Comparison of various Head Injury Prognostic Scales

Goutham, S P (2013) Comparison of various Head Injury Prognostic Scales. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Traumatic Brain injury (TBI) is a considerable health care problem1-3 and is one of the most common causes of death. Its incidence is rising at large proportions in regions with rapidly increasing motorization because of industrialized development. The incidence varies from 67 to 317 per 100000 individuals and mortality rates range from around 4-8% for moderate injury to approximately 50% with severe head injury. The symptoms of TBI can be various depending on the extent of damage to the brain. The outlook for patients with mild TBI is generally a good recovery, while patients with a severe TBI have a substantial risk to die. Predicting outcome for very good or very severe patients is therefore rather easy. However, for severe and moderate TBI patients the outcome is not so easy to predict, while such predictions would be helpful in supporting clinical decision making, providing realistic and evidence based expectations to relatives and care givers, as well as in clinical research. Any ideal prediction score or model should be easy to apply, with high sensitivity and specificity rates irrespective of the management protocol, its time and place of application. Several prospective and retrospective studies have been done to derive a baseline predictive model for patients in the intensive care unit in general or specific to traumatic brain injury. AIM OF THE STUDY: 1. The application of various prognostic scales on outcome of moderate and severe traumatic brain injury patients. 2. To compare the sensitivity, specificity and efficacy of the various prognostic scales. MATERIALS AND METHODS: This study was conducted at Madras Medical College and Rajiv Gandhi Government. General Hospital, Institute of Neurology which included 300 patients with moderate and severe traumatic brain injury. It was a prospective study from 2010 to 2013. A thorough Clinical and detailed neurological examination was done and the patient details were recorded in a Proforma and the following Prognostic Scores were calculated for every patient: - Madras Head Injury Prognostic Scale (MHIPS). - NIMHANS Model (NM). - Edinburgh Prognostic Scale. The efficacy, sensitivity and specificity was noted for every score and compared for the outcome of these patients. All Patients presenting to the trauma ward of our hospital with moderate and severe head injury along with other systemic injuries were included in our study population. All patients presenting with mild head injury were excluded from our study population. The primary reason for choosing to compare these three scores in this study is: 1. All the three scores have taken into account almost similar variables. 2. All these scores are objective and measurable on a numerical scale. 3. All the three scores are simple enough to be used during a routine bed side clinical assessment. 4. Also these scores are easy to apply even for a junior member of the team. CONCLUSION: In patients with moderate and severe head injury age of the patient plays a significant role in deciding the outcome. Older the patient poorer the prognosis. • In Glasgow Coma Scale, the best motor response is the most accurate predictor of outcome in moderate and severe head injury patients. • Both Occulocephalic and pupillary reflexes should be noted on admission in patients with moderate and severe TBI. Their response holds a significant correlation to the final outcome. • Single variable is not enough to prognosticate the outcome in traumatic brain injury patients. The scoring should always be a multivariate analysis • In this study Madras Head Injury prognostic Scale (MHIPS) was the most significant scoring system in accurate prediction of outcome in moderate and severe head injury patients as compared to Edinburgh and NIMHANS models.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Head Injury Prognostic Scales, Comparison study.
Subjects: MEDICAL > Neuro Surgery
Depositing User: Subramani R
Date Deposited: 12 Feb 2020 01:20
Last Modified: 12 Feb 2020 01:20

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