ArticleLiterature Review

Epidemiology of traumatic brain injuries: Indian scenario

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Abstract

Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, disability and socioeconomic losses in India and other developing countries. Specific topics addressed in this paper include magnitude of the problem, causes, context of injury occurrence, risk factors, severity, outcome and impact of TBIs on rapidly transforming societies. It is estimated that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%-25%) and violence (10%). Alcohol involvement is known to be present among 15%-20% of TBIs at the time of injury. The rehabilitation needs of brain injured persons are significantly high and increasing from year to year. India and other developing countries face the major challenges of prevention, pre-hospital care and rehabilitation in their rapidly changing environments to reduce the burden of TBIs.

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... Maximumnumber of the patients in our study were students. The studies conducted by TobiKU et al, [10]Chelly H et al, [11]Wabule A et al, [12]Gao G et al [13] and Para RA et al [9]too had young male dominance of TBI patients which is in synchronicity with ourstudy. TBI is more common in young males, one of the reason being that themobility of male population is higher than their female counterpart and they areexposed to more accidental risk factors at various places. ...
... Among polytrauma patients, chest injuries werethe most common associated injuries. The results are similar to study conducted byKamal VK et al. [8]In their study, TBI was associated with polytrauma in 24.30%patients, whereas study conducted by Chelly H et al [11] have found TBI associatedwith polytrauma in 65% of patients admitted in ICU. The increased incidence ofpolytrauma associated with TBI was attributed to severity of trauma due to roadtraffic accidents. ...
... These investigations not only increase the burden on hospital resources,but also increases the cost of treatment in TBI patients.Among all the patients of TBI admitted in SICU, 49.4% underwent variousneurosurgical interventions. Study conducted by KokkinouM et al [1] hadneurosurgical intervention in 76.65 % of patients, 33% of patients neededneurosurgical intervention in study conducted by Chelly H et al [11] while as in astudy conducted by Para RA et al [9] neurosurgical intervention was done in 30 %of patients. ...
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Background: Traumatic brain injury (TBI) is a leading cause of mortality, morbidity, disability, and socioeconomic losses in the Indian subcontinent. For policy making, there is a lack of reliable and larger data regarding traumatic brain injuries in our setting. Aim: In our study an attempt was made to analyze and assess the clinical characteristics of patients with traumatic brain injuries admitted in Surgical Intensive Care Unit of SMHS hospital Srinagar. Materials and Methods: In this observational study, 89 patients of TBI admitted in SICU during study period were enrolled, after obtaining ethical clearance from institutional ethical clearancecommittee. All the study patients were followed up in SICU on daily basis. All thedata required for study was recorded from the patient’s clinical notes as per studyprotocol. Outcome of patients was assessed in terms of survival at discharge from SICU. Results: Majority of the TBI patients requiring ICU admission had Severe TBI (64%). Allthe patients required CT Brain on arrival to hospital and brain contusions (65.2%) were the most common findings on CT brain. Check CT brain was required in53.9% of patients. There was need for neurosurgical intervention in 49.4% ofpatients and 21.3% required blood transfusions.
... The average cost of treating individuals affected by TBI is estimated to be around $50 billion annually in the United States (2). In India, the incidence of TBI is 1.6 million annually based on epidemiological data (1). Additionally, death due to head injury accounts for 200,000/year, and about 1 million will Sudhakar . ...
... /fneur. . need access to rehabilitation services (1). Therefore, TBI and associated complications create a huge socioeconomic burden. ...
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Traumatic brain injuries (TBI) caused by physical impact to the brain can adversely impact the welfare and well-being of the affected individuals. One of the leading causes of mortality and dysfunction in the world, TBI is a major public health problem facing the human community. Drugs that target GABAergic neurotransmission are commonly used for sedation in clinical TBI yet their potential to cause neuroprotection is unclear. In this paper, I have performed a rigorous literature review of the neuroprotective effects of drugs that increase GABAergic currents based on the results reported in preclinical literature. The drugs covered in this review include the following: propofol, benzodiazepines, barbiturates, isoflurane, and other drugs that are agonists of GABAA receptors. A careful review of numerous preclinical studies reveals that these drugs fail to produce any neuroprotection after a primary impact to the brain. In numerous circumstances, they could be detrimental to neuroprotection by increasing the size of the contusional brain tissue and by severely interfering with behavioral and functional recovery. Therefore, anesthetic agents that work by enhancing the effect of neurotransmitter GABA should be administered with caution of TBI patients until a clear and concrete picture of their neuroprotective efficacy emerges in the clinical literature.
... Alcohol abuse has been known to be associated with increased morbidity and mortality among patients of TBI due to a blunting of sympathetic response. [11,14] Around 28.36% of our patients had a history of alcohol consumption before the traumatic event. However, no significant association between the consumption of alcohol and neurological deterioration was seen in our study. ...
... The effect of alcohol on trauma outcome has been studied with mixed results. [14][15][16] The mechanisms whereby alcohol intoxication reduces the mortality of head injury are still unknown. The diuretic effect of alcohol might reduce the intracranial pressure after trauma. ...
Article
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Objectives In most of the emergency trauma intensive care units (ICUs) of India, neurosurgical opinion is sought for patients presenting with head trauma after earliest possible resuscitation to determine the further line of management. This study aimed to identify common risk factors, leading to neurological deterioration in conservatively managed patients of traumatic brain injury (TBI). Materials and Methods This retrospective study analyzed patients admitted with acute TBI and traumatic intracranial hematoma under emergency trauma care ICU who did not require neurosurgical operation within 48 h of trauma. The recorded data were analyzed to determine the predictors of neurological deterioration using univariate and binary logistic regression analysis in SPSS-16 software. Results Medical records of consecutive 275 patients of acute TBI presenting to the emergency department were studied. One hundred and ninety-three patients were afflicted with mild TBI (70.18%), 49 patients had moderate TBI (17.81%), and 33 had severe TBI (12%). In the outcome, 74.54% of patients were discharged, and operative decision was made on 6.18% of patients and 19.27% died. Severe TBI is the independent predictor of neurological deterioration during their stay in ICU. Progressive hemorrhagic injury (PHI) showed neurological deterioration in 86.5% of patients. Systemic inflammatory response syndrome (SIRS) was present in 93.5% of patients who had deteriorated neurologically. Dyselectrolytemia was the biochemical derangements seen in 24.36% of cases. Conclusion This study revealed severe TBI, PHI, and SIRS to be strong and independent risk factors of neurological deterioration.
