TBI at Tertiary Care Hospital in Western UP-Outcome and Review of Literature

TBI at Tertiary Care Hospital in Western UP-Outcome and Review of Literature

Author Dr. Sanjay Sharma
Co-Author Dr. Nikunj Mendiratta, Dr. Mayank Mishra
DOI

Country : India
Subject : Neurosurgery

Keywords : Decompressive craniectomy; Traumatic Brain injury; Intracranial hypertension, Glasgow Outcome Scale; Severe TBI, DECRA, RESCUE, RESCUEicp, RESCUE-ASDH

Abstract

Head injury cases are increasing nowadays due to rapidly moving vehicle increasing on roads day by day. Road side accident is most common cause for head injury. Severe TBI is a challenge, not only for the public but also for the Neurosurgeon in India. In severe TBI an elevated intracranial pressure is main cause for mortality. The conservative management for reducing the ICP, various modalities like hyperosmolar agent, analgesia, deep sedation and ventriculostomy and ventilator support are commonly used. The surgical management of raised ICP, Decompressive craniectomy has been frequently used for last two -three decades. The aim of study is to analyse the outcome in head injury clinical characteristics, complications and factors associated with the management of Traumatic Brain Injury with emphasis on outcome as measured by Glasgow Outcome Scale in patients who underwent only medical management and among patients who underwent a decompressive craniectomy.
Materials and Methods:
A study was conducted among patients with head injuries presenting to Trauma emergency of SVBP Hospital, Meerut. The Prospective data of 1138 patients admitted from Jan 2019 till Jun 2020 was taken and then analysed categorically with standard analytical software. Comparison was made between various outcomes of two groups of management of severe TBI: Medical Conservative and Surgical Decompressive Craniectomy (DC).
Results: 51 subjects (23.61%) passed away in immediate post-op period. Mean hospital stay duration was 11 days (7-23). 20 subjects could not be followed up as they did not turn up in OPD/Emergency. 3-month mortality rate for subjects who underwent DC was 41.20% (89 subjects). 302 patients expired without undergoing surgical management, due to severity of their injury. Overall mortality rate was 77.73% for all patients with Severe Traumatic Brain Injury. Only 53 participants (24.53%) out of 216 who were treated by surgical modality had Glasgow Outcome Scale Score of 5 at 3 months.
Conclusion: Decompressive craniectomy is an efficient technique to reduce intracranial hypertension. The use of proper surgical technique can be the key to a good surgical outcome. In the future, conduct of clinical trials to standardize the correct technique, surgical timing and better guidelines may make this modality a better choice for patients.

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