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CC BY 4.0 · Indian Journal of Neurotrauma 2025; 22(01): 041-050
DOI: 10.1055/s-0044-1782614
Review Article

A Glimpse into the Prognostic Factors of Outcomes for Isolated, Operated Severe Traumatic Head Injury Patients in a Resource Constrained Trauma Center Setup

Autor*innen

  • Anil Chandra

  • Bal Krishna Ojha

    1   Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India

  • Chhitij Srivastava

    1   Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India

  • Somil Jaiswal

    1   Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India

  • Aman Singh

    1   Department of Neurosurgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Abstract

Background

Severe traumatic brain injury (STBI) continues to burden health care in developing countries. This study focuses on STBI patients undergoing surgical intervention to understand the factors affecting their outcomes in a constrained trauma center setup.

Aim

This aims to study the epidemiological and clinical factors to understand the long-term morbidity, mortality risks, and triaging among STBI patients requiring surgery.

Materials and Methods

A prospective observational study was conducted on 227 isolated STBI patients with Glasgow Coma Scale (GCS) ≤ 8 who underwent surgical evacuation of intracranial lesions. Patients were classified based on their neurological status and lesions on computed tomography head. Postoperative data on complications were collected. At 6-month follow-up, patients with Glasgow (Extended) scores of 7 to 8 were deemed good outcomes, and scores of 1 to 6 were deemed poor. Cox regression analysis was used to identify independent influencing factors, with p < 0.05 as statistically significant.

Results

The clinicoradiological factors including age (p = 0.02), asymmetric pupillary reaction (p = 0.002), low presenting pulse rate (p = 0.041), and low systolic and diastolic blood pressure (p = 0.016 and p < 0.0001, respectively), low GCS (p = 0.011), midline shift > 5 mm (p < 0.0001), and obliterated basal cisterns were significantly associated with poor outcome. Tracheostomy, respiratory tract infection, bedsore, meningitis, deep vein thrombosis, cerebrospinal fluid leak, and bone flap site infection were significantly associated with survival of the patients (p = 0.036). The most common cause of mortality during home care included respiratory tract infection and was associated with the care of the tracheostomized. GCS (p < 0.0001), age (p = 0.005), and alcohol use (p = 0.034) were independent predictors for the outcome of patients.

Conclusion

This study helps clinicians predict prognosis, postoperative recovery, manage challenges, counsel caregivers, and predict long-term patient outcomes.

Keywords

severe traumatic brain injury - Glasgow Coma Scale (GCS) - midline shift - tracheostomy - respiratory tract infection and prognosis

Ethical Approval

The institutional ethical committee approved this study (Ref. code: VII-PGTSC-IIA/P7). It adhered to the principles of the Declaration of Helsinki. Before enrolment, all participants provided written informed consent. A structured form was used to gather each participant's medical, personal, and historical information.


Authors' Contributions

A.C. was responsible for conceptualization, methodology, and supervision. B.K.O. contributed to validation and formal analysis. C.S. managed resources and data curation, while S.J. provided resources and handled software. A.S. was involved in investigation, data curation, writing – review and editing, and visualization.




Publikationsverlauf

Artikel online veröffentlicht:
04. Juni 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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