SEVERE HEAD INJURY

Objective: To assess the outcome of severe head injury in patients with GCS 8 or below. Design:Retrospective study. Setting: Department of Neurosurgery, Allied Hospital, Punjab Medical College, Faisalabad.Period: Two years Aug 2002 to July 2004. Material and Methods: Two hundred patients admitted in the departmentof Neurosurgery, Allied Hospital, with Glasgow Coma scale 8 or below irrespective of mode of injury and age wereselected with a follow up of up to twelve months. The patients were assessed on arrival in the emergency room on thebasis of GCS. The patients were managed accordingly. Results: 71% patients were managed conservatively and 29%patients under went surgical intervention. Overall mortality was 40%. Outcome was good in 15% where as 11% patientsremained vegetative. Conclusion: Severe head injury has a mortality of 40%, especially in very young and very oldpatients.

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Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

Medical & Clinical Research ◽

10.33140/mcr.03.02.09 ◽

2018 ◽

Vol 3 (2) ◽

Keyword(s):

Head Injury ◽

Brain Tumour ◽

Severe Head Injury ◽

Case Reports ◽

Subsequent Development ◽

Malignant Brain Tumour ◽

Tumour Development ◽

Short Period ◽

The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

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The outcome of severe closed head injury

Journal of Neurosurgery ◽

10.3171/sup.1991.75.1s.0s28 ◽

1991 ◽

Vol 75 (Supplement) ◽

pp. S28-S36 ◽

Cited By ~ 355

Author(s):

Lawrence F. Marshall ◽

Theresa Gautille ◽

Melville R. Klauber ◽

Howard M. Eisenberg ◽

John A. Jane ◽

...

Keyword(s):

Head Injury ◽

Mortality Rate ◽

Severe Head Injury ◽

Closed Head Injury ◽

Data Bank ◽

Content Type ◽

Severity Of Injury ◽

Gcs Score ◽

Fine Print ◽

Overall Mortality

✓ The outcome of severe head injury was prospectively studied in patients enrolled in the Traumatic Coma Data Bank (TCDB) during the 45-month period from January 1, 1984, through September 30, 1987. Data were collected on 1030 consecutive patients admitted with severe head injury (defined as a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation). Of these, 284 either were brain-dead on admission or had a gunshot wound to the brain. Patients in these two groups were excluded, leaving 746 patients available for this analysis. The overall mortality rate for the 746 patients was 36%, determined at 6 months postinjury. As expected, the mortality rate progressively decreased from 76% in patients with a postresuscitation GCS score of 3 to approximately 18% for patients with a GCS score of 6, 7, or 8. Among the patients with nonsurgical lesions (overall mortality rate, 31%), the mortality rate was higher in those having an increased likelihood of elevated intracranial pressure as assessed by a new classification of head injury based on the computerized tomography findings. In the 276 patients undergoing craniotomy, the mortality rate was 39%. Half of the patients with acute subdural hematomas died — a substantial improvement over results in previous reports. Outcome differences between the four TCDB centers were small and were, in part, explicable by differences in patient age and the type and severity of injury. This study describes head injury outcome in four selected head-injury centers. It indicates that a mortality rate of approximately 35% is to be expected in such patients admitted to experienced neurosurgical units.

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Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury

Journal of Neurosurgery ◽

10.3171/jns.1982.56.4.0498 ◽

1982 ◽

Vol 56 (4) ◽

pp. 498-503 ◽

Cited By ~ 351

Author(s):

Thomas G. Saul ◽

Thomas B. Ducker

Keyword(s):