... It was discovered that 16 percent of brain injury patients aged 15 and above were intoxicated at the time of injury. The alcohol group had a fatality rate of 14.5 percent compared to 9 percent in the non-alcoholic group [92]. Individuals with an older ABI have a higher chance of poorer physical, intellectual, and psychosocial outcomes, as well as a lengthier recovery period and more comorbidities. ...
... According to several studies, those who take anti-arrhythmic medications are more prone to suffer from brain damage. Several studies show that men had a higher chance of serious brain injuries during a fall than women, despite the possibility of a reverse relationship with nonfatal brain injuries [92,93]. ...
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Any type of brain injury that transpires post-birth is referred to as Acquired Brain Injury (ABI). In general, ABI does not result from congenital disorders, degenerative diseases, or by brain trauma at birth. Although the human brain is protected from the external world by layers of tissues and bone, floating in nutrient-rich cerebrospinal fluid (CSF); it remains susceptible to harm and impairment. Brain damage resulting from ABI leads to changes in the normal neuronal tissue activity and/or structure in one or multiple areas of the brain, which can often affect normal brain functions. Impairment sustained from an ABI can last anywhere from days to a lifetime depending on the severity of the injury; however, many patients face trouble integrating themselves back into the community due to possible psychological and physiological outcomes. In this review, we discuss ABI pathologies, their types, and cellular mechanisms and summarize the therapeutic approaches for a better understanding of the subject and to create awareness among the public.
... It is the leading cause of death and disability among trauma patients. It is estimated that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India [1]. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%e 25%) and violence (10%) [1]. ...
... It is estimated that nearly 1.5 to 2 million persons are injured and 1 million succumb to death every year in India [1]. Road traffic injuries are the leading cause (60%) of TBIs followed by falls (20%e 25%) and violence (10%) [1]. ...
Article
Background Traumatic brain injury is the leading cause of death and disability among trauma patients.They are often in need of mechanical ventilation and intensive care. Due to the lower immunity secondary to trauma, they acquire nosocomial infections quickly. Of them, ventilator-associated pneumonia (VAP) is very common. The microaspiration of the oral secretions containing the pathologic flora results in VAP. So, oral hygiene is of paramount importance. Various mouthwashes and rinses are available and are commonly used. We planned to compare the effectiveness of alkalization of oral cavity with 0.9% sodium bicarbonate on the incidence of VAP. Methods After obtaining ethical committee clearance (IRB/Dean/2019/EC/1783) and written informed consent of the patient's attendants, one hundred eleven patients were randomized into two groups. Group CCC received 2% chlorhexidine mouth wash thrice daily whereas group CCS received 0.9% sodium bicarbonate oral rinse once with 2% chlorhexidine mouth wash twice daily. Our primary outcome was the incidence of VAP using the Clinical Pulmonary Infection Score (CPIS) from day one to day five. Comparison of Quantitative bacterial load and oral pH on day 1, day 3 and day 5 was our secondary outcome. Results There was no statistical difference in the incidence of VAP among both groups from day one to day five (p > 0.05). We didn't find any difference in quantitative bacterial load among both groups on days one, three and five (p > 0.05). There was a statistical difference among both groups on oral pH on day three and day five with group CCS having higher oral pH than group CCC. (p = 0.03 on day 3 and 0.01 on day 5). Conclusion The alkalization of oral cavity with 0.9% sodium bicarbonate oral rinse along with 2% chlorhexidine mouth wash lowered the incidence of VAP as compared to 2% chlorhexidine mouth wash alone but the difference was not statistically significant.
... An epidemiology study in 2002 reports; nearly 1.5 million to 2 million people are injured and 1 million succumb to death every year in India [1]. By affecting physical, psychological, cognitive, emotional and social aspects adversely, traumatic brain injury is also a major cause of disability and socioeconomic losses in India. ...
... Our study noted that around 3.13%, 16.16%, 56.04%, and 24.65% of patients reached the hospital in less than 1 hour, 1-4 hour, 4-12 hour, and more than 12 hours respectively. In a comparative study by Gururaj,13 only 25% reached hospital within 3 hours and 20% reached after 24 hours. The time interval between the time to arrive at the injury site and the hospital is one of the deciding factors between life and death. ...
Article
Introduction. Traumatic brain injury (TBI) is a major public health problem throughout the world. It is one of the leading causes of mortality and disability as a consequence results in a great financial burden on societies. Damage to the brain following trauma does not occur only at the moment of injury but also develops over a period of hours to days with the further secondary insult of the brain. Methods. This was a prospective study done between April 2017 to March 2019. A total of 2134 patients were enrolled for this study with a collection of data in a formatted proforma. All the patients of trauma with clinical or radiological evidence of head injury coming to the trauma centre were included. Results. In our study patient, mortality was 6.79% in patients receiving pre-hospital care compared to 12.03% in patients not receiving adequate pre-hospital care. 29.42% were in the age group of 21–30 years. RTA (overall 64.45%) was the most common mode of injury in the age group 21–30 years with 81.36% cases. Mortality in first emergency care provider by ambulance paramedics was 5.69% and member of the public was 10.10%. Conclusion. It was observed that mortality was higher in patients not receiving adequate pre-hospital care. Early resuscitation facilities at the site of the accident have to be introduced and improved with the execution of rapid transportation to trauma care centres.
... Traumatic Brain Injury (TBI) is the major cause of mortality and morbidity in adult population and is responsible for more than 50% of all traumatic deaths. 1 Road traffic injuries are the leading cause of TBIs (60%) and alcohol involvement is known to be present among 15%-20% of TBIs at the time of injury. 2 The Glasgow Coma Scale was first published in the year 1974 by Graham Teasdale and Bryan Jennett. It is a assess the severity of head injury and record the conscious state of a person for initial as well as subsequent assessment. ...
