الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 16 |  |  |
| | | from | 16 | | |
Abstract
Traumatic brain injury (TBI) is a major cause of death and disability among trauma patients. Although official figures are lacking, TBI is a particular problem in developing countries.
The management of severe head injury patients demands the dedication of expensive but limited intensive care resources for considerable length of time. Thus outcome prediction after severe head injury is of great clinical importance especially for developing countries for better targeting of limited healthcare resources.
The aim of the present study is to determine and evaluate the various predictors of early mortality (within one week) in patients with severe traumatic brain injury.
The current study was carried out on 82 patients with severe traumatic brain injury. The majority of patients were males (85.4%) with road traffic accident (75.6%) as most common mode of head injury. Mortality during the first week had statistically significant (p value = 0.005) relationship with age of the patient. We had 50% mortality in 20-40 years age group which was much higher than 26.9% in below 20 year age group and 23.1% in patients > 40 years age group. Mode of injury whether road traffic accident (75.6%), history of fall (14.6%) or direct trauma to head (9.8%) did not had any significant relation with early mortality.
4.9% of patients were hypotensive when they presented in casualty, its relation with mortality was not significant. Hypoxia affected first week mortality in patients with severe head injury. 76.9% of the unsurvived patients had hypoxia at the time of presentation, as compared to 23.1% in non-hypoxic patients. So hypoxia was significantly associated with mortality with p value 0.027. The GCS score and presence of pupillary abnormalities at the time of admission have not been shown to be a reliable predictor of mortality during the first week after severe head injury.
The analysis of CT scan findings showed that 30 patients had mass lesion and 30 had diffuse lesion representing 36.6% each. There were 22 patients with both types of lesions representing 26.8%. The presence of both types of lesions was significantly associated (P value > 0.001) with mortality during first week.
69.2% of the unsurvived group of patients were treated conservatively as compared to 30.8% of patients who had had operative intervention. This signifies the important role of early operative intervention in the management of severe head injury (p value 0.044).
Early mortality in patients with severe TBI is significantly shown in patients having both mass and diffuse lesion on CT scan hypoxia and low hemoglobin. Surgical intervention was significantly associated with less mortality.
It can be concluded from this study that strict enforcement of traffic rules can help us to save life by reducing the incidence of severe head injury. Hypoxia should be avoided on an absolute basis. Anemia should be corrected. Urgent CT scan of the head should be done to look for operable mass lesions as early detection and evacuation of the mass lesions saves life.