Head Injury ◽

Mortality Rate ◽

Severe Head Injury ◽

Aggressive Treatment ◽

Icp Monitoring ◽

Content Type ◽

Standardized Protocol ◽

Previous Series ◽

Fine Print ◽

Overall Mortality

✓ During 1977–1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. The patients' average age was 29 years; 60% had multiple trauma, and 35% needed emergency intracranial operations. Treatment for elevations of ICP was begun when ICP rose to 20 to 25 mm Hg, and included mannitol therapy and drainage of cerebrospinal fluid (CSF) when possible. Forty-three patients (34%) had ICP greater than or equal to 25 mm Hg; of these, 36 (84%) died. The mortality rate of the entire group was 46%. During 1979–1980, 106 patients with severe head injury were admitted and underwent ICP monitoring. Their average age was 29 years; 51% had multiple trauma, and 31% underwent emergency intracranial surgery. All patients received the same standardized protocol as the previous series, with the exception of the treatment of ICP. In this present series: if ICP was 15 mm Hg or less (normal ICP), patients were continued on hyperventilation, steroids, and intensive care; if ICP was 16 to 24 mm Hg, mannitol was administered and CSF was drained; if ICP was 25 mm Hg or greater, the patients were randomized into a controlled barbiturate therapy study. Twenty-six patients (25%) had ICP's of 25 mm Hg or greater, compared to 34% in the previous series (p < 0.05), and 18 of these 26 patients (69%) died. The overall mortality for this current series was 28% compared to 46% in the previous series (p < 0.0005). This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 mm Hg or greater and reduces the overall mortality rate of severe head injury.

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Glasgow Coma Scale is unreliable for the prediction of severe head injury in elderly trauma patients

Emergency Medicine Journal ◽

10.1136/emermed-2013-203488 ◽

2014 ◽

Vol 32 (8) ◽

pp. 613-615 ◽

Cited By ~ 48

Author(s):

A Kehoe ◽

S Rennie ◽

J E Smith

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Severe Head Injury ◽

Trauma Patients ◽

Coma Scale ◽

Elderly Trauma Patients

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A study of correlation of degree of midline shift on computed tomography scan and Glasgow coma scale in patients of acute traumatic head injury

International Surgery Journal ◽

10.18203/2349-2902.isj20213998 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3075

Author(s):

A. K. Chaurasia ◽

Lalit Dhurve ◽

Rajneesh Gour ◽

Rajpal Kori ◽

Avias K. Ahmad

Keyword(s):

Computed Tomography ◽

Head Injury ◽

Glasgow Coma Scale ◽

Severe Head Injury ◽

Road Traffic ◽

Midline Shift ◽

Traumatic Head Injury ◽

Cross Sectional ◽

Common Cause ◽

Coma Scale

Background: Traumatic brain injury is one of most common cause of death in road traffic accident. Most of these classified as mild injury, with approximately 20% classified as moderate to severe. Approximate 50% of the 150,000 trauma deaths every year are caused by head injury.Methods: A prospective cross-sectional study was conducted on 150 patients with a head injury admitted in the Hamidia hospital, Bhopal. The assessment of the severity of head injury using Glasgow coma scale (GCS) at the time of admission, follow up on 5 days and 15 days respectively. The collected data were transformed into variables, coded and entered in Microsoft excel. Data were analyzed and statistically evaluated using statistical package for the social sciences (SPSS)-PC-21 version.Results: Out of 150, a total of 115 patients had no midline shift while 35 patients were having midline shift. Severe head injury patients (GCS 3-8) were having more morbidity and mortality. Moderate head injury (GCS 9-13) was associated with good prognosis and low mortality. A greater degree of midline shift of (more than 5 mm) is indicated severe head injury and is significantly associated with morbid outcome and higher mortality.Conclusions: In our study, road traffic accidents is the most common cause of head injury, with males being affected more than females. The degree of midline shift on computed tomography (CT) scan head in patients with head injuries was found to be significantly associated with high mortality and morbidity.

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Bacterial meningitis and its acute complications.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.3568 ◽

2020 ◽

Vol 27 (10) ◽

pp. 2088-2092

Author(s):

Asif Ali Khuhro ◽

Waqas Ali ◽

Ameer Jamali ◽

Fazal ur Rehman

Keyword(s):

Bacterial Meningitis ◽

Study Data ◽

Subdural Effusion ◽

Mortality And Morbidity ◽

Medical College ◽

Global Issue ◽

Acute Complications ◽

Study Setting ◽

Observational Descriptive Study ◽

Overall Mortality

Objectives: Bacterial meningitis is a major global issue. Despite medical advancement in childcare in the last couple of decades, bacterial meningitis is still causing significant mortality and morbidity. We planned this study to find out the frequency as well acute complications related to bacterial meningitis in our setting. Study Design: Observational descriptive study. Setting: Department of Pediatrics, Unit-II, Children Hospital Chandka Medical College / SMBBMU, Larkana. Period: 1st August 2018 to 31st March 2019. Material & Methods: A total of 78 children, aged 1 month to 10 years with bacterial meningitis were included. Acute complications were noted in all the children during their hospital stay along with mortality. A predesigned proforma was used to record all the study data. Results: Out of a total of 78 cases, 48 (61.5%) male and 30 (38.5%) female. There were 13 (16.7%) children between aged 1 to 3 months, 25 (32.1%) between 3 to 6 months, 27 (34.6%) between the age of 6 months and 5 years and 13 (16.7%) above the age of 5 years. Complications were noted in 33 (42.3%) cases, seizure following 4 days followed by subdural effusion and hydrocephalus were the commonest. Children having complications were compared with those who had none, hospitalization history prior to the admission turned out to be statistically significant (p = 0.010). Overall, mortality was noted in 3 (3.9%) children. Conclusion: Bacterial meningitis still remains a major disease related to significant morbidity and mortality. Most complications are seen in young children. Seizure and subdural effusion are noted to be the most frequent complications.

