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Original Article Epidemiological characteristics affecting outcome in traumatic brain injury Amit Agrawal, Ashok Munivenkatappa1, Neeti Rustagi2, P Rama Mohan3, BV Subrahmanyan4 Departments of Neurosurgery, 3Pharmacology and 4Forensic Medicine, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, 1 National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, 2Department of Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
Abstract Background: Traumatic brain injury (TBI) is affected by multiple injury factors. Geography and vehicle prone to the accident may have an important role on the outcome. Aims: This study aims to study the details of place and mechanism of injury and their effect on discharge outcome. Settings and Design: Prospective study. Methods: This is a prospective study where 337 patients diagnosed with TBI were selected from an emergency department, after obtaining their consent. The details of place and cause of injury data was recorded on standard proforma using FileMaker Pro Advanced 13 software. Statistical Analysis: The data were analyzed using Stats Direct version 3.0.150. Results: The study reports that age, gender, and severity of the injury as per Glasgow coma scale was significant with the outcome at discharge. Higher number of patients was from rural setup (72.6%). Roadside accidents account for about 56% of injuries. About 77% of injuries were due to accidents. Two‑wheeler was cause for accidents in 54% of injuries. Mechanism of injury like motor vehicle accident, fall, blunt, and the penetrating injury was significant with discharge outcome. Conclusion: The study addresses that majority of TBI patients are from rural areas and injuries are due to accidents. Mechanism of injury has significance with discharge outcome. Key Words: Geography, outcome, rural area, traumatic brain injury, vehicle injury
INTRODUCTION Traumatic brain injury (TBI) is a major public health problem with the colossal burden on country development. In developing country like India every year there is an increase in TBIs both in urban and rural areas.[1‑5] A study from tertiary care institute has reported that the occurrence of TBI is approximately 42.5% in rural and 57.5% in urban area.[6] Considering drastic development in both these areas there is raise in transportation vehicle load.[1‑5] People travelling by different mode of the vehicle are prone to accidents due to various reasons such as inadequate safety protocols or improper road infrastructure. The location and mode Address for correspondence: Dr. Amit Agrawal, Department of Neurosurgery, Narayan Medical College Hospital, Chinthareddypalem, Nellore ‑ 524 003, Andhra Pradesh, India. E‑mail:
[email protected]
METHODS The present hospital‑based prospective study was carried out over a period of 6 months. Patients with TBI were evaluated at emergency by history and clinical examination their severity was assessed by Glasgow coma scale (GCS). All consecutive brain injury patients admitted to emergency irrespective of age, gender, education, and cause of injury were selected, but after obtaining their consent. Brain injury patients were first seen at emergency where resuscitation and severity assessment was carried out based on Advanced Trauma Life Support and GCS This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
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DOI: 10.4103/0972-4958.198435
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of injury probably play a role in the outcome.[1‑8] The literature for the same from developing countries is limited. The present pilot study aims to describe the injury characteristics with respect to location, mechanism, and vehicle with discharge outcome.
How to cite this article: Agrawal A, Munivenkatappa A, Rustagi N, Mohan PR, Subrahmanyan BV. Epidemiological characteristics affecting outcome in traumatic brain injury. J Med Soc 2017;31:28-31.
© 2017 Journal of Medical Society | Published by Wolters Kluwer - Medknow
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Agrawal, et al.: Epidemiological characteristics and outcome
respectively. Ethical approval to conduct the study was obtained by Institute Ethical Committee before commencement of the study. Information relevant to study was collected from patient directly or collateral history was obtained from relatives attending the patients. Data were collected using a standard proforma. Data collected included: patient demographic details, geography (rural or urban), reason for injury (accident, self‑inflicted, assault), mechanism of injury (road accident, fall, hit by object), vehicle details (2 or 4 wheeler or heavy vehicle), and outcome at discharge (alive or death). The data were collected by FileMaker Pro Advanced 13 (Santa Clara, California) which was used to create Computerized Patient Data Management Interface. Data collected were analyzed using StatsDirect software version 3.0.150 (StatsDirect Ltd., Sale, Cheshire, UK) Data were summarized in the form of percentages and frequencies for categorical variables. The mean and standard deviation were used to compile continuous variables. The values of P
