scholarly journals The clinical profile and outcome of conservatively managed traumatic brain injuries and its implications on the timing of repeat CT scans

2020 ◽  
Vol 8 (1) ◽  
pp. 137
Author(s):  
Adil Abdulla ◽  
Sunil Sadanandan
Keyword(s):  
Ct Scan ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Ct Scans ◽  
Serial Ct ◽  
Ct Finding

Background: Outcome of traumatic brain injury is multi factorial. It is common to follow up the conservatively managed patients with repeated CT scans at specific intervals. The study was to observe the epidemiology of TBI and ascertain utility of repeating CT scans in conservatively managed TBI.Methods: 318 patients with TBI admitted to a tertiary care center for a period of 1 year was studied. Adult patients, who have undergone multiple CT scans were included and patients underwent surgery or expired after first CT scan excluded. Personal details, clinical details and reason for repeated CT scan was studied. The change in management based on serial CT scans was measured as outcome.Results: Road traffic accidents were the cause of 69.1% of TBI. 72% of the patients were male. Commonest CT finding was occurrence of mixed lesions, seen in 44.3% patients. In patients who underwent repeated CT scans, the mean number of repeat CT scans were 3.7 CT (SD=1.001), while that of elective cases were 2.40 scans (SD=0.629). The use of routine CT scan for follow up did not alter the management of patients with TBI when compared to patients who underwent elective scans as none of them underwent any surgical intervention.Conclusions: RTA are commonest cause for TBI. Use of routine CT scans was not of advantage over elective scans as none of the patients had any change in management with use of repeat CT scans.

scholarly journals Secondary overtriage of pediatric neurosurgical trauma at a Level I pediatric trauma center

2018 ◽  
Vol 22 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Charles E. Mackel ◽  
Brent C. Morel ◽  
Jesse L. Winer ◽  
Hannah G. Park ◽  
Megan Sweeney ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Care Center ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Pediatric Intensive Care ◽  
Ct Scans ◽  
Loss Of Consciousness ◽  
Skull Fractures ◽  
Level I ◽  
Neurosurgical Intervention

OBJECTIVEThe authors reviewed the transfer requests for isolated pediatric traumatic brain injuries (TBIs) at a Level I/II facility with the goal of identifying clinical and radiographic traits associated with potentially avoidable transfers that could be safely managed in a non–tertiary care setting.METHODSThe authors conducted a retrospective study of patients < 18 years of age classified as having TBI and transferred to their Level I tertiary care center over a 12-year period. The primary outcome of interest was identifying potentially avoidable transfers, defined as transfers of patients not requiring any neurosurgical intervention and discharged 1 hospital day after admission.RESULTSOverall, 70.8% of pediatric patients with isolated TBI did not require neurosurgical intervention or monitoring, indicating an avoidable transfer. Potentially avoidable transfers were associated with outside hospital imaging that was negative (86%) or showed isolated, nondisplaced skull fractures (86%) compared to patients with cranial pathology (53.8%, p < 0.001) as well as age ≤ 6 years (81% [negative imaging/isolated, nondisplaced fractures] vs 54% [positive cranial pathology], p < 0.001). The presence of headaches, nonfocal deficits, and loss of consciousness were associated with necessary transfer (p < 0.05). Patients with potentially avoidable transfers underwent frequent repeat CT studies (19.1%) and admissions to the pediatric intensive care unit (55.9%) but at a lower rate than those whose transfers were necessary (p < 0.001). Neurosurgical interventions occurred in 11% of patients with cranial pathology, which accounted for 17.9% of necessary transfers and 5.2% of all transfers.CONCLUSIONSIn the authors’ region, potentially up to 70% of interfacility transfers for pediatric brain trauma in the absence of other systemic injuries warranting surgical intervention may not require neurosurgical intervention and could be managed locally. No patients transferred with isolated, nondisplaced skull fractures or negative CT scans required neurosurgical intervention, and 86% were discharged the day after admission. In contrast, 11% of patients with CT scans indicative of cranial pathology required neurosurgical intervention. Age > 6 years, loss of consciousness, and nonfocal deficits were associated with a greater likelihood of needing a transfer. Further studies are required to clarify which patients can be managed at local institutions, but referring centers should practice overcaution given the potential risks.

scholarly journals A descriptive study of cranio-cerebral injuries admitted in tertiary care center of coastal Andhra Pradesh

2018 ◽  
Vol 32 (2) ◽  
pp. 384-390
Author(s):  
R. Sivakumar ◽  
B.V. Subrahmanyam ◽  
S.V. Phanindra ◽  
Ashok Munivenkatappa ◽  
S. Satish Kumar ◽  
...  
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Clinical Aspects ◽  
Retrospective Data ◽  
Cerebral Contusion ◽  
Mean Values ◽  
One Year

