwar Singh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Clinical Outcome ◽

Road Traffic ◽

Statistical Significance ◽

Platelet Counts ◽

Coagulation Abnormalities ◽

The Mean ◽

D Dimer

Abstract Introduction Traumatic brain injury (TBI) affects the coagulation pathway in a distinct way than does extracranial trauma. The extent of coagulation abnormalities varies from bleeding diathesis to disseminated thrombosis. Design Prospective study. Methods The study included 50 patients of isolated TBI with cohorts of moderate (MHI) and severe head injury (SHI). Coagulopathy was graded according to the values of parameters in single laboratory. The incidence of coagulopathy according to the severity of TBI and correlation with disseminated intravascular coagulation (DIC) score, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen was observed. The comparison was also made between expired and discharged patients within each group. It also compared coagulation derailments with clinical presentation (Glasgow Coma Scale [GCS]) and outcome (Glasgow Outcome Scale [GOS]). Results Road traffic accident was the primary (72%) mode of injury. Fifty-two percent had MHI and rest had SHI. Eighty-four percent of cases were managed conservatively. The mean GCS was 12.23 and 5.75 in MHI and SHI, respectively. Sixty-two percent of MHI and 96% of the patients with SHI had coagulation abnormalities. On statistical analysis, DIC score (p < 0.001) strongly correlated with the severity of head injury and GOS. PT and APTT were also significantly associated with the severity of TBI. In patients with moderate TBI, D-dimer and platelet counts showed association with clinical outcome. Fibrinogen levels did not show any statistical significance. The mean platelet counts remained normal in both the groups of TBI. The mean GOS was 1.54 and 4.62 in SHI and MHI, respectively. Conclusion Coagulopathy is common in isolated TBI. The basic laboratory parameters are reliable predictors of coagulation abnormalities in TBI. Coagulopathy is directly associated with the severity of TBI, GCS, and poor outcome.

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Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1718780 ◽

2021 ◽

Author(s):

Sukriti Das ◽

Bipin Chaurasia ◽

Dipankar Ghosh ◽

Asit Chandra Sarker

Keyword(s):

Head Injury ◽

Road Traffic ◽

Head Injuries ◽

Skull Fracture ◽

Tertiary Care ◽

Acute Subdural Hematoma ◽

Care Hospital ◽

Female Ratio ◽

Mortality And Morbidity ◽

The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

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Emergency Department Referral Profile of Traumatic Brain Injury Records at a Tertiary Care Hospital of Pakistan

10.21203/rs.3.rs-84330/v3 ◽

2021 ◽

Author(s):

Maria Khan ◽

Uzair Yaqoob ◽

Zair Hassan ◽

Muhammad Muizz Uddin

Keyword(s):

Traumatic Brain Injury ◽

Emergency Department ◽

Brain Injury ◽

Road Traffic ◽

Tertiary Care ◽

Initial Assessment ◽

Care Hospital ◽

Mild Tbi ◽

Epidemiological Characteristics ◽

The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This was a cross-sectional study conducted at the Lady Reading Hospital, Peshawar, Pakistan. Data were extracted from the medical records from January 1st to December 31st, 2019. Patient age, sex, type of trauma, and immediate outcome of the referral to the Emergency Department were recorded. The severity of TBI was categorized based on Glasgow Coma Scale (GCS) in mild (GCS 13-15), moderate (GCS 9-12), and severe (GCS <8) classes. The Emergency Department referral profile was classified as admissions, disposed, detained and disposed, referred.Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively commonplace picture of epidemiological data on the burden of TBI in Pakistan. As a large proportion of patients had a mild TBI, and there is a high risk of mild TBI being under-diagnosed, we warrant further investigation of mild TBI in population-based studies.

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Clinico-radiologic Profile of Pediatric Traumatic Brain Injury in Western Rajasthan

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_269_17 ◽

2018 ◽

Vol 09 (02) ◽

pp. 226-231 ◽

Cited By ~ 2

Author(s):

Pawan Kumar Dara ◽

Manish Parakh ◽

Shyama Choudhary ◽

Hemant Jangid ◽

Priyanka Kumari ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Hospital Stay ◽

