Syed Shahzad Hussain, Usman Ahmad, Naveed Ashraf.
Outcome of Severe Traumatic Brain Injury in patients with or without Pre Hospital Care.
Pak J Neuro Surg Jan ;19(4):256-60.

Introduction: Traumatic brain injury (TBI) is the leading cause of death and disability worldwide in the young ones. A severe TBI not only affects the life of a patient and his family, but it is also a social and economic burden. Furthermore, the cost of fatal TBIs and TBIs requiring hospitalization, several of which are severe, account for 90% of the total TBI medical costs. The transportation of TBI patients to hospitals specializing in neurosurgical care is significant regarding outcome. The rationale of our study is that most sophisticated of emergency, operative, or intensive care units cannot reverse damage that has been set in motion by suboptimal protocols of triage and resuscitation, either at the injury scene or en route to the hospital. The quality of pre-hospital care is a major determinant of long-term outcome for patients with traumatic brain injury. Pakistan being a developing country traumatic brain injury patients have a poor outcome due to lack of structured pre-hospital care and availability of emergency neurosurgical care in all the hospitals. Pre-hospital care is the care provided by Rescue 1122 from the scene of trauma to emergency department of hospital in the form of airway management, fluids, oxygen inhalation, analgesia and pressure bandage for scalp wounds. This study delineate guidelines for management and supervision of these patients in terms of pre-hospital care based on their outcome in the form of mortality at four weeks follow-up. Methods and Results: Patients were divided in to two groups (150 each) with and without hospital care. Mean age of the patients was 33.35 ± 13.56. Male patients were 231 (77%) and female patients were 69 (23%). The stratification of various modes of injury regarding road traffic accident was 243 (81%) while of fall was 57 (19.0%). There was a high mortality in these patients as 143 (47.7%) died and just 157 (52.3%) remained alive. Ninety one (63.6%) patients in without pre hospital care group and 52 (36.4%) patients with pre hospital care group died showing a significant difference in favor of pre hospital care. Conclusion: Pre hospital care results in significant decrease in mortality in patients with severe TBI as compared to patients without pre hospital care. Abbreviations: TBI: Traumatic Brain Injury. GCS: Glasgow Coma Scale. ICU: Intensive Care Unit. RTA: Road Traffic Accident.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com