Factors Influencing Outcome in Head Injury Patients with GCS < 8

INTRODUCTION: Traumatic brain injury (TBI) is one of the major and very important public health and socioeconomic problem all over the world. The incidence of TBI is increasing sharply and in particular due to increasing motor vehicle use in our country. TBI will over take many diseases as the major cause of death and disability by the year 2020. Head injury is a collective term and includes injury to the scalp and face such as lacerations and abrasions, which may be present without underlying brain trauma. TBI is a heterogeneous disorder with different signs and symptoms. Brain damage results from external forces, as a consequence of direct impact, rapid acceleration, a penetrating object or blast waves from an explosion. The nature, intensity, direction and duration of these forces determine the pattern and extent of damage. TBI can be divided into 2 phases; 1. Primary brain injury: injury sustained at the time of impact, 2. Secondary brain injury: Injury to brain secondary to primary injury; •It is important to differentiate between risk factors. Direct causative effect on out come eg: Cerebral edema. Prognostic factors – Which are associated with outcome, but aren’t causative eg: Markers of Injury severity are assessed with GCS Scoring and clinical assessment like pupillary response and DEM. •The outcome in severe head injury patient is very poor, hence a study has been conducted in TBI patients with GCS ≤8 and factors that contribute for the outcome are analysed. AIM OF THE STUDY: 1. To Analyse the various factors in severe Head Injury Patients (GCS<8). 2. To identify how they influence the outcome in those patients. 3. To study each factor in detail in relation to Glasgow outcome scale (GOS) and predict Best & worst outcome with each factor. 4. To determine if there is any modifiable risk factor that can improve the outcome in severe head injury patients. MATERIALS AND METHODS: This study was conducted at Department of Neurosurgery, MADRAS INSTITUTE OF NEUROLOGY, Rajiv Gandhi Government General Hospital, Chennai-600 003. Tamilnadu, is one of the most pioneers in the establishment of neurosurgical centre in our country. We have a large separate ward for trauma patients. All facilities and specialties were available round the clock. All head injury patients were received in trauma ward and were immediately assessed by the triage team of doctors (general surgeons, neuro surgeons, orthopaedic surgeons). STUDY PATTERN: •This is a prospective type of study. •350 consecutive acute severe head injury patients with GCS<8 who were admitted in emergency head injury ward were included in the study. •All admitted head injury patients, with GCS 9 and above, paediatric patients with less than 14 yrs of age, patients treated at outside hospitals were excluded from the study. Inclusion Criteria: Patients with GCS