Spectrum of Head Trauma at Tertiary Care Military Hospital CMH Quetta, Pakistan

Abstract

Objective: The objective of this study was to determine the etiological spectrum, injury patterns and outcome of head injured patients at tertiary care military hospital CMH Quetta.
Materials and Methods: This descriptive study includes all patients of head trauma coming to trauma centre at CMH Quetta, Pakistan. Patients with associated injuries of other organs were excluded from the study. We noted the detailed clinical history and examination, demographics, mechanism of injury, treatment offered (operative / non operative) and analyzed the details of operative procedure (craniotomy, craniectomy, elevation of compound depressed fracture, scalp suturing), morbidity and outcome (according to Glasgow outcome scale). Data was analyzed using SPSS version 16.
Results: There were 1026 patients (856 males and 170 females) eligible to be included in the study. The mean age of the patient was 28.9 ± 19.2 years SD. Majority of the patients belonged to the age group 21 – 40 years. The commonest cause of head injury was Road traffic accident 507 (49.41%), fall 273 (26.6%), gunshot wound 97 (9.45%), bomb blast injury 76 (7.41%), sports related 35 (3.41%), mine blast 25 (2.44%) and splinter injury 13 (1.27%) of patients. CT Brain findings were contusions in 116 (11.3%), isolated fractures in 45 (4.38%), SDH in 44 (4.28%), EDH in 43 (4.19%), DAI (diffuse axonal injury) in 36 (3.51%), compound depressed fractures in 16 (1.55%), frontal sinus fractures in 14 (1.36%), combined EDH / SDH in 6 (0.58%) and normal CT brain findings in 706 (68.81%) patients. 662 (64.52%%) patients were managed conservatively and 364 (35.47%) underwent operative management. Major operations (craniotomy / craniectomy / elevation of compound depressed skull fracture) were performed in 138 (13.45%) and minor operations (suturing of scalp laceration) were performed in 226 (22.03%). Good recovery was seen in 894 (87.13%), moderate disability in 26 (2.53%) and severe disability in 12 (1.16%) whereas 16 (1.56 %) patients remained vegetative. The mortality was 78 (7.6%).
Conclusion: In Pakistan, head injury contributes significantly to mortality and morbidity. Road traffic accident, history of fall and gunshot are the commonest causes of head injury. Appropriate medical care facilities needs to be established at district and tehsil level to provide prompt and adequate care to head injured patients.