Background:Age is a strong prognostic factor following traumatic brain injury (TBI), with discrepancies defining the critical prognostic age threshold. This study was undertaken to determine the impact of various age thresholds on outcome after TBI.Materials and Methods:The ages of patients admitted with TBI were prospectively studied in relation to mode of injury, Glasgow coma score (GCS), CT category and surgical intervention. Mortality was assessed at 1 month, and neurological outcome was assessed at 6 months. Appropriate statistical analyzes (details in article) were performed.Results:Of the total 244 patients enrolled, 144 patients had severe, 38 patients had moderate and 62 patients had mild TBI, respectively. Age had significant association with grade of injury, CT category and surgical intervention (P < 0.01). Mortality at 1 month was significantly associated with increasing age with patients dead at 1 month being 15% for age < 18, 44% for age between 18 and 59 years, and 52% in the age group > 59 years respectively (P < 0.001). Unfavorable outcome showed significant association with an increase in age, every decade (P < 0.001). In multivariate analysis, there was stepwise increase in the odds of unfavorable outcome across age groups centered on 40 years, independent of confounding factors. The adjusted odds ratios for unfavorable outcome with regard to age thresholds 30, 40 and 50 years were 11.3, 53.3 and 1171, respectively (P < 0.005). Moreover, there was significant association of unfavorable outcome with age > 40 years in all subgroups, based on GCS and surgical intervention (P < 0.05).Conclusions:In patients with TBI, age demonstrates independent association with unfavorable outcome at 6 months, in stepwise manner centered on a threshold of 40 years.

Traumatic brain injury increases the metabolic response of body, and therefore nutritional demands. This study was undertaken to evaluate various clinical features of malnutrition in TBI and their influence on neurological outcome. Eighty eight adult patients within 24 hours of TBI admitted with GCS 4 to 8 without serious systemic disorder were enrolled for the study. They were monitored serially for various clinical features of malnutrition till 3 weeks and outcome assessed at 6 months. Every week there was a significant increase in number of patients with various clinical features of malnutrition. Pedal edema was the most frequent sign present in 70% of patients at three weeks, followed by skeletal prominence (19%) and cheilosis (12%). Clinical malnutrition showed significant association with poorer GCS (p=0.03), admission hypoproteinemia (p=0.03), and delayed full enteral feeding (p< 0.001). Unfavorable outcome at 6 months was noted in 30 out of 37 patients who had clinical malnutrition as compared to 3 out of 15 patients who had no clinical features of malnutrition (odds ratio 17.2, p< 0.001). In multivariate analysis, clinical malnutrition was significantly associated with unfavorable outcome independent of GCS (p=0.002). Analysis of individual clinical markers revealed pedal edema as the only single clinical marker with significant influence on unfavorable outcome at 6 months (p=0.01). Clinical malnutrition developed more among patients with poorer GCS, admission hypoproteinemia, delayed full enteral feeding, and was associated with unfavorable outcome at 6 months. Among the various clinical markers, only pedal edema showed independent association with unfavorable outcome.

Background:Socioeconomic status is an important determinant of the standard of living and health status of people.Objectives:To assess the influence of economic status on the outcome following severe head injury.Materials and Methods:Adult patients of severe head injury, whose guardians' volunteered information on family income, were enrolled for the study. The family per capita income was then calculated. They were studied prospectively in relation to various factors and followed-up.Results:Among 99 patients, monthly per capita income of Rs. <500, 500-1000, 1000-2000, and >2000 were noted in 20, 43, 22, and 14 patients, respectively. The credibility of information on income was confirmed by positive correlation with patients' mid arm circumference measurements (P<0.001). They were divided into two groups (family monthly per capita income ≤Rs.1000 and >Rs.1000). The comparability of both groups based on age, Glasgow Coma Scale, systemic injury, and surgical intervention was confirmed (P>0.05). Mortality at one month was 49% among patients whose monthly per capita income ≤Rs.1000 compared with 17% of the rest (Odds ratio [OR] 4.0, P=0.003). Unfavorable outcome at three months was noted in 63% of patients whose monthly per capita income ≤Rs.1000, as compared with 35% of those with per capita income >Rs.1000 (OR 4.1, P=0.01). In multivariate analysis, family monthly per capita income ≤Rs.1000 emerged as an independent risk factor for unfavorable outcome at three months (P=0.02).Conclusion:In patients of severe head injury, lower economic status is significantly associated with unfavorable outcome at three months, independent of other factors.