scholarly journals TRAUMATIC EXTRADURAL HEMATOMA

2014 ◽  
Vol 21 (03) ◽  
pp. 540-543
Author(s):  
Mian Iftikhar ul Haq

Objectives: To determine the frequency, clinical presentation and outcome ofextradural hematoma in patients with head injury. Study Design: Cross sectional descriptivest study. Setting: Neurosurgery department of Hayatabad Medical Complex, Peshawar. Period: 1st January 2011 to 1 July 2012. Patients and methods: All patients of head injury, from all ages andboth genders were included. Patients in whom EDH caused by bleeding disorders or vascularmalformations of the dura mater and post surgical EDHs were excluded from the study. CT scanbrain was done for all patients to confirm their diagnosis. The information regarding patientdemographical details, clinical presentation and site and size of hematoma was documented inpatient's Performa. The data was analyzed by SPSS version 16. Results: A total of 331 patientswith head injuries were included in the study. Out of 331 patients, there were 221(66.76%) malesand 110(33.23%) females. Majority of patients 90(27.2%) were in the age range of 21-30 years.EDH was found in 29(8.76%) patients. The commonest location of extradural hematoma wastemporo-parietal region i.e 3.93%. One patient had left side weakness postoperatively andtwo(6.89%) died. Conclusions: The outcome of operated extradural hematoma patients wasgood in those patients having higher GCS score

2018 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Adrian Kelly

Background: Community mob assault is a significant social problem in the townships of South Africa. We aimed to evaluate the prognostic variables associated with cranial injuries secondary this mechanism of injury over a 2 year period in patients referred to a single Neurosurgical center. Materials and methods: Descriptive cross-sectional data analysis of cranial injuries following community mob assault, from January 2015 to December 2016, was performed. Medical records were analyzed in terms of patient demographics and the subsequent continuity of care from initial patient referral to eventual discharge. The Outcome measure utilized was the Glasgow Outcome Scale (GOS). Results: Of the 41 patients treated, 100% were male. Mean age was 30.5 +/-9.1 years. No statistical significance was demonstrated between age and GOS (p=0.94). Socioeconomic status revealed that 33 (81%) were unemployed and 8 (19%) were employed. Alcohol involvement was confirmed in 14 (34%) of subjects and excluded in 3 (7%) of subjects, however in 24 (58%) of subjects this was unknown. Only 3 (7%) of subjects has isolated head injuries while 38 (93%) had additional injuries. Severity of head injury analysis showed that 15 (41%) presented with mild head injuries, 20 (49%) presented with moderate head injuries, 5 (2.4%) presented with severe head injuries and 1 patient presented with a critical head injury. Statistical significance was demonstrated with outcome (p=0.02). Site of head trauma recorded showed that 11 (37%) of subjects had isolated parietal injuries, 9 (30%) had isolated frontal injuries, 4 (13%) had base of skull fractures and 5 (17%) had multiple sites of cranial injury. CT features showed that 9 (26.4%) of subjects had an acute subdural hematoma, 8 (24%) of subjects had an extradural hematoma, 7 (21%) of subjects had an intracerebral contusion and 4 (12%) had cerebral edema. At discharge 6 (14.5%) of subjects were GOS 1, 10 (24%) were GOS 3, and 6 (15%) were GOS 4. Only 19 subjects (46%) were GOS 5 at discharge. Conclusion: The study revealed that secondary to Community mob assault 39% of subjects either demised or are so disabled they are dependent in their daily life due to physical or mental disability. Less than half (46%) of subjects resumed normal life post community mob assault. The severity of the head injury was found to be statistically significant in predicting outcome.


2017 ◽  
Vol 14 (3) ◽  
pp. 13-18 ◽  
Author(s):  
Azam Niaz ◽  
Muhammad Hammad Nasir ◽  
Kiran Niraula ◽  
Sumra Majeed ◽  
Joshan Neupane ◽  
...  

