PREDICTORS OF MORTALITY IN PATIENTS WITH SEVERE HEAD INJURY PRESENTING TO NEUROSURGICAL UNIT

ABSTRACT
Background: Trauma is the most common cause of morbidity and mortality in people younger than 45 years and head
injury is mostly highly weighted predictor of outcome in trauma population, timely intervention that can improve the
outcome from severe head injury and has the potential of improving the lives of many accident victims.
Objective: A study regarding factors influencing mortality of severehead injury patients was conducted in a tertiary
care hospital of Peshawar (Pakistan).
Methods:Severe head injury patients(n 395) were taken prospectively by simple random sampling method for a period
of one year from January to December2011 for this study. The basic predictors in this study included age, sex, rural/
urban, mechanism of injury, with injury to other organs, Glasgow Coma Scale, pupil size and reactivity, radiological
findings, treatment given in hospital and referral to other hospitals.
Results: Majority of patients belonged to age group ofup to 10 years (27.5%) and maximum deaths (30) were seen in
age group 31 to 40 years. Maximum number of patients were males 264 (75.9%) and 281 (71.1%) Traumatic brain Injury
patients were from rural areas. All the patients were having GCS 4±2 (3-8) and 180 (45.56%) patients were having equal
size and bilaterally reactive pupils at the time of presentation. The most common cause of severe head injury was Road
Traffic Accident (154 patients) followed by History of all (128patients).The most common radiological features were
Extradural hematoma (21%), followed by Depress skull fracture (20%) and brain contusion (17%). Most of the patients
(65.06%) were treated conservatively. One hundred and thirty sex patients (34.43%) expired during course of treatment.
Conclusion:Head injury is one of the major problems in Khyberpakhthunkhwa. Lady Reading Hospital is the biggest
tertiary care hospital for management of severe head injury patients. In spite of inadequate first aid facility at the site
of injury, delays in transportation, lake of awareness, poor referral system, and many lives are saved and morbidity
minimized after providing prompt and quality treatment at this premier medical centre.
Key words: Predictors, Mortality, Severe head injury, Glasgow Coma Scale (GCS), Traumatic Brain Injury (TBI)