Abstract

Background: Traumatic brain injury is the leading cause of mortality, morbidity, disability and socio-economic losses worldwide.  The aim of this study was to determine the proportion of poor outcome among the head injury patients with Glasgow coma scale < 12 and to determine the role of initial CT scan in predicting the outcome among them.

Materials and Methods: The study was carried out in the department of Radio diagnosis, Medical college, Kottayam for a period of 12 months in patients coming to casualty with features of moderate to severe traumatic head injury (GCS <12) and had taken the initial CT head scan within 24 hours of injury. All CT scans taken in the department were reviewed in digital form. Rotterdam CT scoring and Glasgow outcome score at and after 3 months of discharge were noted.

Results: A total of 150 patients were included in the study. 57.3% had moderate head injury and 42.7% had severe head injury. Abnormal CT findings were noted in 95.3% of patients. The incidence of poor outcome was 52.7% in patients with moderate to severe head injury. Statistically significant association with poor outcome was noted in status of basal cistern, midline shift, tSAH, IVH, SDH and contusions. Among these variables, absent basal cistern had the highest PPV of 95.5% and highest odds ratio of 26.011 with 95% confidence interval (7.747 – 85.135). With Rotterdam scoring, the higher the grades, more the probability for poor outcome

Conclusion: More than half of the patients with moderate and severe head injury patients had poor outcome. The status of basal cistern was the best predictor among the CT variables. Rotterdam scoring can be used as an objective score to predict the mortality in patients with moderate or severe head injury.