Article
Introduction: Head injury or traumatic brain injury is defined as non-degenerative, non-congenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions. It is a leading cause of morbidity, mortality, disability, and socio-economic losses in India and other developing countries. Young males are affected more than females and road traffic accident is the commonest cause of head injury. Materials and Methods: We studied patients who presented with head injury to a tertiary health care centre from ages 18 years to 60 years. Clinical profile was studied which included clinical examination and CT scan of brain. Severity of head injury was evaluated on admission by Glasgow Coma Scale (GCS) and functional outcome was assessed by Glasgow Outcome Scale (GOS) at 10th day, 1 month and 3 months after injury. Results: Study was conducted with 200 patients. Most of the patients with head injury were males (79.5%) and peak incidence was in the age group 31–40 years. The commonest cause of head injury was road traffic accidents (72.5%). Most common presentation was loss of consciousness (49%). On admission, GCS score was found to be mild, moderate, and severe in 77%, 9%, and 14.5% patients. Severe GCS score was mostly associated with subdural hematoma in 21.5% patients and also contributes to 82.5% mortality. Fractures (43%) were the commonest CT finding. 12.5% were treated with surgery. Overall mortality was 12.2%. GOS was calculated on 10th day, at the end of 1 month and at the end of 3 months. At the end of 3 months, 87% patients showed complete recovery, 0.5% patients showed moderate disability, 0.5% showed severe disability, 0% showed vegetative state and 12.2% was the mortality. There was considerable improvement in GOS scores with respect to disability and recovery from 10th day to follow-up at 3 months post trauma. Conclusion: GCS score on admission and the type of CT lesion are both important factors in determining the outcome, and both must be considered when describing severely head injured patients. GOS is a good modality to predict functional outcome of these patients and assess their recovery and disability.
... 3 Traffic-related accidents account for between 45 and 60% of brain injuries in India, followed by falls (20-30%) with violence accounting for another 10 to 20%, depending on the research. 4 Because of the risk of cerebral edema and intracranial hypertension (IH) that TBI patients face, treating them is a huge problem. A mass effect from cerebral hematomas, concussions, diffuse brain edema, or hydrocephalus can raise intracranial pressure (ICP) following TBI. ...
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Introduction Computed tomography perfusion (CTP) brain usefulness in the treatment of traumatic brain injury (TBI) is still being investigated. Comparative research of CTP in the various forms of decompressive surgery has not yet been reported to our knowledge. Patients with TBI who underwent decompressive surgery were studied using pre- and postoperative CTP. CTP findings were compared with patient's outcome. Materials and Methods This was a single-center, prospective cohort study. A prospective analysis of patients who were investigated with CTP from admission between 2019 and 2021 was undertaken. The patients in whom decompressive surgery was required for TBI, were included in our study after applying inclusion and exclusion criteria. CTP imaging was performed preoperatively and 5 days after decompressive surgery to measure cerebral perfusion. Numbers of cases included in the study were 75. Statistical analysis was done. Results In our study, cerebral perfusion were improved postoperatively in the all types of decompressive surgery (p-value < 0.05). But association between type of surgery with improvement in cerebral perfusion, Glasgow Coma Scale at discharge, and Glasgow Outcome Scale-extended at 3 months were found to be statistically insignificant (p-value > 0.05). Conclusion CTP brain may play a role as a prognostic tool in TBI patients undergoing decompressive surgery.
... Road traffic injuries are the leading cause (60.0%) of traumatic brain injury followed by falls (20.0% to 25.0%) and violence (10.0%). Almost half of the deaths in 10 to 25 years age group are due to injuries and traumatic brain injuryis the most common injury leading to death 10 . About 1.35 million people globally die every year in road traffic accidents (RTA), and more than one-fourth of these fatalities are estimated to happen in South Asia. ...
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Traumatic brain injury is a significant public health problem. Objective: This study was aimed to clinical characteristics of traumatic brain injury patients by collection of detailed data on demography, clinical, injury patterns, co-morbidities, laboratory findings, and outcome of mild and moderate TBI. Methodology: This cross-sectional study was conducted from September 2019 to June 2020. Patients attending Department of Trauma Neurosurgery of National Institute of Neurosciences & Hospital, Dhaka, Bangladesh and Department of Neurosurgery of Dhaka Medical College Hospital, Dhaka, Bangladesh with a history of having mild or moderate traumatic brain injury and patients of 18 years and above irrespective of their sex were included in the study after informed written consent. The study included socio-demographic information and history of injury, mechanism of injury, information of physical examination, clinical features including cognitive change and co-morbidities were recorded. Results: A total number of 210 patients were included in this study. Motor vehicle related accident was 56.2% cases. About 21.4% cases of them were assaulted (physically), 12.9% cases of them were fall from the height. About 58.0% patients were normal cognition; 22.0% cases were mild cognitive impairment; 17.6% cases were moderate cognitive impairment and only 2.0% cases were severe cognitive impairment during discharge. Glasgow Coma Scale (GCS) during admission after resuscitation around 78.0% cases were moderate head injury and 22.0% cases were mild head injury. About 47.14% patients had single or multiple cerebral hemorrhagic contusion; 13.8% patients had traumatic subarachnoid hemorrhage; 8.6% cases had thin layer of subdural hematoma; 6.2% cases had epidural hematoma; Conclusion: Traumatic brain injury patients have mostly due to road traffic accidents and are presented with cerebral hemorrhagic contusion, subarachnoid hemorrhage and subdural hematoma Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):105-111
... Glasgow Coma Scale (GCS) ranks the severity of brain injury from mild to severe. While road accidents develop moderate-to-severe brain injury, mild-TBI and concussion type of injury have been reported in military persons and athletes (Gururaj, 2002). The long-term neurological sequelae of post-traumatic concussions are anxiety, mood disorders, post-traumatic stress disorder (PTSD), and Alzheimer and Parkinson disease (Ladak et al., 2019). ...
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Repeated mild traumatic brain injury (rmTBI) poses adversity in the form of neurological deficits. The ignition of long-term neurological aberrations post-TBI is appended with the microbiota gut–brain axis perturbation. Herein, we examined whether quercetin, which is anti-inflammatory and antioxidant flavonoid, serves as a prebiotic and modifies the compromised microbiome gut–brain axis in rmTBI mouse model. Male C57BL/6 mice were subjected to rmTBI for 7 times. The quercetin (50 mg/kg) was administered peroral from the day1 of first injury till 7 days post-injury. The neurobehavioral assessments were performed using return of righting reflex (ROR), rotarod, forced swimming test (FST), elevated zero maze (EZM), novel object recognition test (NORT), and Y-maze. Mice fecal samples, brains, and intestines were collected for molecular studies. Mice underwent rmTBI showed significant neurological deficits in ROR and rotarod test and also exhibited long-term neuropsychiatric aberrations like anxiety- and depression-like phenotypes, and cognitive deficits in EZM, FST, and Y-maze assays, respectively. Repeated peroral administration of quercetin ameliorated these neuropsychiatric problems. Quercetin treatment also restored the increased expression of GFAP and decreased expression of occludin and doublecortin in the frontal cortex and hippocampus of rmTBI mice. The altered levels of acetate and propionate, and microbial phylum abundance in fecal samples were also normalized in the quercetin-treated group. We also noted an improved intestinal permeability indicated by reduced villi rupture, blunting, and mucosal thinning in quercetin-treated mice. We suggest that the neuroprotective effect of quercetin may be mediated via remodeling of the microbiome gut–brain axis in rmTBI mouse model.