Head injury is a leading cause of death in young age group. Extra Dural hematoma, a complication of head injury, is often fatal if not treated in time. The surgical outcome of EDH is dependent upon many variables including preoperative GCS, time between injury and surgery, associated intracranial injuries, anisocoria and hematoma volume. In order to reduce the mortality near to nil, it is essential to determine the magnitude of effect of affecting factors on surgical outcome which will also help us in preoperative counseling and prioritizing the operative candidates. This study was conducted determine the factors affecting surgical outcome of traumatic intracranial extradural Hematoma in Punjab Institute of Neurosciences/ Lahore general hospital, Lahore. It was a Cross sectional study conducted for 3 years from 28th May 2012 to 28th May 2015.The study was conducted on the patients admitted through emergency and diagnosed as Extramural hematoma. These patients underwent surgical evacuation of EDH on emergent basis and outcome was measured by Glasgow Outcome Scale (GOS) after 48 hours of surgery. Using GOS, good surgical outcome was observed in 80.9% (157 out of 194) patients. Preoperative GCS, anisocoria, hematoma volume, associated intracranial injuries and time between injury and surgery were the factors affecting the outcome significantly (p value=0.000) while age and sex of the patient had no significant effect. In Conclusion, good surgical outcome is associated with patients with solitary Extra Dural Hematoma of volume less than 60 ml, preoperative GCS more than 8, absence of anisocoria and undergoing surgical evacuation within 6 hours of injury. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, Page: 13-18


2017 ◽  
Vol 5 (1) ◽  
pp. 7-10 ◽  
Author(s):  
Suraiya Nazneen ◽  
Fatema Ahmed ◽  
SM Ashrafuzzaman ◽  
Khwaja Nazim Uddin ◽  
ASM Areef Ahsan ◽  
...  

Objective: To see the clinical presentation and biochemical abnormalities in hospitalized patients of Diabetic ketoacidosis.Methodology: This cross sectional observational study was carried enrolling 55 subjects with Diabetic ketoacidosis, in the Department of Medicine, BIRDEM General Hospital, Dhaka, over a period of six months starting from April 2013 to September 2013.Results: The mean age was 48.35±16.76 with age range from 30 to 68 years. Infection (pneumonia, urinary tract infection, cellulitis) 22(40%), omission of insulin or drugs 14 (25.4%), myocardial infarction 5(9.0%), and reduction of insulin dose 3(5.4%) worked as precipitating cause.Most patients had drowsiness 16(29.0%), moderate dehydration 30(55.5%), signs of infection 22(40%). About 13(23.56%) had Kussmaul’s type of respiratory pattern. Other signs were less obvious. Majority of the subjects 40(72.7%) had 3+ ketonuria at the time of admission in hospital. About 32(58.1%) of the known diabetic patients were on insulin from the beginning of their diagnosis.19 (34.4%) were initially on OHA followed by insulin and 14 (25.4%) patients took OHA alone.7 patients were on dietary modification and exercise without any drugs. Majority 52 (96.46%) patients had blood sugar level between 21-34 mmol/l and mean HbA1c was 12.31(SD±2.50).About 4(7.2%) patients had severe hyponatraemia and 22(40%) patients had hypokalaemia. Eight (14.5%) patients had severe acidosis while 18(32.7%) patients had only mild acidosis. Most of the subjects 29(52.7%) had moderate acidosis. Complete cure from DKA was observed in 53(96.3%) subjects. Only 2(3.6%) subjects developed cerebral oedema. It took 4 to 5 days in mild group, 6 to 8 days in moderate DKA and more than 9 days in severe DKA for recovery.Conclusion: From the study result it could be concluded that infection control and regular administration of insulin or control of diabetes and proper Diabetes Self Management Education (DSME) can prevent diabetic ketoacidosis.Bangladesh Crit Care J March 2017; 5(1): 7-10


2020 ◽  
Vol 9 (2) ◽  
pp. 1173-1178
Author(s):  
Nuniek Tri Wahyuni ◽  
Winda Indahsari

