DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161764

A clinical analysis of outcome in management of head injury in patients with highway road accidents

Kiran Shankar H., Paparajamurthy ., Mohan Kumar K., Anand K.

Abstract


Background: Road traffic accidents (RTAs) are a major cause of misery, disability and death globally, with a disproportionate number occurring in developing countries. Complications from closed head injuries are the single largest cause of morbidity and mortality in patients who reach the hospital alive. The present study assesses the outcome in the management of head injury admitted in our hospital following RTA in the period of one year.  Methods: This retrospective study carried out in the department of Neurosurgery in a rural tertiary hospital, Kolar, Karnataka, India. Patients who got admitted between periods of January 2012 to January 2013 were included in the study. All patients were clinically evaluated by a team comprising of doctors from surgical, medical and orthopedics specialties in the emergency department and subsequently admitted and treated at neurosurgery. The study was conducted based on these reports and observations and outcome of patients. The results were expressed as percentages.

Results: At the time of admission 41% patients were under alcoholic influence, 97% patients had history of LOC, 50% patients had ENT bleed and 7.5% had CSF leak.  The GCS score of less than 8 was seen in 33% cases, 9 to12 in 52% cases and between 12 to 14 in 15% patients. As per Glasgow outcome scale (GOS), 91% of patients had good recovery, 5.5% patients had disability (hemiparesis, ptosis) and 3.5% patients died in the course of treatment. Conclusions: Head injury due to RTA is a recognized major public health problem causing death and disability among the population. So it should be managed in time and also should be looked seriously by concerned authority for reducing the incidences of head injury associated with RTA and protecting people by debilitating conditions.


Keywords


Head injury, Road traffic accidents, Management

Full Text:

PDF

References


Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World Report on Road Traffic Injury Prevention Geneva: World Health Organisation. 2004.

Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. Br Med J. 2002;324:1139-42.

Lagarde E. Road traffic injury is an escalating burden in Africa and deserves proportionate research efforts. PLoS Med. 2007;4(6):170.

Jacobs G, Aaron Thomas A, Astrop A. Estimating Global Road Fatalities London: Transport Research Laboratory. 2000;(TRL Report 445).

Field JH. Epidemiology of head injury in England and Wales. Department of Health and Social Security. Her Majesty’s stationery office, London. 1976.

Kraus JF, Black MA, Hessol N, Ley P, Rokaw W, Sullivan C, et al. The incidence of acute brain injury and serious impairment in defined population. Am J Epidemiol. 1986;119:186-8.

Kraus JF. Epidemiology: In: Elizabeth Frost (eds) Head Injury Management and Research AIREN- Geneva, Switzerland. 1990;113-24.

Edna TH, Cappenlen J. Hospital admitted head injury: a prospective study in Tromdelag, Norway. Scan J Sco Med. 1984;12:7-11.

Fife D, Faith G, Hollinshead W. Incidence and outcome of hospital treated head injury in Rhode Island.Haradhan Deb Nath, Vivek Tandon, Ashok Kumar Mahapatra, Saquib Azad Siddiqui, Deepak Kumar Gupta Indian Journal of Neurotrauma (IJNT), Am J Public Health. 1986;8(1):76:773-7.

Ramamruthi B. Road accidents, Epidemiology and Prevention. Neurology India. 1995;43:9-15.

Mahapatra AK. Current management of head injury. Neuroscience Today. 1997;1:197-204.

Kalyanaraman S. Organization of a head injury services. Ann Ind Aca Med Sci 1971; 7:1-3.

Guerreo JL, Thurman DJ, Snievek JE. Emergency department visits associated with traumatic brain injury. Brain injury. 2000;14:181-6.

Thurman D, Guerrero J. Trends in hospitalization associated with traumatic brain injury. JAMA 1999;282:954-7.

Mehta SP. An epidemiological study of road traffic accident cases admitted in Safdarjang Hospital, New Delhi. Ind J Med Res. 1968;56:456-66.

Chalya PL, Mabula JB, Ngayomela IH, Kanumba ES, Chandika AB, Giiti G, et al. Motorcycle injuries as an emerging public health problem in Mwanza City, north-western Tanzania. Tanzan J Health Res. 2010;12:214-21.

Greenfield LJ, Mulholland MW, Oldham KT, Zelenock GB. Head Injuries. Surgery Scientific Principles and practice I edition. 1993:267-72.

Smith WT, Cavanagh JB. Brain damage in non- missile head injury. Recent advances in neuropathology I edition. 1982:165- 87.

Akang EE, Kuti MA, Osunkoya AO, Komolafe EO, MalomoAO, Shokunbi MT, et al. Pattern of fatal head injuries in Ibadan—a 10 year review. Med Sci Law. 2002;42:160-6.

Report of road safety cell: Ministry of Transport. Government of India, January 1993.

Head injuries. A neglected field in India. National Medical Journal. 1991;4:53-44.

Becker DP, Povlishock JT. Central Nervous System Trauma Status Report. National Institute of Health and Communicative Disorders and Stroke, Bethesda, MD; National Institute of Health, 1986.

Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic Brain Injury in the United States/ A public health perspective. J Trauma Rehabil. 1999;14:602-15.

Ahmad FU, Mahapatra AK, Mehta VS. Outcome of unknown head injury patients at a tertiary care neurosurgical centre: Neurology India. 2006;54:73-4.

Lannoo E, Van Rietvelde F, Colardyn F, Lemmerling M, Vandekerckhove T, Jannes C, et al. early predictors of mortality and morbidity after severe closed head injury. J Neurotrauma. 2000;17:403-14.

Sahdev P, Lacqua MJ, Singh B, Dogra TD. Road Traffic fatalities in Delhi: causes, injury patterns and incidence of preventable deaths. Accid Ann Prev. 1994;26:377-84.

Friedman Z, Kungel C, Hiss J, Margovit K, Stein M, Shapira S. The Abbreviated injury scale –a valuable tool for forensic documentation of trauma. Am J For Med Patho. 1996;17:233-8.

Henriksson EM, Ostrom M, Eriksson A. Preventability of vehicle- related fatalities. Accid Ann Prev. 2001;33:467-75.

Sharma BR, Harish D, Sharma V, Vij K. RT A. A demographic and topographic analysis. Med Sci Law 2001;41:266-74.

Montazeri A. Road-traffic-related mortality in Iran: a descriptive study. Public Health. 2004;118:110-3.

Elesha SO, Daramola AO. Fatal head injuries: the Lagos University Teaching Hospital experience (1993-1997). Niger Post grad Med J. 2002;9:38-42.

Menon A, Pai VK, Rajeev A. Pattern of fatal head injuries due to vehicular accidents in Mangalore. J For Leg Med. 2008;15:75-7.

Wagner AK, Sasser HC, Hammond FM, Wiercisiewski D, Alexander J. International Traumatic Brain Injury: Epidemiology and risk factors associated with Severity and Mortality. J Trauma. 2000;49:404-10.

Bulger EM1, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich G. Brain Trauma Foundation: Management of severe head injury: Institutional variations in care and effect on outcome. Crit Care Med. 2002;30:1870-6.

Salgado MSL, Colombage SM. Analysis of fatalities in road accidents. Forensic Sci Int. 1998;36;91-6.