... TBIs are most commonly caused by road traffic accidents followed by falls and violence. 6 About 17% of patients who survive a TBI, experience a period of total unconsciousness or, coma in which they are completely unaware of themselves or their surroundings. 7 cerebrovascular accidents are the second largest cause of death globally, with around 5.5 million deaths each year. ...
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Background & Objective: Traumatic brain injury and cerebrovascular accidents can result in altered levels of consciousness. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on the level of consciousness in these patients. Methods: A total of 100 patients admitted to the neurological ICU of the hospital were screened and 40 subjects after satisfying inclusion criteria were recruited within the first one to two weeks of injury. They were randomly divided into two groups after written consent from a caretaker, Group A (experimental) (n=20) and Group B (control) (n=20) by computerized randomization. Group A received Anodal tDCS to the motor area (C3/C4 ipsilesional), sensory area (P3/P4 ipsilesional) and left dorsolateral prefrontal cortex (F3) according to the 10/20 EEG montage for two sessions of 20min/day for 7 consecutive days and routine physiotherapy. Group B only received routine physiotherapy similar to Group A. Glasgow coma scale (GCS) and Rancho Los Amigos scale (RLAS) was taken pre and post- intervention to assess the level of consciousness. Results: The pretest and post- test GCS and RLAS scores in groups A and B showed statistical significance at p<0.01. The differences of mean GCS and RLAS between pretest and posttest in group A showed better improvement than that of group B. The results were statistically significant at p<0.01. The effect size was large, calculated by Cohen’s d. Conclusion: The tDCS can be effective in improving GCS and RLAS in altered consciousness patients in the acute period after injury. It is non-invasive, cost-effective with minimal contraindications, and doesnot interfere with other modalities in the intensive care unit.
... Traumatic Brain Injury (TBI) is an extremely incident condition worldwide (1), accounting for a major reason for morbidity, mortality, disability, and reduced quality of life (2)(3)(4). The most recent data from the Center for Disease Control (CDC) reports more than 610 TBI-related hospitalizations and 166 TBI-related deaths per day in the United States (US) (5). ...
Article
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Background Traumatic Brain Injury (TBI) is one of the leading causes of injury related mortality in the world, with severe cases reaching mortality rates of 30-40%. It is highly heterogeneous both in causes and consequences, complicating medical interpretation and prognosis. Gathering clinical, demographic, and laboratory data to perform a prognosis requires time and skill in several clinical specialties. Machine learning (ML) methods can take advantage of the data and guide physicians toward a better prognosis and, consequently, better healthcare. The objective of this study was to develop and test a wide range of machine learning models and evaluate their capability of predicting mortality of TBI, at hospital discharge, while assessing the similarity between the predictive value of the data and clinical significance. Methods The used dataset is the Hackathon Pediatric Traumatic Brain Injury (HPTBI) dataset, composed of electronic health records containing clinical annotations and demographic data of 300 patients. Four different classification models were tested, either with or without feature selection. For each combination of the classification model and feature selection method, the area under the receiver operator curve (ROC-AUC), balanced accuracy, precision, and recall were calculated. Results Methods based on decision trees perform better when using all features (Random Forest, AUC = 0.86 and XGBoost, AUC = 0.91) but other models require prior feature selection to obtain the best results (k-Nearest Neighbors, AUC = 0.90 and Artificial Neural Networks, AUC = 0.84). Additionally, Random Forest and XGBoost allow assessing the feature's importance, which could give insights for future strategies on the clinical routine. Conclusion Predictive capability depends greatly on the combination of model and feature selection methods used but, overall, ML models showed a very good performance in mortality prediction for TBI. The feature importance results indicate that predictive value is not directly related to clinical significance.
... It is difficult to analyze and treat such fractures for a medical specialist. The sphenoid sinus, foramen magnum, worldly bone, and sphenoid wings are the most widely recognized site of these cracks [2][3][4][5][6]. Every day many persons suffer from head injuries worldwide due to reasons like fall or trip, accident, sport, etc. ...
Article
Bio-Medical modeling system used to assist medical study, diagnosis, analysis, monitoring, and investing in the medical domain. The medical scanning tools scan, collect, and assemble the fragmented skull-specific geometric data before the medical analysis by various experts for investigations. The skull assembly may undergo severe damage, significantly affecting the medical analysis process. Therefore, need to have an efficient and robust automatic skull prototyping technique. This article proposes the novel Automatic Skull Prototyping (ASP) framework using deep learning and computer vision technique. The ASP framework consists of two main phases: Skull Damage Detection (SDD) and Skull Damage Repairing (SDR). For SDD, we propose the integrated deep learning model using Convolutional Neural Network (CNN) and Long Short-Term Memory (LSTM). The SDR model performs the template loading and template matching process to discover the damaged regions and repair them by fusing the missing geometric data of the skull template into the original damaged skull. Experimental results demonstrate the improved efficacy and robustness of the proposed framework. The SDR outcomes show the effective repairing of skull models but scalability limitations. The real-time skull model dataset preparation and analysis will be interesting for future research. The ASP framework benefited the forensic, archaeological, anthropological, biomedical applications for processing, analysis, investigation, and diagnosis.
... 14 The majority (60%) cases are due to road traffic injuries (RTI), followed by falls (20-25%) and violence (10%). 15 The majority of the patient 60.61% out of 71.22% with TBI in our series underwent CP due to RTA, followed by MCA infraction (18.18%), fall injury (9.09%), aneurysm surgery (4.55%), meningioma surgery (3.03%), AVM surgery (1.52%), glioma surgery (1.52%) and physical assault (1.52%). ...