Banyak hal yang menjadi penyebab terjadinya cedera kepala, salah satu penyebab terjadinya cedera kepala yang serius adalah kecelakaan lalu lintas (sekitar 60% kematian yang disebabkan kecelakaan lalu lintas merupakan akibat cedera kepala). Tujuan penelitian ini utuk mengidentifikasi cedera kepala dengan disorientasi pada pasien kecelakaan lalu lintas di IGD RSD Gunung Jati Kota Cirebon tahun 2018. Jenis penelitian yang digunakan dalam penelitian ini adalah studi kolerasi yang bersifat deskriptif, dengan menggunakan pendekatan cross sectional. Populasi dalam penelitian ini adalah pasien cedera kepala di RSD Gunung Jati Kota Cirebon, teknik pengambilan sampel menggunakan accidental sampling dengan jumlah sampel 22 responden. Teknik pengumpulan data menggunakan lembar observasi penilaian GCS dan lembar kuesioner TOAG. Analisis bivariat  menggunakan uji  chi square. Hasil penelitian ini menunjukan bahwa sebagian besar cedera kepala ringan yaitu sebanyak 16 dari 22 responden atau sekitar (72.7%) dan sebagaian besar mengalami disorientasi sedang, yaitu sebanyak 14 orang dari 22 responden atau sekitar (63,6%). Berdasarkan analisa statistik uji Spearman’s Rho menunjukan bahwa terdapat hubungan cedera kepala dengan disorientasi pada pasien kecelakaan lalu lintas di IGD RSD Gunung Jati Kota Cirebon serta nilai probabilitas (p = 0.001). Kata Kunci : Cedera Kepala, Disorientasi  ABSTRACTMany of the causes of head injury, one of the causes of serious head injuries are traffic accidents (about 60% of deaths caused by traffic accidents are the result of head injury). The purpose of this study was to identify head injury with disorientation in traffic accident patients at IGD RSD Gunung Jati Kota Cirebon 2018.The type of research used in this study is a descriptive correlation study, using a cross sectional approach. The population in this study were head injury patients at IGD RSD Gunung Jati Kota Cirebon, the sampling technique used was accidental sampling with a sample of 22 respondents. Data collection techniques used the GCS assessment sheet and TOAG questionnaire sheet. Bivariate analysis using the chi square test.The results of this study indicate that, which is mostly light weight that is as much as 16 out of 22 respondents or approximately (72.7%) and most of moderate disorientation, which is as many as 14 people from 22 respondents or approximately (63.6%).Based on statistical analysis Spearman’s Rho showed that there was correlation with the patient in RSD Teachers Mountain Jati Cirebon City and probability value (p = 0,001).Keywords: Head Injury, Disorientation


2020 ◽  
Vol 27 (10) ◽  
pp. 2182-2186
Author(s):  
Roohi Jabbar ◽  
Rukhshan Khurshid ◽  
Uzma Jabbar ◽  
Mudassir Zia ◽  
Abeera Mazhar Siddiqui ◽  
...  

Objectives: The study was designed to find out the association of PCOS with insulin resistance and GLUT4. Study Design: Cross Sectional study. Setting: Outdoor Department of Sir Ganga Ram Hospital Lahore. Period: March 2016 to December 2016. Material & Methods: 37 PCOS women visited Outdoor Department of Sir Ganga Ram Hospital Lahore. Their age range was 25- 36 years. 20 ages matched medical staff of the Sir Ganga Ram Hospital, Lahore with no history of any disease were selected as control. Rotterdam’s criteria were used to confirm PCOS. Levels of circulating insulin, GLUT 4 and fasting glucose were estimated. Results: Mean age of PCOS patients and of controls was 30.55 and 29.00 years respectively. Values of BMI were insignificantly raised in PCOS in comparison to controls. Levels of circulating GLUT-4, fasting glucose, insulin and resistance of insulin were increased significantly in women with PCOS in comparison to the controls. Decreased ratio of glucose to insulin was seen in PCOS women in comparison to their controls. Conclusion: A good association of PCOS was observed with insulin mediated release of glucose transporter GLUT 4 and insulin resistance.


Med Phoenix ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 71-74
Author(s):  
Bikash Sah ◽  
Bishwanath Yadav ◽  
Shivendra Jha ◽  
Abdul Sami Khan

Background: Head injury is regarded as a main health problem that is a common cause of morbidities and mortalities and makes great demand to control and prevent it. For this, policy makers need to see the pattern of head injury and this study is done to describe the pattern.Methods: Hospital based, descriptive cross sectional study done on one year autopsy cases of fatal blunt trauma head injury which was 76 in which proportion of different types of head injuries, their causes and their distribution as per age, sex, and duration of survival were studied.Results: Skull-vault fractures were present in 57 (75%) cases in which most common type of fracture was linear fracture constituting 29(49.12%). 50% of the cases were with skullbase fracture in which the most common was of anterior cranial fossa fracture(60.5%). 56.34% of the victims were with subarachnoid haemorrhage (SAH) followed by subdural haemorrhage (SDH) and extradural haemorrhage (EDH). 6.6% victims were without any intracranial haemorrhage. Road traffic accident alone accounted for 71% of total blunt trauma causations of this fatal head injury. 70% cases were in age group from 11 to 50 years and 78.9% were male. 51.3% died at the spot. Conclusions: The research findings have shown that among the fatal blunt trauma head injury cases, skull vault fracture was present in 75% and skull base fracture was present in 50%. The most common intracranial haemorrhage was subarachnoid haemorrhage (56.34%) followed by subdural and extradural haemorrhage.  Med Phoenix. Vol. 3, Issue. 1, 2018, Page: 71-74                                                         