Abstract Introduction: Demographic and clinical profile of traumatic brain injury (TBI) of a particular place is very crucial for strengthening the guidelines. The details of same are scant from a tertiary institute, Nellore district. The present study aims to explore the demographic, injury and clinical aspects of cerebro-cranial injury patients from an institute setup. Methods: The study consists of two years retrospective data and one year prospective data. The study was approved by institute ethical committee. The patient data was entered on pre designed proforma that includes the desired variables. The data analysis was done using StatsDirect software. Both prospective and retrospective data was merged for analysis. Percentages for categorical data and mean values for continuous data were calculated. Results: There were total of 336 patients. Patients in age group of 21 to 50 years constituted 67% and males were four times higher than females. Nearly one fourth of patients were influenced by alcohol. Three fourth of accidents were due to road traffic accidents (RTAs) followed by falls (17%) and assault (6%). About one tenth of patients were pedestrians. One fourth of patients had associated injuries other than head and brain. On CT findings majority of patients had cerebral contusion (46%) followed by skull fracture (40%), SDH (28%) and EDH (23%). Twenty two patients died in the study period. Conclusion: Knowledge of injury and its later consequences to public is very important. Strict rules to consider safety precautions and compulsory family insurances should be encouraged. Rules to prevent paediatric drive.

scholarly journals Male genital injuries attending a tertiary hospital in a western region of Nepal: A two-year snapshot.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 337
Author(s):  
Alok Atreya ◽  
Suman Baral ◽  
Ritesh G Menezes ◽  
Samata Nepal
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Medical College ◽  
Medical Issues ◽  
Clinical Scenarios ◽  
Male Genital ◽  
Genital Injuries

Background: Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic intervention may lead to chances of loss of fertility due to infections and anatomical disruption of normalcy. This study highlights the clinical scenarios, etiology and outcome of male genital injury cases that were managed at a tertiary care center in Nepal. Such injuries are not frequently encountered as lack of reporting by patients means cases are rare. The present study is the first from Nepal which depicts a comprehensive report on male genital injuries.   Methods: A retrospective analysis of discharge summaries was carried out and the cases of male genital injuries were reviewed during June 2020. All the treated cases during the two-year period from April 2018 to April 2020 at Lumbini Medical College, Nepal were included in the study.  Results: There were eight cases of genital trauma admitted and treated during the study period. All the patients were males and age ranged from six to 71 years with a mean age of 33 ± 21.45 years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause in the majority of cases.  Conclusion: Superficial injuries to the penis and scrotum do not require surgical exploration and could be managed conservatively. However, deeper and complicated injuries, testicular preservation, the functionality of the part and cosmetic issues are taken into consideration which might require a multi-disciplinary approach. Apart from the medical issues pertaining to genital injuries, there are legal and psychological aspects of such events too which should not be ignored.

scholarly journals Male genital injuries treated at a tertiary hospital in the western region of Nepal: A two-year snapshot.

F1000Research ◽  
2022 ◽  
Vol 10 ◽  
pp. 337
Author(s):  
Alok Atreya ◽  
Suman Baral ◽  
Ritesh G Menezes ◽  
Samata Nepal
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Medical College ◽  
Medical Issues ◽  
Clinical Scenarios ◽  
Male Genital ◽  
Genital Injuries

Background: Male genital injuries are urological emergencies which if not promptly treated with correct therapeutic intervention may lead to loss of fertility due to infections and anatomical disruption of normalcy. This study highlights the clinical scenarios, etiology and outcome of male genital injury cases that were managed at a tertiary care center in Nepal. Such injuries are not frequently encountered as patients are hesitant to report such injuries. The present study is the first from Nepal which depicts a comprehensive report on male genital injuries.   Methods: A retrospective analysis of discharge summaries of the cases of male genital injuries was reviewed during June 2020. All the treated cases during the two-year period from April 2018 to April 2020 at Lumbini Medical College, Nepal were included in the study.  Results: There were eight cases of genital trauma admitted and treated during the study period. All the patients were males and age ranged from six to 71 years with a mean age of 33 ± 21.45 years. Fall injury and road traffic accidents (RTA) were observed to be the primary cause in the majority of cases.  Conclusion: Superficial injuries to the penis and scrotum do not require surgical exploration and could be managed conservatively. However, deeper and complicated injuries, testicular preservation, the functionality of the part and cosmetic issues are taken into consideration which might require a multi-disciplinary approach. Apart from the medical issues pertaining to genital injuries, there are legal and psychological aspects of such events too which should not be ignored.

