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

Abstract Background: Traumatic Brain Injury (TBI) which is the leading cause of morbidity and mortality all over the world and the impact is much worse in Pakistan. The objective of the study 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%). 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 for further investigation of MTBI in population-based studies across the globe.

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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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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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Temporal Delays Along the Neurosurgical Care Continuum for Traumatic Brain Injury Patients at a Tertiary Care Hospital in Kampala, Uganda

Neurosurgery ◽

10.1093/neuros/nyy004 ◽

2018 ◽

Vol 84 (1) ◽

pp. 95-103 ◽

Cited By ~ 11

Author(s):

Silvia D Vaca ◽

Benjamin J Kuo ◽

Joao Ricardo Nickenig Vissoci ◽

Catherine A Staton ◽

Linda W Xu ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Care Continuum

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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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Anemia and Blood Transfusion in Patients with Isolated Traumatic Brain Injury

Critical Care Research and Practice ◽

10.1155/2015/672639 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Hasan M. Al-Dorzi ◽

Waleed Al-Humaid ◽

Hani M. Tamim ◽

Samir Haddad ◽

Ahmad Aljabbary ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Transfusion ◽

Hospital Mortality ◽

Injury Severity ◽

Tertiary Care ◽

Hemoglobin Level ◽

Secondary Insult ◽

The Impact ◽

Present On Admission

Rationale. By reducing cerebral oxygen delivery, anemia may aggravate traumatic brain injury (TBI) secondary insult. This study evaluated the impact of anemia and blood transfusion on TBI outcomes.Methods. This was a retrospective cohort study of adult patients with isolated TBI at a tertiary-care intensive care unit from 1/1/2000 to 31/12/2011. Daily hemoglobin level and packed red blood cell (PRBC) transfusion were recorded. Patients with hemoglobin < 10 g/dL during ICU stay (anemic group) were compared with other patients.Results. Anemia was present on admission in two (2%) patients and developed in 48% during the first week with hemoglobin < 7 g/dL occurring in 3.0%. Anemic patients had higher admission Injury Severity Score and underwent more craniotomy (50% versus 13%,p<0.001). Forty percent of them received PRBC transfusion (2.8 ± 1.5 units per patient, median pretransfusion hemoglobin = 8.8 g/dL). Higher hospital mortality was associated with anemia (25% versus 6% for nonanemic patients,p=0.01) and PRBC transfusion (38% versus 9% for nontransfused patients,p=0.003). On multivariate analysis, only PRBC transfusion independently predicted hospital mortality (odds ratio: 6.8; 95% confidence interval: 1.1–42.3).Conclusions. Anemia occurred frequently after isolated TBI, but only PRBC transfusion independently predicted mortality.

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Seroprevalence of transfusion transmitted infections in voluntary and replacement blood donors in a tertiary care hospital blood bank of Anantapur, Andhra Pradesh, India: 5 years retrospective study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200013 ◽

2020 ◽

Vol 8 (2) ◽

pp. 455

Author(s):

V. Siva Sankara Naik ◽

Neeraja M. ◽

Sujeeva Swapna R. ◽

Bhavani C. ◽

Sravani P. ◽

...

Keyword(s):

Retrospective Study ◽

Blood Donors ◽

Tertiary Care ◽

Epidemiological Data ◽

Blood Bank ◽

Care Hospital ◽

Donor Population ◽

Screening Assays ◽

Blood Screening

Background: Critical part of transfusion is effective screening of TTI, to reduce the risk of transmission is as safe as possible. The present study has undertaken to focus on seroprevalence of TTIs among both voluntary and replacement donors and also to project epidemiological data of TTIs in this community.Methods: This is a retrospective study conducted from January 2014 to December 2018. All blood samples collected from donors were screened for HIV, HBV, HCV, Syphilis and malaria according to blood bank policy. Before drawing blood, donors were asked to fill pre structured Blood bank questionnaire and consent form.Results: In this present 5-year study, total number of blood donor population was 54937, among them voluntary donors were 33891 and replacement donors were 21046. Out of 33891 voluntary donors, 33486(98.8%) were males and remaining 405(1.19%) were females. All replacement donors (21046) were males. The seroprevalence of HBV was highest, 1.82% (1003/54937) followed by HCV 0.31% (175/54937) in all the donors. The seropositivity for HIV is 0.23% (129/54937), for syphilis 0.04% (24/54937) and for malaria 0.01% (6/54937).Conclusions: National blood transfusion policy should be strengthening the standards and quality of screening across the country. For blood screening, resources and appropriate screening assays must be available at all health centres.