2017 ◽  
pp. 122-126
Author(s):  
Trong Ai Quoc Hoang ◽  
That Hoang Quy Ton ◽  
Dang Tri Vo ◽  
Thi Kim Tram Hoang ◽  
Thi Thanh Nga Chau

Background: Head injury is one of common trauma at ED. It is also main cause of dead and disability of trauma. In Vietnam, accident traffic is most common cause of head injury. ED admits a large number of moderate and severe head injury patients everyday. These injuries can result in physical and mental consequences because of traumatic brain injury (TBI); burden to family and society. However, there is not a consensus in statistics of cause, severe symptom, risk factors to severity and short-term outcome at these patients. Objectives: assessement of cause, symptom and risk factors of moderate and severe head injuries as well as presentations of CT scanner. Materials and Methods: This is a cross sectional study. Population of interest: Patients with trauma who transported to ED of Hue Central Hospital and classified as moderate and severe head injuries were chosen conveniently into the study. Inclusion criteria: Patients with trauma by any reason; Glasgow score≤13, Sample size: There was not limitation of case number. Results: There were 50 patients with severe and moderate head injury. Main cause of trauma was traffic accident (92.2%). Patients were transported to ED by private vehicles (84,3%). Mean age of male was 38.20±14.28, female was 33.00±17.82 (p>0.05). Most of accident were not witnessed by family and not rescued by bystanders. There was an evaluable concentration of plasma ethanol in 88.2% of patients with mean level of 33.99±21.88 mmol/L in male and 12.90±19.98 mmol/L in female (p<0.05). Ethanol levels in severe head trauma were lower than ones in moderate head trauma (p<0.001). Ethanol levels were not different in patients with different lesions on CT scanners (p>0.05). It existed a correlation between Glasgow score and ethanol levels (r=0.43, p<0.01). Expired rate of patient at ED was 21.6%. Conclusion: Main cause of trauma was traffic accident (99.2%). There were 88.2% of patients used ethanol before trauma; 15.7% of patients were transported by ambulance. There were 64.7% with headache; amnesia of accident 82.4%; vomiting 78.4%; scalp wound 45.1%; ear bleeding 7.8%; nose bleeding 7.8%; raccoon eye 19.6%. It did not exist a difference of ethanol levels in different lesions on head CT scanner. Expired rate of patient at ED was 21.6%. Key words: head injury, traffic accident, ethanol, Glasgow


2017 ◽  
Vol 3 (2) ◽  
Author(s):  
Nanang Bagus Sasmito ◽  
Titin Andri Wihastuti ◽  
Heri Kristianto

Abstract : Head injuries will affect more serious disorder compared with other organ traumatic. Lack of nurse competences, particularly on identify the early sign of critical head injuries and misunderstood of onset head injuries happened with the patient, will cause delays to give precise treatment and decision for the patient, such as giving reference to other hospital. The objective of this study is to analyze the influencing factor related to outcome of head injury patient in RSUD dr. Iskak Tulungagung using Interpersonal Interpersonal Nursing Model by Heldegrad E. Peplau approach. This research used analytical analytics comparative with cross-sectional approch. The data collected by purposive sampling and finally 78 respondent were included in this research. With regard to outcome of head injury patient whose referenced in, the bivariat analysis result showed conditions patients a head injury (p-value 0,005), assistance referral (p-value 0,042), the distnace referral (p value 0,020), and time referral (p value 0,006). In addition, the regression analysis showed variable pattients condition the most dominant relating to outcome patients a head injury referred (p value 0,001 and OR 16.184). The decrease of GCS value for patients who reference at other hospital indicated the deterioration of their condition. Hence, the values of GCS was important indication to be noticed.When in every phase in interpersonal nursing implementation well in patients referred to a head injury, so outcome head injuries with the glasgow outcome scale would be good.Key Word : Outcome Patient Head Injuries, Referrals, Interpersonal Nursing. Abstrak : Cedera kepala akan memberikan gangguan yang sifatnya lebih kompleksbila dibandingkan dengan trauma pada organ tubuh lainnya. Minimnya kompetensi yang dimiliki perawat dalam mengenali tanda dini kegawatan cedera kepala dan tidak memahami onset cedera kepala yang dialami oleh korban memberi dampak pada keterlambatan tindakan segara yang harus diberikan kepada pasien cedera kepala, salah satunya dalam membuat keputusan rujukan.Beberapa hal yang dapat mengurangi dampak dari pelaksanaanrujukan pasien yang tidak optimal, perlu disusun manajemenrujukan pasien gawat darurat yang berfungsi sebagai kerangka acuan bagi petugas kesehatan terlebih lagiperawat. Salah satu teori model keperawatan yang menunjang dan mengembangkan pelaksanaan rujukan adalah teori interpersonal relations in nursingdari Heldegard E Peplau. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang berhubungan dengan outcome pasien cedera kepala yang dirujuk di IGD RSUDdr. Iskak Tulungagung melalui pendekatan model interpersonal nursing Heldegrad E. Peplau. Metode dalam penelitian ini adalah analitik komparatif dengan pendekatan cross-sectional. Jumlah sampel sebanyak 78 responden dengan menggunakan purposive sampling. Dari analisis bivariat faktor yang berhubungan dengan outcome pasien cedera kepala yang dirujuk adalah tingkat kesadaran pasien cedera kepala (p value 0,005), pendampingan saat merujuk (p value 0,042), jarak rujukan (p value 0,020) dan faktor waktu yang ditempuh (p value 0,006). Hasil analisis uji regresi logistik menunjukkan faktor kondisi pasien yang paling dominan berhubungan dengan outcome pasien cedera kepala yang dirujuk (p value 0,001 dan nilai OR 16.184). Pasien cedera kepala mengalami penurunan nilai GCS pada saat dirujuk merupakan petunjuk bahwa terjadi perburukan kondisi pasien, sehingga nilai GCS menjadi parameter yang penting utnuk diperhatikan. Sehingga apabila dalam setiap fase dalam interpersonal nursing dapat dilaksanakan dengan baik pada pasien cedera kepala yang dirujuk, maka outcome cedera kepala dengan penilaian glasgow outcome scale akan baik.Kata Kunci : Outcome Pasien Cedera Kepala, Rujukan, Interpersonal Nursing.