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Objective: Ex-vivo preservation of autologous bone flap for Cranioplasty involves various techniques but there are no fixed guidelines as preservation time, temperature, technique differs. It was preserved submerging in the mixture of 10% betadine and 90 % ethyl alcohol solution in an airtight container in refrigerator at constant temperature of 0 ‫ﹾ‬ C and was autoclaved 1 hour before reimplantation. The Primary objective of the study is to analyze surgical site infection, secondary its association with dependent variables age, sex, mode of injury, number of procedure performed. Materials and methods: This is a retrospective study conducted in Nepal Mediciti hospital from September 2017 to November 2019.Data of all patients who underwent Cranioplasty was reviewed from medical record, U/L autologous bone Cranioplasty preserved with this technique were only included in the study. The primary outcome SSI was classified according to guidelines of the centers of disease control and established with organism isolated in the culture. Results: Only 66 out of 78 Cranioplasty was included in this study.The majority was male 83.3%.The mean age was 37.16(standard deviation [SD]±14.58).The SSI was 7.5% and was associated with number of procedures performed (p=0.02).RTA was major cause of Cranioplasty in 60.61%. Conclusion: Ex-vivo preservation of autologous bone flap for Cranioplasty with this technique is safe to be applied in resource limited settings as it can produce similar results as other techniques.
... Road traffic accidents are the primary cause of head injuries (60 percent), followed by falls (20-25 percent) and violence (10 percent) (1,2,3). Alcohol is reported to be present in 15-20% of individuals who have suffered a head injury (4). ...
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Introduction: TBI is one of the primary causes of disability, illness, and death in people of all ages all over the world. In addition to clinical evaluation by the Glasgow Coma Score (GCS), cerebral abnormalities in these individuals can be found early by computed tomography (CT), which is still the primary study of choice in the majority of TBI cases. Aims and Objectives: The purpose of this study was to see if the Glasgow coma scale and CT findings in individuals with head trauma correlated. Material and Methods: After receiving ethical committee clearance, prospective research was undertaken for a period of one year in a tertiary care hospital in North India. The Glasgow coma score was applied to 77 TBI cases, and computed tomography was conducted on all of them, with the results recorded. IBM Corp.'s SPSS statistics for Windows, was used to analyse the data. Results: Head trauma was most prevalent in people aged 26 to 35. (27.2 percent). The average age was 40.97 14.09 years, with a standard deviation of 14.09 years. Males made up the majority of the patients (83.1 percent). Road traffic accidents were the most prevalent cause of head injuries (84.4 percent). Half of the patients evaluated (50.6 percent) had severe head damage, followed by moderate (33.7 percent) and mild (15.5 percent) brain injury, according to GCS score. Intracranial haemorrhages were observed in 55 (71.42 percent) CT images, making them the most prevalent single or multiple lesions finding. In 45 (61%) of the patients, skull fractures were discovered. Midline shift was seen in 25 instances, with 18 individuals with serious head injuries having a midline displacement of less than 5mm. Patients with a low GCS had more CT results than those with a high GCS. The mean GCS score of individuals with a single lesion (11.3 1.99) differed significantly from the mean GCS of patients with multiple lesions (8.92 2.45). Conclusions: The degree of head damages as measured by the Glasgow coma scale and CT findings in individuals with head trauma were shown to be positively correlated in our study.
... This is more concerning as the mean age of trauma victims usually falls in the highly productive middle age group. [5,7] This not only leaves long-lasting scars on the entire family of the victims but also cripples the economy of the nation. It is therefore important to understand the common modes of injury resulting in head and neck trauma and factors associated with the severity of head injury. ...
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Background: Head and neck trauma is an increasing cause of morbidity and mortality in India. The mode of trauma has varies with geographical progress and it is important to understand the factors associated with severe head injury among this cohort. Methods: This was a retrospective observational study of all adult trauma patients with head and neck trauma presenting to our emergency department (ED). Details of the incident, injuries and outcome were analyzed. Results: During the 3-month study, the ED attended to 16,169 patients with 2022 being trauma victims. Among them, 51.4 3% (n = 835) adults who sustained head, face or neck trauma and hence were included in the final analysis. Overall, RTA s were the predominant mode of injury (81.2% (n = 678), followed by fall on level ground (6.5%; n = 54), fall from height (5.1%; n = 43) and assault (3.7%; n = 31). A history of consuming alcohol prior to the incident was obtained in 16.2% (135) of the patients. Head, face, and neck injuries were seen in 74.9% (n = 626), 64.1% (n = 536), and 4.9% (n = 41) of patients respectively. Bivariate analysis showed male sex (90.3% vs. 76.8%; unadjusted odds ratio [OR]: 2.81, 95% confidence intervals [CI]: 1.19–6.64; P = 0.018) and pedestrian injuries (19.4% vs. 8.5%; unadjusted OR: 2.57, 95% CI: 1.30–5.07; P = 0.006) to have a statistically significant association with sustaining severe head injury. Conclusion: Head and neck trauma comprises a significant proportion of patients with trauma with RTA and falls being the most common causes. Among patients with head and neck trauma, males and pedestrians have an increased odds of sustaining severe head injury (Glasgow Coma Scale ≤8).
... 3 The majority (60%) cases are due to road traffic injuries (RTI), followed by falls (20-25%) and violence (10%). [3,4] It affects all ages; however, majority of road traffic injuries (RTI) occurs in young adults of produc ve age group. Approximately 8% of persons aged 65 and older visit the emergency department each year because of a fall-related injury. ...
Article
Background: Head injury is considered as a major health problem in developed and developing nations. Analysis of etiology, patterns, and outcome of head injury in trauma patient is essential for understanding and planning for better management. Materials and Methods: The prospective observational study carried out among patients who presented with head injury at the tertiary care hospital, Mumbai from July 2015 to July 2017. Demographic details recorded were age, sex, blood pressure on arrival, Glasgow Coma Scale (GCS) score, the interval between injury and admission, associated injury, co-morbidities, hospital stay, and outcome. Results: The age group at which maximum patients of head injury were admitted was 18-29 years (31%) followed by 40-49 years (21%). Eighty one percent patients were males and 19% patients were females, the male to female ratio being 4:1. Road traffic accidents (36% cases) were the commonest cause leading to acute head injury followed by accidental fall (21% cases). 47% patients presented with mild head injury according to GCS. Conclusion: Head injuries mainly caused by vehicular accidents and affect mainly the young men. Road traffic accidents were the commonest mode of head injury, but railway accident had the worst outcome in our study. Factors associated with outcome were Pre-hospital delay, GCS on arrival, Blood pressure on arrival, Associated injury, Need for ventilator support, CT scan findings.
