Abstract

Background: Millions of people sustain head injuries by different MOIs due to various causes most of them being preventable. Head injuries mostly end up in either mortality or de-capacitating disabilities, often persisting lifelong. They cause the society to pay the heavy penalty of “the global loss of economy and human resources.” The study of the profiles of the head injury patients throws light on many important causes for concern to formulate strategies for patient management and injury prevention, as proved by studies. Early institution of appropriate management and care based on the head injury severity per GCS scores and timely transfers of patients to facilities that can cope with the patients’ needs play a pivotal role in preventing the worsening of primary and occurrence of secondary neuronal damages. Aim: To evaluate the clinical profile of Head Injury patients presenting to ED. Objectives: 1) To evaluate the correlation between GCS scores and the Head Injury severity 2) To evaluate the correlation between the time bound changes in the GCS scores and head injury severity Materials and Methods: The pre-approved prospective observational study was conducted on 100 head injury patients of both genders of all ages, presented to the ED of a quaternary care hospital in Kerala, India. Inclusion and exclusion criteria were strictly adhered to in the patient selection. MOIs in these patients were RTAs and nonaccidental (slip and fall) and accidental falls (fall from height). The clinical profile data collected, analyzed, and studied included gender, age, vital signs (heart rate and blood pressure on arrival), mechanism of injury, the need for cervical spine immobilization, the patient disposal, and GCS scores, and head injury severity based on GCS scores the last two assessed on patients' arrival, and subsequently at 2 and 4 hours after that. Results: The head injury prevalence was preponderant in the males and the age group between 20 and 50 years. Almost all the head injuries were due to high energy impacts, caused mainly through RTAs (> 2/3) and many (about 1/3) by non-accidental falls, and the last few (3%) because of accidental falls from heights. Except for a hand full of patients, all others needed cervical spine immobilization. However, all others were hospitalized in the ICU for the few duly discharged after observation in the ED, and the others were wheeled to or for emergent neurosurgical procedures after resuscitation. Based on GCS scores on arrival, the head injury severity was moderate and severe in one-fourth and one-third of the patients, respectively. There had been time bound de-escalation of the GCS scores with a proportional escalation of the severity in an appreciable number of patients. Conclusion: A part from the preponderance of head injury prevalence in the males and the second to fifth decade of life, most of the head injuries were due to high energy impacts, the majority of them being caused by RTAs and next by non-accidental falls, especially in the older adults and lastly in the least few due to accidental falls from height, often of occupational in nature. Except for very few, all others needed cervical spine immobilization and ICU care. In situations inaccessible for immediate access for Imaging, GCS scoring played a vital role in assessing and reassessing the head injury severity, which helped make patient management and transfer decisions early to prevent secondary neuronal injuries. “Most of the head injuries are often preventable.”A closer look globally at the prevailing traffic conditions, laxity in the traffic rules and regulations, including the lacuna in their implementation, would ensure safety on the road averting a high incidence of RTAs. Not only this, but also there needs to be a deep concern for the older adults succumbing to head injuries by ‘slip and fall’ and those sustaining head injuries by accidental falls from heights, mostly of occupational origin, are all of preventable nature by appropriate measures. Every health care personnel involved in the care of the head injury patients straight from the pre-hospital setup is being endorsed with the great responsibility of preventing the occurrence of secondary neuronal injuries in addition to averting further worsening of the already sustained neural damages.

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