Clinical Profile and Outcome in Patients with Head Injury at a Tertiary Health Care System

Abstract

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.