Road Traffic ◽

Tertiary Care ◽

Care Hospital ◽

Pediatric Traumatic Brain Injury ◽

Csf Rhinorrhea ◽

Temporal Bone Fracture ◽

Fall From Height

ABSTRACTObjective: The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI). Design: Prospective observational study Setting: Intensive Care Unit, ward and OPD of Pediatrics, Dr. S. N. Medical College, Jodhpur (tertiary care hospital). Participants: A total of 188 children (1 month–18 years) were enrolled and 108 admitted. Intervention: TBI classified as mild, moderate, or severe TBI. Neuroimaging was done and managed as per protocol. Demographic profile, mode of transport, and injury were recorded. Outcome: Measured as hospital stay duration, focal deficits, mortality, and effect of early physiotherapy. Results: Males slightly outnumbered females mean age was 5.41 ± 4.20 years. Fall from height was the main cause of TBI (61.11%) followed by road traffic accident (RTA) (27.78%). Majority (56.56%) reached hospital within 6 h of injury, out of which 27% of patients were unconscious. Mild, moderate, and severe grade of TBI was seen in 50%, 27.78%, and 22.22% of cases, respectively. About 12.96% of cases required ventilator support. The average duration of hospital stay was 11.81 ± 12.9 days and was lesser when physiotherapy and rehabilitation were started early. In all children with temporal bone fracture, magnetic resonance imaging (MRI) brain revealed a temporal lobe hematoma and contusion in spite of initial computed tomography (CT) head normal. Children who have cerebrospinal fluid (CSF) rhinorrhea/otorrhea had a high chance of fracture of base of skull and contusion of the basal part of the brain. Conclusion: In India, fall from height is common setting for pediatric TBI besides RTA. Early initiation of physiotherapy results in good outcome. MRI detects basal brain contusions in children presenting with CSF rhinorrhea/otorrhea even if initial CT brain is normal.

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Immediate Outcomes of Traumatic Brain Injury at a Tertiary Care Hospital Of Pakistan- A Retrospective Study

10.21203/rs.3.rs-84330/v2 ◽

2021 ◽

Author(s):

Maria Khan ◽

Uzair Yaqoob ◽

Zair Hassan ◽

Muhammad Muizz Uddin

Keyword(s):

Traumatic Brain Injury ◽

Retrospective Study ◽

Brain Injury ◽

Road Traffic ◽

Tertiary Care ◽

Initial Assessment ◽

Care Hospital ◽

Hospital Data ◽

Epidemiological Characteristics ◽

The Impact

Abstract Background: Traumatic Brain Injury (TBI) is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective here is to describe the epidemiological characteristics of patients with TBI in our country and to determine the immediate outcomes of patients with TBI after the presentation.Method: This retrospective study was conducted at the Lady Reading Hospital. Data were extracted from the medical record room from January 1st to December 31st, 2019. The severity of TBI was based on Glasgow Coma Scale (GCS) and was divided into mild (GCS 13-15), moderate (GCS 9-12), and severe TBI (GCS <8) based on the GCS. SPSS v.23 was used for data analysis. Results: Out of 5047 patients, 3689 (73.1%) males and 1358 (26.9%) females. The most commonly affected age group was 0-10 years (25.6%) and 21-30 years (20.1%). Road Traffic accident was the predominant cause of injury (38.8%, n=1960) followed by fall (32.7%, n=1649). Most (93.6%, n=4710) of the TBIs were mild. After the full initial assessment and workup, and completing all first-aid management, the immediate outcome was divided into four, most frequent (67.2%, n=3393) of which was “disposed (discharged)”, and 9.3% (n=470) were admitted for further management.Conclusion: Our study represents a relatively conclusive picture of epidemiological data on the burden of TBI in Pakistan. Although a large proportion of patients had a mild TBI, they may likely be under-diagnosed. This warrants further investigation of MTBI in population-based studies across the globe.

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Incidence of Benign Paroxysmal Positional Vertigo in Head Injury Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i48a33237 ◽

2021 ◽

pp. 188-194

Author(s):

Celastina Synthia ◽

. Rameshwar

Keyword(s):

Head Injury ◽

Traffic Accidents ◽

Benign Paroxysmal Positional Vertigo ◽

Road Traffic ◽

Tertiary Care ◽

Care Hospital ◽

Female Ratio ◽

Posterior Canal ◽

Positional Vertigo ◽

Paroxysmal Positional Vertigo

Background: Traumatic brain injury is a common secondary cause of Benign Paroxysmal Positional Vertigo(BPPV). Objective: To determine the incidence and clinical profile of patients with BPPV in mild and moderate head injury. 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. 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. 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%).

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