... In India, approximately 9.7 million TBI cases were recorded, out of which 16% of individuals suffer from sustaining severe TBI. Every year in India around 1.6 million individuals suffered from a sustain brain injury with 200,000 deaths and approximately one million people needed recovery treatment at any stage of time (Gururaj 2002). TBI affecting a wide range of people in all age group and its effect is largely unknown to the common population so it is considered as a silent epidemic. ...
Article
Full-text available
Traumatic brain injury (TBI) is a neurological disorder which represents a major health issue worldwide. It causes mortality and disability among all group ages, caused by external force, sports-related events or violence and road traffic accidents. In the USA, approximately one-third people die annually due to injury and 1.7 million people suffer from traumatic brain injury. Every year in India around 1.6 million individuals suffer from sustain brain injury with 200,000 deaths and approximately one million person needed recovery treatment at any stage of time. Sports-related head impact and trauma has become an extremely controversial public health and medico-legal problem that accounts for 20% of all brain injury (including concussion). It is difficult to reverse the primary injury but the secondary injury can be minimized by using proper pharmacological intervention during the initial hours of injury. This article highlights the pathophysiology and types of TBI along with treatment therapies. Till date, there is no single medication that can decrease the progression of the disease so that symptomatic treatment is given to the patient by determining proper pathology. Recently various herbal medicine therapies and traditional supplements have been developed for TBI. Nutritional supplementation and nutraceuticals have exposed potential in the treatment of TBI when used before and after TBI. The compiled data will enable the readers to know the pathophysiology as well as the allopathic and natural remedies to treat the TBI.
Article
Traumatic brain injury (TBI) is a significant healthcare concern in several countries, accounting for a major burden of morbidity, mortality, disability, and socioeconomic losses. Although conventional prognostic models for patients with TBI have been validated, their performance has been limited. Therefore, we aimed to construct machine learning (ML) models to predict the clinical outcomes in adult patients with isolated TBI in Asian countries. The Pan-Asian Trauma Outcome Study registry was used in this study, and the data were prospectively collected from January 1, 2015, to December 31, 2020. Among a total of 6,540 patients (≥15 years) with isolated moderate and severe TBI, 3,276 (50.1%) patients were included for model evaluation, and 3,264 (49.9%) patients were included for model training and validation. Logistic regression was considered as a baseline, and ML models were constructed and evaluated using the area under the precision-recall curve (AUPRC) as the primary outcome metric, area under the receiver operating characteristic curve (AUROC), and precision at fixed levels of recall. The contribution of the variables to the model prediction was measured using the SHapley Additive ExPlanations method. The ML models outperformed logistic regression in predicting the in-hospital mortality. Among the tested models, the gradient-boosted decision tree showed the best performance (AUPRC, 0.746 [0.700-0.789]; AUROC, 0.940 [0.929-0.952]). The most powerful contributors to model prediction were the Glasgow Coma Scale, O2 saturation, transfusion, systolic and diastolic blood pressure, body temperature, and age. Our study suggests that ML techniques might perform better than conventional multivariate models in predicting the outcomes among adult patients with isolated moderate and severe TBI.
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Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
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Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
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Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
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Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Chapter
Traumatic Brain and Spinal Cord Injury comprehensively covers the medical and pathological issues related to neurotrauma and its often devastating consequences. Written by globally renowned experts in the field, both clinicians and researchers will find this book invaluable to update their knowledge. This volume is divided into two sections, one covering the brain, the other the spinal cord. Each section discusses the following topics: • The demographic in the developed and developing world where neurotrauma is witnessing a massive expansion • Major clinical issues including advanced semi-experimental monitoring techniques utilized by neurosurgeons and intensivists and the potential use of identifying markers of tissue injury • Overview of major pathophysiological changes • The development of animal models; successes and limitations • Past, current and future therapeutic strategies including rehabilitative opportunities. Presenting the most up-to-date clinical and experimental research in neurotrauma, this volume is essential reading for neurologists, neurosurgeons, intensive care physicians and rehabilitative physicians.
Article
Background Cortisol levels are elevated in severe traumatic brain injury (TBI) and gradually decrease during patient recovery. Thus, dynamic changes in cortisol levels may serve as a prognostic biomarker of TBI. Aim This study aimed to examine the relationship between serum cortisol levels and outcomes in TBI patients. Methods In this prospective case-cohort study, 238 patients with TBI were enrolled. Demographic, clinical, and radiological data were recorded within the first 24 h of hospitalization. Serum cortisol levels were measured using chemiluminescence assay (Immunoassay i1000). The association between cortisol levels and outcome (Glasgow Outcome Scale score) was evaluated at discharge from the hospital and after six months of follow-up. Results The mean age of the patients was 35.03 ±17.68 years and the male: female ratio was 4.3:1. At the time of admission(day-1), cortisol levels in the TBI patients were significantly higher than those on day-7 (9.81±4.20 µg/dl versus 23.41 ± 11.83 µg/dl; p<0.001). There was a significant relationship between cortisol levels and Glasgow Coma Scale (GCS) (p= 0.018). Moderate head injury (GCS;9-12) was observed in 108(45.4%) patients and 130(54.6%) patients with severe head injury (GCS;3-8) at presentation. CGS was significantly associated with the survival of patients with TBI (alive(n=143) vs. dead (n=77); p<0.001). At 6 months follow-up of patients (n=184), the findings revealed that the Glasgow Outcome Scale (GOS) and GCS score were significantly associated(p=0.018). One-way ANOVA showed a significant difference in cortisol levels on day-1, day-7 and six months of sampling (p <0.0001). Based on the GOS E score, the cortisol levels in the unfavorable and favorable groups significantly differed from those in the GOSE groups (p=0.05). Similarly, cortisol levels were significantly associated with survival in patients with TBI (p=0.04). With increasing cortisol levels, the GOSE score was poor and at >50 µg/dl, non-patients survived. Conclusions Day 1 and 7 cortisol, correlated with the outcomes at 6 months, had predictive value post-TBI.
