Evaluation of Midline Shift and GCS as an Outcome in Severe Traumatic Brain Injury

  • SYED SHAHZAD HUSSAIN Department of Neurosurgery, Jinnah Hospital, Lahore
  • USMAN AHMAD KAMBOH Department of Neurosurgery, Jinnah Hospital, Lahore
  • MUHAMMAD ASIF RAZA Department of Neurosurgery, Jinnah Hospital, Lahore
  • SAMAN SHAHID Department of Sciences & Humanities, National University of Computer & Emerging Sciences (NUCES), Lahore
  • NAVEED ASHRAF Department of Neurosurgery, Jinnah Hospital, Lahore
Keywords: Severe Traumatic Brain Injury, Motor Response, Mortality

Abstract

Objectives: We determined the frequency of mortality in patients with traumatic brain injury and to compare frequency of midline shift and poor motor response in traumatic brain injury patients with and without mortality.
Materials & Methods: Total 108 patients with severe TBI aged between 18 to 60 years were included. Admission GCS and motor response of post-nonsurgical resuscitation were recorded, along with midline shift on initial CT-scan. All patients were followed for the mortality up to 2 weeks. Chi square test applied for the frequency comparisons of ‘midline shift’ and ‘poor motor response’.
Results: Mean age was 38.88 ± 8.94 years. Out of the 108 patients, 68 (62.96%) were males and 40 (37.04%) were females. Mean admission GCS was 3.39 ± 1.87. Mean motor response was 3.12 ± 1.68. Mean midline shift was 7.37 ± 2.09 mm. Mortality was found in 66 (61.11%) patients, whereas, there was no mortality in 42 (38.89%) patients. High mortality percentage (60%) was found in age group: 20-30 years. In male patients, high mortality percentage was found (63.24%) as compared to female patients. Comparable differences were found in the frequencies of ‘midline shifts’ and ‘poor motor response’ in patients with mortality.
Conclusion: The frequency of mortality in patients with severe TBI was found high. The ‘motor scores’ and ‘midline shifts’ can predict the outcome of severe TBI, because, comparable differences were found in the frequencies of ‘midline shifts’ and ‘poor motor response’.

References

1. Bruns J Jr, Hauser WA. The epidemiology of traumaticbrain injury: a review. Epilepsia. 2003; 44 (Suppl. 10): 2-10.
2. Fleminger S, Ponsford J. Long term outcome after traumatic brain injury. BMJ. 2005; 331: 1419-20.
3. Shamim S, Razzak JA, Jooma R, Khan U: Initial results of Pakistan’s first road traffic injury surveillance project. International journal of injury control and safety promotion, 2011; 18 (3): 213-217.
4. Umerani MS, Abbas A, Sharif S: Traumatic brain injuries: experience from a tertiary care centre in pakistan. Turk. 2014; 24 (1): 19-24.
5. Menon DK, Schwab K et al. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010 Nov; 91 (11): 1637-40.
Doi:10.1016/j.apmr.2010.05.017.
6. Swadron SP, LeRoux P, Smith WS, Weingart SD. Emergency neurological life support: traumatic brain injury. Neurocrit Care, 2012 Sep; 17 Suppl. 1 (81): S112-21. 7. Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. J Neurotrauma. 1996 Nov. 13 (11): 641-734.
8. Bullock R, Chestnut RM, Clifton G, Ghajar J, Marion DW, Narayan RK, et al. Guidelines for the management of severe head injury. J Neurotrauma. 1996; 13 (11): 643–734.
9. Bullock R, Chestnut RM, Clifton G, Ghajar J, Marion DW, Narayan RK, et al. Guidelines for the Management of Severe Traumatic Injury. J Neurotrauma. 2000; 17: 453–553.
10. Bullock R. Guidelines for the Management of Severe Traumatic Brain Injury, J Neurotrauma. 2007: 3. Suppl. 1. Vol. 24: pp. S1–S106.
11. Vukic M, Negovetic L, Kovac D, Ghajar J, Glavic Z, Gopcevic A. The effect of implementation of guidelines for the management of severe head injury on patient treatment and outcome. Acta Neurochir (Wien), 1999; 141 (11): 1203–8.
12. Ratnasingam D, Lovick DS, Weber M, Buonocore RV, Williams VW. An unusual recovery from traumatic brain injury in a young man. The Linacre Quarterly, 2015; 82 (1): 55-56.
13. Sherer M, Madison C, and Hannay H. A review of outcomes after moderate and severe closed head injury with an introduction to life care planning. Journal of Head Trauma Rehabilitation, 2000; 15: 767–82.
14. Marshall L, Gautille T, Klauber M, Eisenberg H, Jane J, Luerseen T, et al. The outcome of severe closed head injury. Journal of Neurosurgery, 1991; 75: 28–36.
15. Van der Naalt J, Van Zomeren AH, Sluiter WJ, Minderhoud JM. One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work, J Neurol Neurosurg Psychiatry, 1999; 66: 207-13.
16. Klauber MR, Marshall LF, Luerssen TG, Frankowski R, Tabaddor K, Eisenberg HM. Determinants of head injury mortality: importance of the low risk patient, Neurosurgery, 1989; 24: 31-6.
17. Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI. Disability in young people and adults one year after head injury: prospective cohort study, Br Med J. 2000; 320: 1631-586.
18. Murray GD, Teasdale GM, Braakman R. The European Brain Injury Consortium survey of head injuries, Acta Neurochir (Wien) 1999; 141: 223-36.
19. Davis DP, Serrano JA, Vilke GM. The predictive value of field versus arrival Glasgow Coma Scale score and TRISS calculations in moderate-to-severe traumatic brain injury, J Trauma. 2006; 60: 985-90.
20. Marmarou A. et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. Journal of Neurosurgery, 1991 Nov. 75 (7): 59-66-805.
21. Fearnside MR, Cook RJ, McDougall P, McNeil RJ. The westmead head injury project outcome in severe head injury. a comparative analysis of prehospital, clinical, and ct variables. Br J Neurosurg. 1993; 7: 267-279.
Published
2019-06-04
Section
Original Article