Outcome of cerebral contusion in mild traumatic head injury patients

Jagadish B. Hedawoo, Maheshkumar S. Soni


Background: Mild traumatic head injury is classified as one with Glasgow coma scale (GCS) score between 13 and 15. The aim of the study was to find underlying cause of deterioration of mild traumatic brain injury (TBI) and its association with other factors like bony injury.

Methods: A prospective observational study at a tertiary centre with patients admitted for mild TBI with GCS 13-15 were followed up in ward and reviewed after every 6 hours interval, those who deteriorated repeat computed tomography (CT) scan was done for further diagnosis and intervention.

Results: Determining the level of deterioration after 24 hours observation following mild TBI, 268 (63.4%) of the admitted patients were discharged home after 24 hours of observation, 89 (20.7%) needed more observation while 63 (14.8%) deteriorated and 3 (0.7%) died. As the GCS on admission was decreasing; deterioration increased i.e., 12.7%, 16.7% and 33.3% for GCS of 15, 14 and 13 respectively. Likewise, as the GCS increased, recovery improved. Subdural haematoma (39.7%) was the leading cause of deterioration while (13.8%) despite their deterioration, CT brain did not reveal any abnormality.

Conclusions: Patients presenting with mild TBI (i.e., GCS- 13-15) secondary to high velocity/energy trauma i.e., road traffic accidents have to be carefully observed for at least 24-48 hours post-trauma as the chances for neurological deterioration are significant especially in polytrauma patients. The most cause for deterioration is subdural haemorrhage among others, has to be investigated so appropriate management for the same can be instituted as soon as possible. 


Traumatic brain injury, GCS, Polytrauma

Full Text:



Raymond K. Mwanga on pattern of traumatic brain injury at MOI (not published).

Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics. 2000;41(2):95-103.

Bruns J, Hauser WA. The epidemiology of traumatic brain injury: a review. Eplepsia. 2003;44(10):2-10.

Adeleye AO, Olowookere KG, Olayemi OO. Clinico epidemiological profiles and outcomes during first hospital admission of head injury patients in Ikeja, Nigeria. Neuroepidemiol. 2009;32:136-41.

Ong L, Selladurai BM et al. The prognostic value of the Glasgow Coma Scale, hypoxia and computerised tomography in outcome prediction of pediatric head injury. Pediatr Neurosurg. 1996;24(6):285-91.

Kiboi GJ, Kitunguu KP. Predictors of functional recovery in african patients with traumatic intracranial hematomas. World Neurosurg. 2011;75(5):586-91.

Reilly PL, Graham DI, Adams JH, Jennett B. Patients with head injury who talk and die. Lancet. 1975;2(7931):375-7.

Kitumka O. Mulago hospital on the short term outcomes of head injuries in Uganda (not published).

Shackford SR, Wald SL, Ross SE, Cogbill TH, Hoyt DB, Morris JA, et al. The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma. 1992;33:385-94.

Iverson GL, Lovell MR, Smith S, Franzen MD. Prevalence of abnormal CT scans following mild head injury. Brain Inj. 2000;14:1057-61.

Stahel PF, Ertel W, Heyde CE. Traumatic brain injury: impact on timing and modality of fracture care. Orthopade. 2005;34:852-64.

McKee MD, Schemitsch EH, Vincent LO, Sullivan I, Yoo D. The effect of a femoral fracture on concomitant closed head injury in patients with multiple injuries. J Trauma. 1997;42(6):1041-5.

Seibel R, LaDuca J, Hassett JM, Babikian G, Mills B, Border DO, et al. Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg. 1985;202:283-95.

Jeret JS, Mandell M, Anziska B, Lipitz M, Vilceus AP, Ware JA, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurg. 1993;32:9-15.

Moran SG, McCarthy MC, Uddin DE, Poelstra RJ. Predictors of positive CT scans in the trauma patient with minor head injury. Am Surg. 1994;60:533-5.

Verwe BH, Muizelaar JP, Vinas FC, Peterson PL, Xiong Y, Lee CP. Impaired cerebral mitochondrial function after traumatic brain injury in humans. J Neurosurg. 2000;93(5):815-20.