Background Clinicians treating patients with head injury often take decisions based on their assessment of prognosis. Assessment of prognosis could help communication with a patient and the family. One of the most widely used clinical tools for such prediction is the Glasgow coma scale (GCS); however, the tool has a limitation with regard to its use in patients who are under sedation, are intubated, or under the influence of alcohol or psychoactive drugs. CT scan findings such as status of basal cistern, midline shift, associated traumatic subarachnoid hemorrhage (SAH), and intraventricular hemorrhage are useful indicators in predicting outcome and also considered as valid options for prognostication of the patients with traumatic brain injury (TBI), especially in emergency setting. Materials and Methods 108 patients of head injury were assessed at admission with clinical examination, history, and CT scan of brain. CT findings were classified according to type of lesion and midline shift correlated to GCS score at admission. All the subjects in this study were managed with an identical treatment protocol. Outcome of these patients were assessed on GCS score at discharge. Result Among patients with severe GCS, 51% had midline shift. The degree of midline shift in CT head was a statistically significant determinant of outcome (p = 0.023). Seventeen out of 48 patients (35.4%) with midline shift had poor outcome as compared with 8 out of 60 patients (13.3%) with no midline shift. Conclusion In patients with TBI, the degree of midline shift on CT scan was significantly related to the severity of head injury and resulted in poor clinical outcome.

Introduction: Head injury or traumatic brain injury is defined as non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions. It is a leading cause of morbidity, mortality, disability, and socio-economic losses in India and other developing countries. Young males are affected more than females and road traffic accident is the commonest cause of head injury. Materials and Methods: We studied patients who presented with head injury to a tertiary health care centre from ages 18 years to 60 years. Clinical profile was studied which included clinical examination and CT scan of brain. Severity of head injury was evaluated on admission by Glasgow Coma Scale (GCS) and functional outcome was assessed by Glasgow Outcome Scale (GOS) at 10th day, 1 month and 3 months after injury. Results: Study was conducted with 200 patients. Most of the patients with head injury were males (79.5%) and peak incidence was in the age group 31–40 years. The commonest cause of head injury was road traffic accidents (72.5%). Most common presentation was loss of consciousness (49%). On admission, GCS score was found to be mild, moderate, and severe in 77%, 9%, and 14.5% patients. Severe GCS score was mostly associated with subdural hematoma in 21.5% patients and also contributes to 82.5% mortality. Fractures (43%) were the commonest CT finding. 12.5% were treated with surgery. Overall mortality was 12.2%. GOS was calculated on 10th day, at the end of 1 month and at the end of 3 months. At the end of 3 months, 87% patients showed complete recovery, 0.5% patients showed moderate disability, 0.5% showed severe disability, 0% showed vegetative state and 12.2% was the mortality. There was considerable improvement in GOS scores with respect to disability and recovery from 10th day to follow-up at 3 months post trauma. Conclusion: GCS score on admission and the type of CT lesion are both important factors in determining the outcome, and both must be considered when describing severely head injured patients. GOS is a good modality to predict functional outcome of these patients and assess their recovery and disability.

INTRODUCTION - Traumatic brain injury [TBI] most affects the working population and their earning capacity. The various sub categories of TBI in terms of clinical features,Glasgow coma scale [GCS] and radiology are well defined.We have attempted an analysis in terms of long term Glasgow outcome score [GOS] and tried to correlate with the various factors of TBI. MATERIALS AND METHODS – All patients of TBI over 12 years and below 60 years and those without other major trauma were included over a period of about two years. The clinical features, presentation GCS, treatment given, and outcomes were assessed.The three month GOS was scored for all patients and was used to analyse the the initial data in its light. RESULTS – A total of 200 patients were eligible for the study and were included. Of these 159 were males and 41 were females.The average age was 37.16 years.There was a relatively higher proportion of mild TBI and greater prevalence of fractures and EDH [extradural hematoma].On analyzing with three month GOS we found that 90.4 % of the patients with mild TBI had a three month GOS of 5 whereas only 31.9% of patients with moderate or severe TBI had a three month GOS of 5. CONCLUSION – The long term GOS is most representative of the extent to which the patient has been able to return to their pre TBI lives. In our study the three month GOS co related well with the initial GCS. Further prospective data can elaborate more on the effect of other clinical features and radiology on long term GOS