scholarly journals Neurotrauma in Old Aged: A Study from India

2017 ◽  
Vol 06 (01) ◽  
pp. 004-009
Author(s):  
Ashok Munivenkatappa ◽  
Vineet Kumar ◽  
Prashant Bhandarkar ◽  
Nobhojit Roy ◽  
Jyoti Kamble ◽  
...  
Keyword(s):  
Ct Scan ◽  
Traffic Accidents ◽  
Brain Injuries ◽  
Road Traffic ◽  
Age Groups ◽  
Indian Government ◽  
Chi Square ◽  
Aged Patients ◽  
Significance Level ◽  
Chi Square Test

Introduction Traumatic brain injury (TBI) is common in all the age groups. In India with increased life expectancy and more active old-aged population, basic details of neurotrauma in old aged are limited. The aim of the present study is to determine injury pattern and factors influencing outcome of the neurotrauma in old-aged patients, and also to contribute to national trauma data. Methods The study is based on prospective observational registry Towards Improved Trauma Care Outcomes (TITCO) database collected from four Indian government hospitals during October 1, 2013 to September 30, 2015. Data of neurotrauma patients aged 60 years or older were considered for analysis. SPSS version 24.0 was used for statistical analysis. The chi-square test was used for comparison of categorical data with significance level of p < 0.05. Results Old-aged patients contributed for 1,629 (10.2%) of total neurotrauma data. Men were 2.4 times higher than women, but mortality was almost same in both the sexes. Approximately 860 (53%) of injuries were due to falls and 490 (30%) due to road traffic accidents (RTA). Approximately 708 (44%) of subjects patients had moderate to severe brain injuries. Approximately 1,136 (70%) of patients required CT scan and 435 (27%) of patients underwent brain surgery. Approximately 588 (36%) of patients expired during study period. There was significant (p = 0.0001) difference between mortality of old-aged and productive age group (19–59 years). The deaths between the two groups differed significantly (p = 0.0001) among sex, injury cause, severity, requirement of CT scan, and surgery. Conclusion Our study highlights that geriatric TBI is a significant phenomenon and reflects our national data. Possible risk factors associated with deaths are identified in our population. More research is needed to develop specific management and preventive protocols.

scholarly journals Prevalence of Head Injury of Patients Arriving in a Tertiary Care Center

2020 ◽  
Vol 2 (1) ◽  
pp. 38-41
Author(s):  
Arbindra Kumar Yadav ◽  
Jagat Narayan Rajbanshi ◽  
Saroj Kumar Kushwaha ◽  
Pankaj Raj Nepal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Emergency Admission ◽  
P Value ◽  
Cross Sectional ◽  
Severity Of Injury

Background and purpose: The prevalence of head injury is increasing with increasing number of automobiles, especially motorbike. With the objective to evaluate the prevalence of head injury and factors that could affect the severity of head injury, this study was performed in a tertiary hospital at far- eastern Nepal. Methodology: This is a cross-sectional study over the duration of one year. Association of age, gender, and mode of injury was checked with severity of injury using Chi-square test where P-value was kept significant at <0.01. Result: Total numbers of patient admitted through the emergency department, during the study period, were 832. Mean age of patient in the study group was 34.59 (SD 18.92) years. Majority of them falls in the category of 20-29 years. Among the different categories of head injuries, mild head injury (76%) was the most common presentation followed by moderate head injury and severe head injury, which were 14% and 10% respectively.  Conclusion: Head injury seems to be the major cause of emergency admission in for eastern part of Nepal. Among them road traffic accidents seems to be the major burden which is more common in young gentlemen with significant number of severe head injury.

scholarly journals Epidemiology of Hand Injuries in a Tertiary Care Center

2018 ◽  
Vol 5 (2) ◽  
pp. 35-39
Author(s):  
Suraj Bajracharya ◽  
S Shrestha
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Bone Fractures ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Metacarpal Bone ◽  
Hand Injuries ◽  
Medical Sciences ◽  
The Common

INTRODUCTION: This retrospective review was performed to identify the incidence, causes, and details of hand injuries in patients presenting to a tertiary hospital of Kathmandu.  MATERIAL & METHODS: Records of all patients who had sustained hand injuries for last 5 years were collected from the Medical Record section. 832 injuries of the hand in 484 patients were reported in this review. These patients were reviewed for a geat the time of injury, gender, location of the incident, mechanism of injury, and fracture specifics.RESULTS: Majority (85.5%) of patients were males with a mean age of 28.79±12.81years and the rest were females with a mean age- of 30.43 ±17.13 yrs. Machinery injuries (25.2%) were the most common cause of injuries followed by road traffic accidents (14.5%). Metacarpal bone fractures (34.6%) were the common estinjuries of the hand. Most of the patients were treated with open reduction and fixation with Kwires.CONCLUSION: The study revealed the aetio-epidemiological and clinical profile of hand injuries, and its burden in eastern Nepal.Journal of Universal College of Medical Sciences, Vol. 5, No. 2, 2017, Page: 35-39

scholarly journals Head Injury in Nepal: An Institutional Based Prospective Study on Clinical Profile, Management and Early Outcome of Traumatic Brain Injury in Eastern Part of Nepal

