Profile And Outcome Of Traumatic Brain Injury Patients In A Tertiary Care Centre In North Karnataka:

Abstract

ABSTRACT Background Traumatic Brian injury (TBI) has been one among the significant Public Health problems. It remains one of the leading causes of Mortality, morbidity, disability in developed and developing nations. It was estimated that TBI would be the third main cause of death and disability by 2020 according to World Health organization1. It is a leading cause of disability and death among young adults in the world, with devastating impact on patients and their families. Objective The objective of study is to assess the Epidemiological profile of patients with Traumatic brain injury attending tertiary care hospital in North Karnataka and to follow them up for six months, document the outcome and estimate the outcome predictors for the same Methods Over the course of three months, 172 cases of Traumatic Brain Injury at the Shri B.M. Patil Medical College, Hospital & Research Centre, Vijayapura, were studied as a part of an observational study. The TBI cases with or without Loss of consciousness and/or CT scan findings of Traumatic Brain Injury were selected. The data collection has been done in six different Google formats, which included initial assessment and care, details of hospital stay and follow up after 3rd and 6th month separately and autopsy details, in case of death. Results The study revealed, male preponderance (87.8%), the distribution was more in early adulthood (age group (18-45 years) (82%) for TBI than other age group. The area distribution was Rural (71%), semi urban (12%) and Urban (17%),. RTA(85%) was cause of most TBI cases followed by fall from height (10%) and Assault (5%). Most of the cases presented within first hour (37.9%) and subsequent 6 hours (41%) of time since injury. The presentation symptoms were LOC (94%), Vomiting (66%), Seizures (1%). 11 were brought dead cases, and rest presented as Mild TBI (55.3%), Moderate TBI (24.3%), Severe TBI (20.5%). On CT Scan, Skull fractures (63.4%), Traumatic SAH (36.6%), Epidural Hematoma (15.7%), Subdural Hematoma (30.8%), Contusions (44.2%), Diffuse axonal Injury (9.3%) were found. Out of 172 cases, 126 cases were admitted and treated conservatively (72.2%), Underwent neurosurgery (18.3%), other surgical procedures (7.9%) and observation (1.6%), during admission 5.6% of cases suffered non neurological complications. 8.1% of cases treated at the hospital on OPD and IPD basis, succumbed to death, and 85.8% had upper good recovery on GOS-E score. Out of 24 cases that underwent neurosurgery, only 4 cases succumbed to death. Age, gender, and delay in presentation were not significantly associated as outcome predictor of TBI in this study with p value >0.05. GCS score at initial presentation was associated with high significance, as outcome predictor at patient’s discharge, 3rd month and 6th month follow ups with p value <0.001. Conclusion TBI is a major health problem with RTA being the most common cause of TBI. The occurrence is highest and prognosis is better of Mild TBI, though those suffering from Moderate and severe TBI suffer disabilities of various degree and/or death. Neurosurgery is having better outcome in those who are operable. GCS at initial presentation is an outcome predictor for TBI cases, at discharge, as well, at the end of 3rd and 6th month follow up.