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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.4318.1

Abstract

Head injury is a devastating problem worldwide including India. Loss of young people at their productive years is a great emotional and financial concern for the families affected by it which contributes to the economic loss of 3% to GDP [1]. The incidence of head injury shows a rising trend due to urbanization and industrialization. Injury to the head can be either primary or secondary. Primary injury occurs due to the initial processes occurring in neuronal tissue as a result of trauma to brain where as secondary injury is the consequence of further physiological insult [2-3]. Despite of major steps being taken during the “golden hour” to prevent head injury, regrettably secondary brain injuries contributes to a huge number in patients transferred to neurosurgical units [4]. Prognostication in Traumatic Brain Injury (TBI) is a multivariate analysis. Some of these factors are favourable while others unfavourable. Most commonly used factors to predict TBI are age, Glasgow Coma Scale, Pupils, CT findings, hypotension, hypoxia. Few factors like hyperglycemia and anemia are studied to have strongest effect on the outcome of TBI [5-7] However, rest metabolic and neurochemical abnormalities that underlie TBI remains poorly understood. So, the purpose of this study is to correlate few of these parameters in one study in order to generate fruitful results.

Objective of the Study: Primary Objective: To study the effects of these systemic markers of traumatic brain injury on mortality and morbidity of the patient. Secondary

Objective: To predict which amongst these markers has the highest effect on the outcome of the patient.

Methods and Materials: Study was done at Max Superspeciality Hospital, Shalimar Bagh. Patients coming with complaints of traumatic brain injury were included in the study. After obtaining informed consents, all the details of the patients were filled in a data collection forms. All the in hospital events were recorded from July 2015 to March 2017.

Statistical Analysis Used: The data collected was entered in the Excel spreadsheet using Microsoft Excel Software. Then this data was transferred to Statistics Package for Social Sciences (SPSS) version 20, IBM Inc. for analysis. It was subjected to descriptive statistics for calculation of mean, standard deviation, frequencies and percentages. Summarized data  was presented using Tables and Graphs. Shapiro Wilk test was used to check which all variables were following normal distribution. Chi-square test was used for comparison between categorical variables. Therefore, bivariate analyses was performed using the parametric tests i.e Independent ‘ t’ tests (for comparing two groups).

Results: Total number of patients reported to the Emergency Department who fulfilled the criteria of the study during the time period mentioned were 226 out of which 175 agreed and gave consent for the study as the rest did not gave consent for different reasons. Out of 175 who fulfilled the criteria, 127 were males, 48 were females. The purpose of the study was to individually calculate mortality and morbidity of five factors i.e., blood pressure, carbon dioxide levels, serum sodium, serum lactates and temperature and to identify the factor most likely responsible for poor outcome of the patient. The mortality was calculated by the number of deaths in the ICU and morbidity by the length of hospital stay. The abnormal values was the sum of the variables above and below the reference range of  individual marker. The results which we were able to calculate by the study are: 1. Mortality associated with abnormal systolic pressure was found to be 78.8% and morbidity is 88.2% 2. Mortality associated with abnormal diastolic pressure was found to be 51.8% and morbidity is 63.2% 3. Mortality associated with abnormal carbon dioxide levels was found to be 31.7% and morbidity is 63.1% 4. Mortality associated with abnormal levels of serum sodium was found to be 32.1% and morbidity is 36.8%. 5. Mortality associated with abnormal values of serum lactates was found to be 3.8% and morbidity is 84.2% 6. Mortality associated with abnormal temperature range was found to be 8.2% and morbidity is 100%.

Conclusion: The results generated from the study strongly emphasize strict temperature control along with serum sodium and lactate maintenance in a TBI patient with temperature control as the most significant criteria. Although keeping the values of blood pressure and carbon dioxide within limits was important in such patients but the results generated in this study were insignificant. So we drew a conclusion that it is important to quickly chart all the parameters of primary survey in a TBI patient and draw an ABG sample to look for serum sodium and lactate levels so that immediate action may be taken to maintain them in the ED and thereafter in the ICU. The results of all these factors were dependent on patients age, sex, co-morbidities, GCS or CT/MRI findings as all these are found to have a direct affect on the outcome of TBI patients.
 

Keywords : Traumatic Brain Injury (TBI); Computed Tomography (CT); Arterial Blood Gas (ABG); Emergency Department (ED); Intensive Care Unit (ICU); Glassgow Coma Scale (GCS); Magnetic Resonance Imaging (MRI).

Corresponding Author : Aakansha Singh, Consultant, Department of Emergency, Medicine Max Super Speciality Hospital, Shalimar Bagh, New Delhi, Delhi 110088, India.