2019 ◽  
Vol 4 (2) ◽  
pp. 750-754
Author(s):  
Prakash Kafle ◽  
Babita Khanal ◽  
Dipak Kumar Yadav ◽  
Deepak Poudel ◽  
Tejendra Karki ◽  
...  
Keyword(s):  
Brain Injuries ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
College Teaching ◽  
Clinical Profile ◽  
Tertiary Care Center ◽  
Cross Sectional ◽  
Female Ratio ◽  
Early Outcome

Introduction: Traumatic brain injuries (TBI) are among the worst consequences and are the major causes of death and disability worldwide. It is considered as silent epidemics affecting individuals of all the ages and one of the major burden of neorological disease. Hence, TBIs are often overlooked and are sometimes called “the neglected disease of modern society”. Presenting GCS is the best predictor of outcome. Objective: The present study aims to portray the epidemiology, clinical profile, its management, early outcome and to evaluate the outcome predictors in a tertiary care center in eastern part of Nepal. Methodology: This is a prospective cross-sectional study conducted at the Department of Neurosurgery, Nobel Medical College Teaching Hospital, Biratnagar, Nepal over the period of 1 year (October, 2016 - December 2017). The primary objective of this study was to review the etiology, clinical profile and early outcome of patients with TBI. Results: During the study period, 1056 patients with head injuries were studied. Of these 202 cases required surgical intervention and 32 were excluded. Mean age of the study population was 38.7 years with the male to female ratio of 3.49:1. Road traffic accident was the most common cause of TBI (76%). Overall mortality rate was 11.17%. Unfavorable GOS at discharge was 43.5% and 26.1% at three months follow-up. Conclusion: TBI continues to be a significant burden of neurosurgical care in major neurosurgical centers in Nepal. This study contributes data on the etiology and clinical profile of patients with TBI from tertiary care center of Nepal.

Characterization of mandibular fractures on computed tomography

2021 ◽  
Vol 12 (4) ◽  
pp. 122-126
Author(s):  
Bhavika Jain ◽  
Nikhat Bano ◽  
Devidas B Dahiphale ◽  
Kavita Makasare
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Facial Trauma ◽  
Mandibular Fractures ◽  
X Rays ◽  
Tertiary Care Center ◽  
Road Traffic Accidents ◽  
Associated Injuries

Background: With rapid urbanization and motorization of the society there is an exponential increase in road traffic accidents (RTA). Facial trauma and mandibular fractures are some of the common injuries seen in these cases. Imaging of these fractures is essential part of management. Panoramic and oblique X-rays can be used to diagnose these fractures however computerized tomography gives a unique advantage as it enables 3 D reconstructions of images. We conducted this study to assess the patterns of mandibular fractures and associated injuries presenting to a tertiary care center. Aims and Objectives: The study was conducted to assess the patterns of mandibular fractures and associated injuries presenting to a tertiary care center in Aurangabad. Materials and Methods: This was a prospective study in which 30 cases with complaints of facial trauma and with mandible fractures were included on the basis of a predefined inclusion and exclusion criteria. A detailed history was taken and mode of injury, duration since injury and history of any other trauma was noted down in proforma. Demographic details such as age and gender was also noted down. The CT scan of the face was done. Beam collimation of 2 mm, pitch of 1.2 mm and 120 Kv voltage was used. Patterns of mandibular fracture were analyzed. Results: Out of 30 patients there were 27 (90%) males and 3 (10%) were females with a M:F ratio of 9:1.The mean age of male and female patients was found to be 34.96 +/- 10.49 years and 26.66 +/-5.90 years respectively. Road traffic accidents (RTA) were the predominant causative mechanism and was seen in 27 (90%) of cases. Unilateral multifocal fractures involving body of the mandible were the most common type of fractures. Body of the mandible was seen to have been fractured in 17 (56.66%) cases. Conclusion: Mandibular fractures are commonly seen following road traffic accidents. Though X-Rays can be used for diagnosis of these fractures Computerized tomography gives a distinct advantage of ability to do 3-D reformatting of images.

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