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Introduction Road traffic injury is the 7th most common cause of mortality in low- and middle-income countries. Amongst road traffic injuries, traumatic brain injuries (TBI) are the major cause of mortality and morbidity. The multicentre randomized controlled trial CRASH published a prediction model to estimate prognosis in traumatic brain injury patients. This prediction model was derived based on data from High Income and Low and Middle-Income Countries. The external validity of this prediction model was not assessed in Low and Middle-Income Countries. To fill this gap, we aim to external validate the CRASH prediction model in TBI patients in India, a lower-middle income country. Methods We conducted a prospective observational study at the General Surgery Department of an urban tertiary care public university hospital in India. We collected data on the 14-day mortality and 6-month unfavourable outcomes in patients with traumatic brain injury (TBI). Calibration and discrimination of the CRASH models (Basic and Computed Tomography model) comparing the observed and predicted outcomes using logistic regression and area under the curve (AUC) was analysed to validate the model. Results In this study, 417 patients with the median age of 40 and age range of 18-95 years were evaluated. There was no significant difference between the calibration of the models in prediction of 14-day mortality (basic p = 0.082, CT p = 0.067) and 6-month unfavourable outcome (Basic p = 0.688, CT p = 0.204). The area under the ROC (receiver operating characteristic curve) in basic and CT models in prediction of 14-day mortality were 0.885 and 0.885 respectively. In addition, area under the ROC curve in basic and CT models in prediction of 6-month unfavourable outcome were 0.901 and 0.896, respectively. Conclusion The results of this study showed that the CRASH basic and CT model both accurately predict 14-day mortality and 6-month unfavourable outcomes of TBI patients in an urban tertiary care public university hospital in India.
Preprint
Full-text available
Introduction Road traffic injury is the 7th most common cause of mortality in low- and middle-income countries. Amongst road traffic injuries, traumatic brain injuries (TBI) are the major cause of mortality and morbidity. The multicentre randomized controlled trial CRASH published a prediction model to estimate prognosis in traumatic brain injury patients. This prediction model was derived based on data from High Income and Low and Middle-Income Countries. The external validity of this prediction model was not assessed in Low and Middle-Income Countries. To fill this gap, we aim to external validate the CRASH prediction model in TBI patients in India, a lower-middle income country. Methods We conducted a prospective observational study at the General Surgery Department of an urban tertiary care public university hospital in India. We collected data on the 14-day mortality and 6-month unfavourable outcomes in patients with traumatic brain injury (TBI). Calibration and discrimination of the CRASH models (Basic and Computed Tomography model) comparing the observed and predicted outcomes using logistic regression and area under the curve (AUC) was analysed to validate the model. Results In this study, 417 patients with the median age of 40 and age range of 18-95 years were evaluated. There was no significant difference between the calibration of the models in prediction of 14-day mortality (basic p = 0.082, CT p = 0.067) and 6-month unfavourable outcome (Basic p = 0.688, CT p = 0.204). The area under the ROC (receiver operating characteristic curve) in basic and CT models in prediction of 14-day mortality were 0.885 and 0.885 respectively. In addition, area under the ROC curve in basic and CT models in prediction of 6-month unfavourable outcome were 0.901 and 0.896, respectively. Conclusion The results of this study showed that the CRASH basic and CT model both accurately predict 14-day mortality and 6-month unfavourable outcomes of TBI patients in an urban tertiary care public university hospital in India.
Article
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It is a prospective study of 350 fatal head injury cases brought during the study period extending from Jan’2016 to Dec’2017 admitted and treated in our tertiary health care center. The incidence of fatal head injury is growing with increasing number of high speed vehicle, more mobility of the public and urbanization. In short, it is the single most common cause of morbidity and mortality in emergency wards. Maximum cases were seen in the age range of 21-30yrs, 89 cases (25.42%). Maximum cases were seen amongst males, 281 cases, 80%. The commonest causes of fatal head injuries are Road Traffic Accident (RTA) cases. Other important causes of fatal head injuries are fall from height, assault & railway accidents. External head injuries were mainly seen on frontal and parietal regions. Amongst the scalp injuries lacerations were very common seen in 149 cases, 35.90%. Skull bone fractures were frequently seen in fatal head injury cases. Presence of skull bone fractures are associated more frequently with fatal complications. Though linear fractures are common in general we observed the comminuted fractures as the commonest type of skull fractures in fatal head injury cases, seen in 77 cases, (57.03%). Depressed fractures were less common in fatal cases. Involvement of cranial fssa was seen in 113 cases. Linear type of fractures both transverse and horizontal type was more common seen in 71 coases amongst the 113 cases of cranial fossa involvement i.e. 62.83%. Involvement of middle cranial fossa was high seen in 47 cases of the 113 cases i.e. (41.59%). Presence of comminuted skull bone fractures is associated with higher rate of mortality.
Article
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A highly sensitive time-resolved fluorescence lateral flow immunoassay (TRF-LFIA) was developed to quantify glial fibrillary acidic protein (GFAP), a trauma brain injury (TBI) biomarker in blood, for the purpose of providing a diagnosis of mild brain injury.
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Effect of sensory stimulation in comatose patients: Evidence based review of litrature.
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The 1998 World Disasters Report, published by the International Federation of Red Cross and Red Crescent Societies, highlighted traffic accidents as a major problem. While this differs from the traditional emphasis on the effects of conflict and natural disasters, traffic crashes, collisions and fatalities do indeed kill, injure and disable large numbers of people, result in massive economic losses and often overwhelm societal responses. Traffic-related injuries, fatalities and disabilities are particularly acute in low and middle income countries (LMICs) and are set to increase as industrialisation, urbanisation and motorisation proceed. Of die world's annual 856,000 traffic fatalities, 76% were estimated to occur in LMICs. The World Disaster Report is right to highlight traffic accidents as a grave but under-resourced problem. A necessary starting point for reducing road fatalities is good documentation, information and surveillance data which can assist in raising the profile, stimulating debate and facilitating introduction and evaluation of interventions. Economic evaluation of road safety interventions is urgently required. A multi-sectoral national road safety body with political clout is likely to be an appropriate conduit for balancing competing interests and complementary efforts between the health, transport, police and private sectors. Policy analyses will help identify the best mechanisms for shifting the issue up the political and public health agenda and for mobilising the support of emergent civil society structures to place broader issues of safety and protection on the agenda where these belong.
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Road traffic-related mortality has traditionally been regarded as a problem primarily of industrialized countries. There is, however, growing evidence of a strong negative relationship between economic development and exposure-adjusted traffic-related death rates. Cross-sectional data on road traffic-related deaths in 1990 were obtained from 83 countries. The relationship between such mortality and a number of independent variables was examined at the individual country level by means of multiple regression techniques. These were also used to elucidate factors associated with variations in age, sex, and case-fatality patterns of road traffic mortality. Countries were grouped according to region and socioeconomic features, and the mortality data were summarized by these groups. The gross national product per capita was positively correlated with traffic-related mortality/100,000 population/year (P = 0.01), but negatively correlated with traffic deaths/1000 registered vehicles (P < 0.0001). Increasing population density was associated with a proportionately greater number of traffic-related deaths in the young and the elderly (P = 0.036). Increasing GNP per capita and increased proportional spending on health care were associated with decreasing case-fatality rates among traffic-accident victims (P = 0.02 and 0.017, respectively). Middle-income countries appear to have, on average, the largest road-traffic mortality burden. After adjusting for motor vehicle numbers, however, the poorest countries show the highest road traffic-related mortality rates. Many industrialized countries would appear to have introduced interventions that reduce the incidence of road traffic injury, and improve the survival of those injured. A major public health challenge is to utilize this experience to avoid the predicted increase in traffic-related mortality in less developed countries.
