Author(s): Srinivasa Babu C. R1, Megha R. N2, Nitesh B. N3
BACKGROUND AND PURPOSE
To describe the role of Glasgow Coma Scale (GCS) as an initial and simple tool of neurological assessment and also haematoma volume in selection of patient for surgery.
MATERIALS AND METHODS
After an initial GCS assessment, 50 patients with a history of head trauma were referred for a head CT which was done with a GE Bright Speed Elite 16 slice CT scanner.
42 patients (84%) were males and 8 (16%) were females. The mean age was 33.54 years and the maximum numbers of patients affected belonged to the age group of 21 to 30 years. The most common mode of injury in this study was road traffic accident (RTA) accounting for 86%. 42% of patients presented with a GCS of </= to 8. Most of the patients had more than one type of extraaxial haemorrhage. 20 patients in this study were operated, the indication being either SDH or EDH with a volume more than 20 mL and 30 mL respectively. Among intra-axial haemorrhages, cerebral contusions were the commonest type encountered with 34 out of 50 patients that is 68%. DAI was the other less common type of intra-axial haemorrhage accounting for 6%. Patients were selected for surgery based on the admission GCS and haematoma volume as determined using Petersen and Esperson formula on the CT images. Both GCS score and haematoma volume assessment were most crucial indicators for the surgical management of the patients in this study. Immediate surgery for patients with large haematomas was associated with positive outcome.
It was concluded that the initial GCS score played a major role in quick and reliable assessment of neurological status of the patient. The GCS score also correlated with the haematoma volume as seen on the CT. Both GCS score and haematoma volume assessment were most crucial indicators for the surgical management of the patients in this study.