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Assessing the effectiveness of the full outline of unresponsiveness scale and the Glasgow coma scale in patients of traumatic head injury

International Surgery Journal ◽

10.18203/2349-2902.isj20214759 ◽

2021 ◽

Vol 8 (12) ◽

pp. 3583

Author(s):

Fahad Ansari ◽

Arvind Rai

Keyword(s):

Head Injury ◽

Glasgow Coma Scale ◽

Youden Index ◽

Traumatic Head Injury ◽

Coma Scale ◽

Medical College ◽

Traumatic Head ◽

Four Score ◽

Gandhi Medical College ◽

Gcs Score

Background: The Glasgow coma scale (GCS) is the most commonly used scale while the full outline of unresponsiveness (FOUR) score is a new validated coma scale in the evaluation of the level of consciousness in head injury patients. The aim of the study was to compare and assess the effectiveness of the FOUR score and the GCS in patients of traumatic head injury.Methods: This was a prospective observational study conducted in the department of surgery, Gandhi medical college, Bhopal during a 2 year period in which 100 patients of traumatic head injury were evaluated. The FOUR score and GCS score of these patients were assessed on admission and outcome followed for 2 weeks.Results: The mean age group of 100 patients was 25-45 years with 79% male and 21% female patients. The FOUR scale was found to have a marginally higher sensitivity of 65.6% while the GCS had a sensitivity of 64.2%. The FOUR scale however had a higher specificity of 71.5% compared to 66.4% of GCS. The Youden index showed that FOUR scale (46%) has a better prediction for death than GCS (35%). FOUR had a higher accuracy of 75% than GCS with an accuracy of 65%.Conclusions: Both FOUR score and GCS are valuable scales in assessment of traumatic head injury. The FOUR scale however is more accurate than the GCS in predicting outcome of head injury patients.

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Outcome of Head Injury Patients Undergoing Surgical Management: A Tertiary Level Experience

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i4.6345 ◽

2012 ◽

Vol 9 (4) ◽

pp. 283-285

Author(s):

A Shrestha ◽

R M Joshi ◽

A Thapa ◽

U P Devkota ◽

D N Gongal

Keyword(s):

Head Injury ◽

Severe Head Injury ◽

Surgical Intervention ◽

Head Injuries ◽

Glasgow Outcome Score ◽

Injury Mortality ◽

Outcome Score ◽

Injury Group ◽

Neurosurgical Patient ◽

Severity Of Injury

Background Head injury is the major cause of death in a neurosurgical patient. Objective To find the outcome, and treatment modality affecting the outcome in patients with head injury. Methods Nine hundred eighty seven patients presenting to National Institute of Neurological and Allied Sciences, Kathmandu, with head injury from September 2009 to October 2010 were included in the study. Patients were categorized according to post resuscitation Glasgow Coma Score. Outcome was assessed at discharge using Glasgow Outcome Score and analyzed for any correlation with modality of treatment and severity of injury. Results Among 987 patients with head injury,152 (15.4%) had severe, 126 (12.8%) had moderate and 709 (71.8%) had mild head injuries. Three hundred twelve (31.6%) patients required definitive and supportive surgical intervention. One hundred eighty two required cranial surgical intervention. Overall mortality was 10% (99), 137 patients (13.9%) had unfavorable outcome and 850 (86.1%) had favorable Glasgow Outcome Score of 4 and 5. Mortality was 53.2%, 9.5% and 0.8% in severe, moderate and mild head injury group respectively. Mortality rate was significantly higher (64.6%) in severe head injury group managed conservatively than those in same group treated with supportive and definite surgical intervention (44.8%) (p=0.016). Conclusion Mortality in head injury patients depend upon severity of injury. Mortality in severe head injury group can be reduced by supportive and definite surgical intervention.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6345 Kathmandu Univ Med J 2011;9(4):283-5

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