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Outcome of Cranioplasty Done within and Beyond 2 Months after Decompressive Craniectomy for Traumatic Brain Injury

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/152 ◽

2021 ◽

Vol 10 (10) ◽

pp. 711-714

Author(s):

Khongbantabam Vyas ◽

Khaidem Mani Singh

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Decompressive Craniectomy ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Categorical Variables ◽

P Value ◽

Consecutive Series ◽

Complication Rates ◽

Care Hospital

BACKGROUND Cranioplasty although a simple elective neurosurgical procedure is burdened by considerable morbidity. The timing of doing cranioplasty and a good outcome remains a topic of much debate. We wanted to compare the outcome of doing cranioplasty within (early) and beyond (late) 2 months after decompressive craniectomy for traumatic brain injury. METHODS The study was carried out in a tertiary care hospital. A 5-year retrospective study of patient records was analysed. Consecutive series of traumatic brain injury patients who underwent cranioplasty after decompressive craniectomy from a tertiary care hospital operated by a single neurosurgeon, were studied. Data was analysed using SPSS version 21, IBM. Associations of categorical variables were compared using chisquare test and of continuous variables by using unpaired 2-tailed Student t-test. RESULTS Altogether 90 patients were identified who had undergone cranioplasty after decompressive craniectomy for traumatic brain injury and were grouped into early (within 2 months; 44 patients) and late (beyond 2 months; 46 patients). Cranioplasty operative time was significantly shorter in the early (59.39 mins) than the late (77.28 mins) with a P value of 0.001. Infection rates were significantly higher in the early (4.55 %) than late (0 %), with P value 0.144. Other complication rates were postoperative haematoma (0 % early, 2.17 % late, P = 0.325), hydrocephalus (0 % early, 6.52 % late, P = 0.085), sunken brain (0 % early, 4.35 % late, P = 0.162), and bone graft resorption (0 % early, 2.17 % late, P = 0.325). These differences were not statistically significant though. CONCLUSIONS Early cranioplasty performed within 2 months of decompressive craniectomy has better outcome in the form of reduced hospital stay, decreased cost, and fewer complications. KEY WORDS Traumatic Brain Injury, Decompressive Craniectomy, Outcome, Cranioplasty

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LO79: The impact of access block on consultation time in the emergency department

CJEM ◽

10.1017/cem.2019.122 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S36-S37

Author(s):

L. Carroll ◽

M. Nemnom ◽

E. Kwok ◽

V. Thiruganasambandamoorthy

Keyword(s):

Emergency Department ◽

Performance Metrics ◽

Tertiary Care ◽

Initial Assessment ◽

Inpatient Service ◽

Care Hospital ◽

Important Indicator ◽

Consultation Request ◽

The Impact ◽

Consultation Time

Introduction: Access block (AB) is the most important indicator of Emergency Department (ED) crowding, but the impact of AB on consultation time has not been described. Our objectives were to determine if ED AB affects inpatient service consultation time, and operational and patient outcomes. Methods: We conducted a health records review of all ED patients referred and admitted at a university-affiliated tertiary care hospital over 60-days. A computational algorithm determined hourly ED AB at the time of consultation request, and observational cohorts were determined based on ED AB high (>35% ED bed capacity occupied by admitted patients) or low (<35%). The outcomes included total consultation time (TCT), ED physician initial assessment (PIA) time, ED length of stay (LOS), transfer time to inpatient bed (TTB), hospital LOS, return to ED (RTED) within 30 days, and 30-day mortality. Results: We included 2,871 patients (48% male; M = 63 years, IQR 45–78), and the low AB cohort were higher acuity (N = 1,692; 50.4% CTAS 1–2) than the high AB cohort (N = 1,179; 47.1% CTAS 1–2). Median TCT was not significantly different (low = 209min, high = 212min; p = 0.09), and there was no difference in consults completed within the 3-hour institutional time target (low = 41.1%, high = 40.9%; p = 0.89). Median ED PIA time was not significantly different (low = 66min, high = 68min; p = 0.08), however, patients seen within the funding-associated provincial ED PIA time target was significantly less during high AB (high = 82.2%, low = 89.2%; p < 0.001). Median ED LOS was significantly longer during high AB (high = 12.1hr, low = 11.1hr; p = 0.009), but median hospital LOS was not different (high = 109.5hr, low = 112.4hr; p = 0.44). Median TTB was significantly longer during high AB (high = 8.0hr, low = 5.9hr; p = 0.0004). There was no difference in RTED visits (high = 12.4%, low = 10.6%; p = 0.15) or 30-day mortality (high = 8.4%, low = 9.2%; p = 0.51). Conclusion: In conclusion, consultation time is not affected by AB. However, boarding admitted patients in the ED impairs our ability to meet funding-associated performance metrics. Reducing boarding time should be an ED and hospital-wide priority, as it negatively impacts funding and delays patient care.

