Study of cases of head injury in a government hospital in rural Indian setting

Vinod Pusdekar, Sandeep Ambedkar, Ritesh Bodade


Background: Head injury can be defined as trauma in which the head is struck or moves violently, resulting in transient or permanent alteration of consciousness of an individual. We profiled and analyzed the cases of head injuries reporting to a government hospital a rural Indian setting.

Methods: All the patients with history of antecedent head injury were firstly assessed by detailed history, with emphasis on history of unconsciousness/vomiting/convulsions/ENT bleed. Then a thorough clinical examination was undertaken, including Glasgow Coma Scale (GCS) scoring. Further, all the patients were subjected to CT scan of head for correlation of clinical findings, confirmation of diagnosis, delineation of extent of disease and suitability of operative intervention etc.

Results: Majority of the patients belonged to 15-44 years age group (30, 60%) and were males (38, 76%). Road traffic accidents accounted for majority (38, 76%) of the cases. GCS score was found to range between 13-15 (mild) in 18 (36%) patients, 9-12 (moderate) in 21 (42%) patients and 3-8 (severe) in 11 (22%) patients. Best recovery (88%) was shown by patients of GCS score between 13-15. Among the critical symptoms and signs, unconsciousness and abnormal plantar reflex were the commonest ones. Generalized cerebral edema without associated lesion (50%) was the commonest finding followed by extradural hematoma (EDH) (40%) on CT scan of head. As for recovery w.r.t. CT scan findings, highest rate of recovery (100%) was reported in patients with fracture without intracranial pathology, while highest mortality was reported in those having mixed lesion (90%).

Conclusions: Road traffic accidents in young age group is the commonest mode of head injury and GCS score is a good predictor of recovery in head injury cases.


Glasgow Coma Scale, Head injury, Road traffic accident

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Maas AI, Stocchetti N, Bullock R. "Moderate and severe traumatic brain injury in adults". Lancet Neurology.2008;7(8):728-41.

Gissane W, Bull J, Roberts B. Sequelae of road injuries: A review of one year's admissions to an accident hospital. Injury. 1970;1(3):195-203.

Alkhoury F, Courtney J. Outcomes after severe head injury: a national trauma data bank-based comparison of level I and level II trauma centers. Am Surg. 2011;77(3):277-80.

Rizoli S, Petersen A. Early prediction of outcome after severe traumatic brain injury: a simple and practical model. BMC Emerg Med. 2016;16(1):32.

Ciapetti M, Migliaccio M. Long-term outcome after severe traumatic brain injury. Critical Care. 2014;18(1):P470

Balestreri M, Czosnyka M. Predictive value of Glasgow coma scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry. 2004;75(1):161-2.

Gissane W. The nature and causation of road injuries. Lancet. 1963;2(7310):695-8.

Bahloul M, Chelly H, Hmida MB, Hamida CB, Ksibi H, Kallel H, et al. Prognosis of traumatic head injury in South Tunisia: a multivariate analysis of 437 cases. J Trauma Acute Care Surg. 2004;57(2):255-61.

Zimmerman RA. Cranial CT in diagnosis and management of acute head injury. Am J Roentol. 1978;131:27-34.

Quigley MR, Vidovich D, Cantella D, Wilberger JE, Maroon JC, Diamond D. Defining the limits of survivorship after very severe head injury. J Trauma Acute Care Surg. 1997;42(1):7-10.

Tseng Shih L, Tai-Ngar L. Features of head injury in a Developing Country–Taiwan (1977-1987). Jour of Trauma, Injury, Infection, and Critical Care: 1990;30:90-5.

Young B, Rapp RP, Norton JA, Haack RND, Tibbs PA, Bean JR. Early prediction of outcome of head injury patients. J Neurosurg. 1981;54:300-3.

Lobato RD, Cordobes F, Rivas JJ, de la Fuente M, Montero A, Barcena A, et al. Outcome from severe head inury related to type of intracranial lesion: a computerized tomography study. J Neurosurg. 1983;59(5):762-74.

Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, et al. Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg. 1982;56:26-32.

Lieberman JD, Pasquale MD, Garcia R, Cipolle MD, Li PM, Wasser TE. Use of admission GCS, pupil size and pupil reactivity to determine outcome for trauma patients. J Trauma. 2003;55:437-43.

Levati A, Farina ML, Vecchi G, Rossanda M, Marrubini MB. Prognosis of severe head injuries. J Neurosurg. 1982;57:779-83.