Author(s): Pankaj Gupta, 1 Jitendra Singh 2 , Arvind Sharma 3 , Shameer Deen 4 , Aditya Chaudhary 5 , Nikhil Bhansal 6 , Akansha Tanwar 7
BACKGROUND Trauma is one of the leading causes of death and disability in the Indian Population. OBJECTIVE To evaluate and describe the epidemiological and clinical characteristics of patients with traumatic brain injury and their clinical outcomes following admission to a rural tertiary care teaching hospital in India. STUDY DESIGN Retrospective, cross-sectional, hospital based analysis of 1713 patients of Traumatic Brain Injury [TBI] admitted to the Department of Neurosurgery in a tertiary health centre in Jaipur from January 2014 to August 2015. METHOD The medical records of all eligible patients were reviewed and data collected on age, sex, mechanism of injury, severity of injury Glasgow Coma Scale (GCS) and Outcome (GOS) score, Computed Tomography (CT) scan results, modality of management and type of surgical intervention and outcome. RESULTS Among the 1713 patients admitted, age of patients varied >1 year to 92 years (mean age 21 years), majority of TBI’s were reported in the age group 20–29 years (34.38%), followed by 30–39 years (26.97%), 40–49 years (16.70%), p value <0.05. Most of the patients were male (63.46%), mostly unmarried. Majority lived in sub-urban areas (51.26%) followed by rural (26.85%) and urban (21.89%). Patients were mostly from middle class (46.58%) and poor socio-economic background (42.62%), upper class only accounted for 10.8% of the cases. In terms of occupation, servicemen and farmers accounted for the majority (54.73%). Patients were brought to the hospital mainly by known persons (68%) and rest by bystanders and policemen. The most common mechanism of injury was road traffic accidents (RTA) 1199 (69.99%), followed by assault 251 (14.65%), 15.35% accounted for fall from height and fall of object on head. Mean hospital stay was 7.6±9.3 days (range <1 day to 87 days). In our study, patients were classified by GCS as mild TBI in 983(57.38%) patients; moderate in 488 (28.48%) and severe in 242 (14.12). 1481 (86.46%) patients experienced loss of consciousness; 788 (46%) had one or more episodes of vomiting; 312 (18.21%) patients presented with bleeding from ear, nose or throat, seizures were noted in 282 (16.46%) patients and vertigo in 411 (23.99%). Clinical examination also revealed abnormal pupils in 208 (12.14%) patients, abnormal motor response in 211 (12.32%) patients, only 3–5% patients showed cranial nerve deficit, racoon eyes or battle’s sign. CT scan revealed contusions (42.50%) and fractures (35.14%) were the most common findings followed by sub dural hematoma (32.87%), extradural hematoma (18.21%). 85% patients were managed conservatively and 27% managed surgically. The overall mortality was 149 (8.69%). In a 6 month follow-up, 54 patients were persistently vegetative, 37 were severely disabled (dependent for day to day activities). 1452 patients recovered to be healthy.