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Surgical intervention and patient factors associated with poor outcomes in patients with traumatic brain injury at a tertiary care hospital in Uganda

Journal of Neurosurgery ◽

10.3171/2020.9.jns201828 ◽

2021 ◽

pp. 1-10

Author(s):

Charis A. Spears ◽

Syed M. Adil ◽

Brad J. Kolls ◽

Michael E. Muhumza ◽

Michael M. Haglund ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Low Income ◽

Surgical Intervention ◽

Tertiary Care ◽

Care Hospital ◽

Treatment Variable ◽

Patient Factors ◽

Poor Outcome ◽

Poor Outcomes

OBJECTIVE The purpose of this study was to investigate whether neurosurgical intervention for traumatic brain injury (TBI) is associated with reduced risks of death and clinical deterioration in a low-income country with a relatively high neurosurgical capacity. The authors further aimed to assess whether the association between surgical intervention and acute poor outcomes differs according to TBI severity and various patient factors. METHODS Using TBI registry data collected from a national referral hospital in Uganda between July 2016 and April 2020, the authors performed Cox regression analyses of poor outcomes in admitted patients who did and did not undergo surgery for TBI, with surgery as a time-varying treatment variable. Patients were further stratified by TBI severity using the admission Glasgow Coma Scale (GCS) score: mild TBI (mTBI; GCS scores 13–15), moderate TBI (moTBI; GCS scores 9–12), and severe TBI (sTBI; GCS scores 3–8). Poor outcomes constituted Glasgow Outcome Scale scores 2–3, deterioration in TBI severity between admission and discharge (e.g., mTBI to sTBI), and death. Several clinical and demographic variables were included as covariates. Patients were observed for outcomes from admission through hospital day 10. RESULTS Of 1544 patients included in the cohort, 369 (24%) had undergone surgery. Rates of poor outcomes were 4% (n = 13) for surgical patients and 12% (n = 144) among nonsurgical patients (n = 1175). Surgery was associated with a 59% reduction in the hazard for a poor outcome (HR 0.41, 95% CI 0.23–0.72). Age, pupillary nonreactivity, fall injury, and TBI severity at admission were significant covariates. In models stratifying by TBI severity at admission, patients with mTBI had an 80% reduction in the hazard for a poor outcome with surgery (HR 0.20, 95% CI 0.04–0.90), whereas those with sTBI had a 65% reduction (HR 0.35, 95% CI 0.14–0.89). Patients with moTBI had a statistically nonsignificant 56% reduction in hazard (HR 0.44, 95% CI 0.17–1.17). CONCLUSIONS In this setting, the association between surgery and rates of poor outcomes varied with TBI severity and was influenced by several factors. Patients presenting with mTBI had the greatest reduction in the hazard for a poor outcome, followed by those presenting with sTBI. However, patients with moTBI had a nonsignificant reduction in the hazard, indicating greater variability in outcomes and underscoring the need for closer monitoring of this population. These results highlight the importance of accurate, timely clinical evaluation throughout a patient’s admission and can inform decisions about whether and when to perform surgery for TBI when resources are limited.

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Admission characteristics and outcome in traumatic brain injury patients: a preliminary report from a tertiary care hospital

Romanian Neurosurgery ◽

10.1515/romneu-2016-0039 ◽

2016 ◽

Vol 30 (2) ◽

pp. 252-257

Author(s):

Amit Agrawal ◽

Ashok Munivenkatappa ◽

B.V. Subrahmanyam ◽

S. Satish Kumar ◽

P. Ramamohan

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pilot Study ◽

Developing Country ◽

Rural Areas ◽

Tertiary Care ◽

Study Finding ◽

Care Hospital ◽

Intracranial Surgery ◽

Present Pilot Study

Abstract Introduction. Traumatic brain injury (TBI) is affected by multiple factors. Patient’s education, manifesting symptoms and surgical management play a significant role on discharge outcome. The literature of same from developing country is limited. The present pilot study aims to describe patient characteristics, presenting symptom and management aspects of TBI patients from a tertiary hospital. Methods. The present study is a prospective study, where TBI patients were selected and data of injury was entered on standard proforma on electronic data base. The study was approved by institute ethical board. The data was analyzed using Stats Direct version 3.0.150 software. Results. Three hundred and thirty three patients were evaluated. Eighty percent of patients were from rural areas. About 75% of patients were illiterates and married. Patient employment was significant with discharge outcome. All the patients manifested with symptoms loss of consciousness (LOC) was higher (73%) followed by vomiting (44%). LOC and oral bleed was significant with outcome. Associated injuries was higher in extremities (22.5%) followed by chest (4.4%). About 15% of patients require intracranial surgery that was significant with discharge outcome. Conclusion. The present pilot study finding is similar to available literature data and adds knowledge to TBI data of a developing country like India.

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