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Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. This review summarizes studies on the epidemiology of motor vehicle accidents in developing countries and examines the evidence for association with alcohol.
Article
This paper reports a followup study of 2190 cases of head injury. A statistical analysis of neurological defects (hemiplegia, tremor, aphasia, visual disturbances, cranial nerve involvement) is made. A description is given of post concussional syndrome, post traumatic epilepsy, otorrhoea and rhinorrhoea. Attention is paid to psychiatric complications of brain injury (neurotic and psychotic decompensations).
Article
The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p less than 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p less than 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with "moderate" head injuries.
Article
Road use patterns in Delhi, India are very different from those in cities in highly industrialized countries. In Delhi roads are also shared by unmotorized vehicles in large numbers. This study is an attempt to understand fatal crash patterns in Delhi in 1980 using police data. The results indicate that fatality patterns in Delhi are very different from those in highly industrialized countries. Pedestrians, two-wheeler riders and bus commuters comprise 80% of fatalities and motor-vehicle occupants a small minority. It appears that priorities for safety countermeasures in Delhi would have to be significantly different from those in more industrialized high-income countries. Some short-term and long-term measures are suggested in the paper.
Article
A clinical scale has been evolved for assessing the depth and duration of impaired consciousness and coma. Three aspects of behaviour are independently measured—motor responsiveness, verbal performance, and eye opening. These can be evaluated consistently by doctors and nurses and recorded on a simple chart which has proved practical both in a neurosurgical unit and in a general hospital. The scale facilitates consultations between general and special units in cases of recent brain damage, and is useful also in defining the duration of prolonged coma.
Article
India reported nearly 50,000 traffic accident deaths in 1989. Yet, literature addressing the causes, timing, and preventability of these deaths is sparse. We undertook an autopsy study of road traffic fatalities in South Delhi to determine the injury patterns and incidence of deaths that could be prevented by optimal utilization of available medical resources. Among the 177 autopsies reviewed, neurological injury caused death in 60% of patients and hemorrhagic shock in 25%. Twenty-three percent of the deaths were felt to be preventable, 41% possibly preventable, and the rest not preventable. The majority of preventable deaths resulted from a failure to diagnose or treat a treatable injury. Adherence to establish principles in the hospital management of intracavitory hemorrhage could have salvaged 70% of preventable deaths.
Article
In a perspective study of follow-up of 141 head-injured patients, neurological, behavioural, neuropsychological and psychosocial parameters of outcome were used to measure the patient's functional status for 18 months. Neurophysical sequelae including seizure disorders were seen in 29 patients. Cortical functional disturbances observed were nominal difficulties in 5 patients, perseveration in 5 patients, disturbed kinetic melodies in 9 patients, frontal acalculia in 4 patients, constructional apraxia in one patient and left side neglect in one patient. These deficits were reversed except in 13 cases. Only 32 patients (22.7%) did not suffer from any behavioural changes. The role of compensation as an aetiologic factor was found in 5 patients. Out of 94 patients in whom scores in memory test was done, 11 patients performed better than their age and education-related norms. Scores in Raven's matrices for level of intellectual performance were done in 71 patients. The score was below 25th percentile in majority (58 cases). Among 130 patients with some jobs, 56 patients (43%) were fully restored. Out of 105 married patients, 45 patients (43%) had disturbed relations after head injury. Seven patients had separation of marriage. Compared to neurological deficits, behavioural and neuropsychological impairments were more prevalent and disabling. Psychosocial outcome, particularly vocational restoration was adversely affected by behavioural changes and cognitive deficits. Need for a multidisciplinary intervention to minimise the avoidable morbidity is emphasised.
Article
To assess the mortality incidence among trauma victims, one year prospective study comprising all patients admitted in Rajendra Hospital, Patiala, Punjab with physical trauma was undertaken. Road traffic accidents were the commonest cause of trauma-death followed closely by thermal injury. Mortality was highest among victims of multiple injuries. The mortality rate increased in direct proportion to increase in transportation time and Injury Severity Score (ISS). We advocate some simple preventive and regulatory steps to lower the mortality incidence in trauma cases.
Neurotrauma Prevention. Strategies and counter-measures
  • G Gururaj
Adjustmental Problems of Head Injured Patients
  • M Natarajan
Factors contributing to mortalityfrom head injuries in India
  • G Gururaj
  • P Satishchandra
  • D Banerjee
Pattern of trauma in Western Uttar Pradesh
  • P Bharti
  • A M Nagar
  • T Umesh
Emergency medical services and road traffic crashes
  • G A Ryan
Epidemiology of road traffic injuries in Bangalore
  • G Gururaj
  • M N Reddi
  • A Amythomas
Prevention, Critical Care and Rehabilitation of Neurotrauma. Perspectives and Future Strategies, WHO Collaborating Centers for Neurotrauma
  • C Romer
  • H V Hoist
  • G Gururaj
Management of head injury: Fads, fashions and facts
  • P N Tandon
Epidemiology of Head Injuries in Bangalore. National Institute of Mental Health and Neuro Sciences, Karnataka State Council for Science and Technology
  • S M Channabasavanna
  • G Gururaj
  • B S Das
  • V G Kaliaperumal
Neuroepidemio-logy in Developing Countries: Manual for Descriptive Studies
  • M Gourie-Devi
  • G Gururaj
  • Satishchandra
Follow-up of 2190 cases of head injury
  • L R Pathak
  • R C Ruythen
  • A Mitra
Assessment of facilities at casualty and emergency care services in Bangalore hospitals
  • G Gururaj
  • V L Sateesh
Neuroepidemio-logical Survey in Urban and Rural Bangalore- Final Report
  • M Gourie-Devi
  • G Gururaj
  • Satishchandra
Need and scope of rehab ilitaticn services for traumatic brain injury survivors
  • G Gururaj