Outcome in 2068 patients of head injury: Experience at a level 1 trauma centre in India

BACKGROUND: Traumatic brain injury (TBI) is one of the leading causes of death. Evidence-based guidelines for TBI care have been widely discussed, but in-hospital treatment and outcome of these patients has been highly variable especially in developing countries like India. OBJECTIVES: To evaluate the epidemiology and outcome of patients with head injuries at a Level 1 trauma center in India. MATERIALS AND METHODS: In this retro-prospective study, all patients with head injury who were admitted in the department of neurosurgery over a 15 months period (November 2007-January 2009) were included in the study. Post-resuscitation GCS was used for categorizing the severity of head injuries and outcome was assessed at discharge using GOS. All patients were managed as per laid down departmental protocols. RESULTS: A total of 2068 patients of head injury were admitted during the study period. The mean age was 24 years (range 1-85). 71.4% were male and 28.6% were female. The most commonly involved age group was 20-40 years (43%) and the most common mode of injury was road traffic accidents (64%). 53% of the patients had severe head injury (GCS ≤ 8), 18% had moderate head injury (GCS 9 ≤ 13) and 29% had minor head injuries (GCS ≥ 14). The mean hospital stay was 14 days (range 1-62 days). Overall in-hospital mortality was 22% (454 cases). 39% died within 48 hours of injury. 2% of minor, 12% of moderate and 36% of severe head injured patients expired; Mortality was 38% in children (≤12 years). Amongst those who survived, 45% had good outcome (GOS 4 or 5), 13% were severely disabled (GOS 3) and 19% were vegetative (GOS 2). CONCLUSIONS: This is the one of the largest single center study on severe head injuries and shows enormity of the problem facing developing countries like India.