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Demographic profile, clinical features, imaging and outcomes in patients with traumatic brain injury presenting to emergency room

Background: Traumatic brain injury (TBI) accounts for one-quarter to one-third of all accidental deaths, and for two-thirds of trauma deaths in hospitals. Head trauma is the cause of death in more than 50% of trauma patients which made me undertake this study. Methods: A prospective observational study was conducted in a tertiary care teaching hospital, in South India during March 2016–July 2017. Demographic details, mode of injury, clinical features, radiological findings and outcomes were studied. Results: Of the 247 patients studied, majority of TBIs were in the age group of 21–40 years with male preponderance of 2.67:1. The most common mechanism of injury was road traffic accident (65.5%). In the present study, patients were classified by Glasgow Coma Scale (GCS) as mild TBI 129 (52.23%) patients, moderate 71 (28.74%) and severe 47 (19.03%). The common clinical presentation includes loss of consciousness (LOC) 65%, vomiting 61%, ear, nose and throat bleed 17% and seizures 8.9%. Computed tomography scan revealed contusions 42%, fractures 21%, subdural haematoma 21% and extradural haematoma 16%. Seventy-nine per cent patients were managed conservatively and 21% managed surgically. Mean hospital stay was 4.97 ± 5.4 days. The overall mortality was 19 (7.7%), and 209 patients were discharged in healthy condition. Conclusions: Young male adults presenting with LOC and vomiting were the common presenting features. Patients with low GCS (severe TBI) have very poor outcome. Patients with higher Rotterdam score and severe TBI had high mortality.