2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ibrahim Alnaami ◽  
Shbeli Alshehri ◽  
Saeed Alghamdi ◽  
Meshal Ogran ◽  
Asim Qasem ◽  
...  

Background. Head injuries contribute to almost 50% of all injuries. Head injuries are still one of the major causes of loss of life and loss of function among young adults. Nowadays, head injury has become a major community problem. Recently, head injury has become one of the biggest issues of almost more than 57 million people in the whole world living with the neurological problem raised by TBI, in which 10 million people require hospital base care. Objectives. To determine the epidemiological aspects of patients with head injury (HI) in Aseer Central Hospital (ACH). Materials and Methods. This is a retrospective cross-sectional study. Data were gathered from patients’ files and the registrar’s database of ACH. The study duration was January 2015–December 2017. All patients with head injury admitted to ACH during the study duration were included in the study. SPSS software was used for analysis. Descriptive statistics were obtained (mean SD frequencies, percentages). Statistical tests, t test, and chi-squared test were applied to measure the significant difference among the variables. P-value less than 0.05 was considered as a significant difference. Results. There were 353 patients with head injury, and the mean ± SD of age was 27.01 ± 13.9. Motor vehicle accidents (MVA) accounted for (89.3%) of head injury. A total of 87.3% of the patients were male while 12.7% were female. Conclusion. In this study, we observed that MVA is the leading cause of brain/head injuries in the KSA, despite the implementations of new speed rules. However, with new regulations of forbidding cell phone use while driving and forcing the seat belt regulations, a major impact on these numbers is expected in the future. Thus, a future study is recommended to assess these expectations.


2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Chaiyaporn Yuksen ◽  
Yuwares Sittichanbuncha ◽  
Jayanton Patumanond ◽  
Sombat Muengtaweepongsa ◽  
Kasamon Aramvanitch ◽  
...  

Patients with mild head injuries, a GCS of 13–15, are at risk for intracranial hemorrhage. Clinical decision is needed to weigh between risks of intracranial hemorrhage and costs of the CT scan of the brain particularly those who are equivocal. This study aimed to find predictors for intracranial hemorrhage in patients with mild head injuries with a moderate risk of intracranial hemorrhage. We defined moderate risk of mild head injury as a GCS score of 13–15 accompanied by at least one symptom such as headache, vomiting, or amnesia or with alcohol intoxication. There were 153 patients who met the study criteria. Eighteen of the patients (11.76%) had intracranial hemorrhage. There were four independent factors associated with intracranial hemorrhage: history of hypertension, headache, loss of consciousness, and baseline GCS. The sensitivity for the presence of intracranial hemorrhage was 100% with the cutoff point for the GCS of 13. In conclusion, the independent factors associated with intracranial hemorrhage in patients with mild head injury who were determined to be at moderate risk for the condition included history of hypertension, headache, loss of consciousness, and baseline GCS score.


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