A study of serum cortisol levels in acute head injury patients

IntroductionAdrenal insufficiency has a great impact on the prognosis of patients with traumatic brain injury. In healthy persons during normal day-to-day activity, the concentration of plasma cortisol is high in the morning, decreases during the day and rises again during night. But this diurnal rhythm is abolished in long-term unconscious patients and in those with disturbed sleep cycles. In addition, patients with central nervous system disease, who are conscious but have lesions in the temporal lobe, and the pretectal or hypothalamus area, demonstrate abnormal rhythms.MethodsThis cross-sectional study recruited 33 consecutive patients attending emergency medical departments of Prathima Institute of Medical Sciences Hospital between July 2017 and April 2018 with mild to severe traumatic head injury within 6 h of injury. The selected patients were mainly divided into three groups depending on the Glasgow Coma Scale (GCS) [mild head injury (14–15); moderate head injury (9–13); severe head injury (3–8)]. In each group, 11 patients were selected. GCS was calculated at the time of admission. The adrenal function of the patients was assessed by using the serum cortisol tests.ResultsIn this comparative study of acute head injury among three groups, males are more prone to injury than females, with 81%, 90% and 72% in mild, moderate and severe injuries, respectively. The result mainly shows that the mean cortisol levels estimated were significantly increased in mild head injury and were with greater increase in cases of moderate & severe head injuries. Statistically significant positive correlation was observed between serum cortisol & GCS levels.ConclusionsIn this study of serum cortisol levels in head injury patients, we observed that there is increase in the serum cortisol level immediately after trauma. The increase is linearly related with the severity of head injury. Hence performing serum cortisol test is recommended for the assessment of adrenal function in patients with traumatic head injury.

Coma with Glasgow Coma Scale Score 3 at Admission following Acute Head Injury: Experiencing the Complete Recovery Supported through Ayurveda – A Case Report

Road traffic accidents (RTAs) are a common cause of untimely death, particularly of youth. RTA mortality and morbidity are predominantly associated with trauma to the brain tissue resulting in traumatic brain injury (TBI). The Glasgow Coma Scale (GCS) is commonly employed to predict the prognosis of such cases at the time of hospital admission. A lower GCS score is invariably found to be associated with poor prognosis, often resulting in death or severely com­promised recovery. A 17-year-old male suffering from TBI due to a RTA was treated with Ayurveda after initially been kept under modern neurological care. The whole course of Ayurvedic therapy began 2 weeks after the initial trauma, continued for about 3 months, and resulted in coma reversal with near complete recovery. This case is one among few reports describing a complete recovery despite presence of bad prognostic predictors in TBI. This is the first such case reported where Ayurveda was used as the intervention in case of TBI, resulting in coma reversal and near complete recovery of neurological deficits.

An Epidemiological Analysis of Head Injuries in Taiwan

Traumatic head injuries occur frequently in Taiwan, having catastrophic consequences for the victims, their families, and society as a whole. However, little is known about the risk factors at the population level in Taiwan. The primary aim of this study was to obtain more information on these variables and their relationships. Another aim was to analyze the effects of independent variables such as sex, age, residency, pre-existing conditions, mechanisms of injury, associated injuries, and severity on the probability of in-hospital death. Using the 2007–2008 total admissions claim dataset from Taiwan’s National Health Insurance system, total admissions due to acute head injury were selected for further analysis. The obtained data included patient demographics and trauma hospitalization rate. A total of 99,391 patients were admitted with head injury, 48,792 of which had moderate-to-severe head injury. There were 4935 cases recorded as in-hospital mortality and the standardized in-hospital mortality rate was 10.7 deaths per 100,000 person-years. The mortality rate increased with age. After adjustments, male sex, age older than 54 years, living in a rural area, lower monthly income, a Charlson comorbidity index greater than one, being a pedestrian hit by a motor vehicle, fall from a height, and having significant chest, abdominal, or lower extremity injury increased the risk of death during admission. This population-based analysis provides information about the incidence rate and death rate for admissions in Taiwan due to acute head injury and the factors that affect in-hospital mortality. Our results that highlight the risk factors for adverse outcome can help us prevent or improve rural area trauma care of head injury patients in the future.