DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20194310

A clinico-radiological study of mild traumatic brain injury using the national emergency x-radiation utilization study decision instrument

Krupa V. Shingada, Manjusha M. Litake, Kedar M. Tilak

Abstract


Background: While traumatic Brain Injury (TBI) is one of the leading causes of morbidity and mortality in the Indian subcontinent, little is known regarding its basic characteristics. While CT scanning plays an important role in primary assessment of TBI, it is not always indicated in cases of mild TBI. Thus, the present study was carried out to describe the characteristics of cases of mild TBI presenting to a tertiary care hospital in India and determine the need for CT scanning in them using the National Emergency X-radiation Utilization Study (NEXUS) decision instrument.

Methods: In this prospective study, a detailed history was obtained, and clinical examination performed for each patient, followed by calculation of the NEXUS score. CT scan findings were recorded. Outcome measures were safe discharge, need for neurosurgical intervention or death.

Results: Out of the 425 patients, 87.05% were males. Road Traffic Accident (RTA) was the most common mode of injury. 206 patients had significant intracranial injuries, with skull fractures and hemorrhagic contusions being the most common.138 out of these 206 had a positive NEXUS score. ENT bleed and history of loss of consciousness were also found to be important predictors of significant intracranial injuries. 83 patients were discharged safely from the emergency department, 14 required neurosurgical intervention and 2 died during the course of their stay in the hospital. 

Conclusions: NEXUS decision instrument can be a useful tool to determine the need for CT scanning in patients of mild TBI.


Keywords


Head injury, Mild traumatic Brain Injury, National Emergency X-radiation Utilization Study

Full Text:

PDF

References


Kamal VK, Agrawal D, Pandey RM. Epidemiology, clinical characteristics and outcomes of traumatic brain injury: Evidences from integrated level 1 trauma center in India. J Neurosci Rural Pract. 2016;7(4):515-25.

World Health Organization. World Health Report 2003-Shaping the Future.Available at https://www.who.int/whr/2003/en/. Accessed 15 May 2019.

Medscape. Definition of Traumatic Brain Injury. Available at: https://emedicine.medscape.com/article/326510-overview/. Accessed 27 June 2019.

Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990‑2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743‑800.

Massenburg BB, Veetil DK, Raykar NP, Agrawal A, Roy N, Gerdin M. A systematic review of quantitative research on traumatic brain injury in India.Neurol India. 2017;65(2):305-14.

Shukla D, Devi BI. Mild traumatic brain injuries in adults. J Neuro sci Rural Pract. 2010;1(2):82-8.

Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV Jr, Zucker MI; NEXUS II Investigators. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005 Oct;59(4):954-9.

Mower WR, Hoffman JR, Herbert M, Wolfson AB, Pollack CV Jr, Zucker MI; NEXUS II Investigators. National Emergency X-Radiography Utilization Study. Developing a clinical decision instrument to rule out intracranial injuries in patients with minor head trauma: methodology of the NEXUS II investigation. Ann Emerge Med. 2002; 40:505-15.

Mower WR, Gupta M, Rodriguez R, Hendey GW. Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomographic (CT) decision instrument for selective imaging of blunt head injury patients: An observational study. PLoS Med. 2017;14(7):e1002313.

Ro YS, Shin SD, Holmes JF, Song KJ, Park JO, Cho JS, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Acad Emerg Med. 2011;18(6):597-604.

Stein SC, Fabbri A, Servadei F, Glick HA. A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med. 2009 Feb; 53(2):180-8.