Context:High intracranial pressure is the most frequent cause of mortality and disability after severe traumatic brain injury (TBI) which is treated by first-line therapeutic measures. When these measures fail, second-line therapies are started. Among second-line therapies, decompressive craniectomy (DC) has been used. It improves the functional outcome in these patients.Aim:This study aims to analyze the clinicoradiological factors associated with the prognosis of severe TBI in patients undergoing DC.Settings and Design:It was a retrospective case series study from April 2014 to March 2016.Subjects and Methods:A total of 85 patients (admitted at Tata Main Hospital, Jamshedpur) with severe diffuse TBI with clinical and radiological evidence of intracranial hypertension who were refractory to first-tier therapies and required DC were included in our study. Cases excluded were patients with age <10 years and polytrauma patients.Results:Out of 85 cases, 55 were males, and thirty were females (male:female = 1.8:1) with the age ranging from 17 to 68 years. Road traffic accident was the leading cause of injury in 69.5% cases. A total of 49 (58%) patients were of Glasgow coma scale (GCS) 4–6 whereas 36 (42%) patients had GCS 7–8. Computed tomography (CT) scan brain was classified as per Marshall CT classification. Bifrontotemporal DC was done in 29% cases, and unilateral frontotemporoparietal craniectomy was done in 71%.Conclusions:Patients with younger age, early surgical intervention, better preoperative GCS score, and with low Marshall CT score have better prognosis.
Background: Traumatic Brain Injury (TBI) is one of the leading causes for morbidity, mortality and economic loss. Aim: To study the etiology, epidemiological aspect and outcome of Traumatic Brain Injuries admitted at Tata Main Hospital. Material and Methods: Retrospective case series study undertaken for a period of 2 years from January 2014 to December 2015.2855 patients presenting to our Emergency Department with head injury were included in the study. Patients underwent detailed clinical and radiological evaluation as per trauma protocol. Results: The most commonly affected age group was 21 to 30 years (25,6%)%) with male to female ratio of 2.3:1. Injuries were predominantly caused by road traffic accident (69.4%), followed by fall from height (15%) and assault (5.1%). The most common CT scan finding was brain contusion (14%); others included acute subdural hematoma (9%), extra-dural hematoma (6%) and depressed skull fracture (4%) and traumatic sub-arachnoid hemorrhage (2%).Out of 400 severe head injuries 227 ( 57% ) expired. Out of 685 casas with moderate Head Injury 301 (44% ) cases showed complete recovery.100% recovery was seen in Mid Head Injury cases. Conclusion: Road Traffic Accidents are a major cause of severe traumatic brain injury. About 66% cases reported to Emergency after 2 hours suggestive of an imperetive need of timely referral to hospitals so as to minimize the consequences of secondary brain injury. Only 5.5% cases required surgical intervention signifying the need for proper treatment measures.
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