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 Table of Contents  
Year : 2017  |  Volume : 31  |  Issue : 1  |  Page : 28-31

Epidemiological characteristics affecting outcome in traumatic brain injury

1 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Neurosurgery, National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India
3 Department of Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
4 Department of Pharmacology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
5 Department of Forensic Medicine, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayan Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-4958.198435

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Background: Traumatic brain injury (TBI) is affected by multiple injury factors. Geography and vehicle prone to the accident may have an important role on the outcome. Aims: This study aims to study the details of place and mechanism of injury and their effect on discharge outcome. Settings and Design: Prospective study. Methods: This is a prospective study where 337 patients diagnosed with TBI were selected from an emergency department, after obtaining their consent. The details of place and cause of injury data was recorded on standard proforma using FileMaker Pro Advanced 13 software. Statistical Analysis: The data were analyzed using Stats Direct version 3.0.150. Results: The study reports that age, gender, and severity of the injury as per Glasgow coma scale was significant with the outcome at discharge. Higher number of patients was from rural setup (72.6%). Roadside accidents account for about 56% of injuries. About 77% of injuries were due to accidents. Two-wheeler was cause for accidents in 54% of injuries. Mechanism of injury like motor vehicle accident, fall, blunt, and the penetrating injury was significant with discharge outcome. Conclusion: The study addresses that majority of TBI patients are from rural areas and injuries are due to accidents. Mechanism of injury has significance with discharge outcome.

Keywords: Geography, outcome, rural area, traumatic brain injury, vehicle injury

How to cite this article:
Agrawal A, Munivenkatappa A, Rustagi N, Mohan P R, Subrahmanyan B V. Epidemiological characteristics affecting outcome in traumatic brain injury. J Med Soc 2017;31:28-31

How to cite this URL:
Agrawal A, Munivenkatappa A, Rustagi N, Mohan P R, Subrahmanyan B V. Epidemiological characteristics affecting outcome in traumatic brain injury. J Med Soc [serial online] 2017 [cited 2022 May 19];31:28-31. Available from:

  Introduction Top

Traumatic brain injury (TBI) is a major public health problem with the colossal burden on country development. In developing country like India every year there is an increase in TBIs both in urban and rural areas. [1],[2],[3],[4],[5] A study from tertiary care institute has reported that the occurrence of TBI is approximately 42.5% in rural and 57.5% in urban area. [6] Considering drastic development in both these areas there is raise in transportation vehicle load. [1],[2],[3],[4],[5] People travelling by different mode of the vehicle are prone to accidents due to various reasons such as inadequate safety protocols or improper road infrastructure. The location and mode of injury probably play a role in the outcome. [1],[2],[3],[4],[5],[6],[7],[8] The literature for the same from developing countries is limited. The present pilot study aims to describe the injury characteristics with respect to location, mechanism, and vehicle with discharge outcome.

  Methods Top

The present hospital-based prospective study was carried out over a period of 6 months. Patients with TBI were evaluated at emergency by history and clinical examination their severity was assessed by Glasgow coma scale (GCS). All consecutive brain injury patients admitted to emergency irrespective of age, gender, education, and cause of injury were selected, but after obtaining their consent. Brain injury patients were first seen at emergency where resuscitation and severity assessment was carried out based on Advanced Trauma Life Support and GCS respectively. Ethical approval to conduct the study was obtained by Institute Ethical Committee before commencement of the study. Information relevant to study was collected from patient directly or collateral history was obtained from relatives attending the patients. Data were collected using a standard proforma. Data collected included: patient demographic details, geography (rural or urban), reason for injury (accident, self-inflicted, assault), mechanism of injury (road accident, fall, hit by object), vehicle details (2 or 4 wheeler or heavy vehicle), and outcome at discharge (alive or death). The data were collected by FileMaker Pro Advanced 13 (Santa Clara, California) which was used to create Computerized Patient Data Management Interface.

Data collected were analyzed using StatsDirect software version 3.0.150 (StatsDirect Ltd., Sale, Cheshire, UK) Data were summarized in the form of percentages and frequencies for categorical variables. The mean and standard deviation were used to compile continuous variables. The values of P < 0.05 were considered statistically significant.

  Results Top

During the study, a total of 337 patients were enrolled. 271 (80.4%) patients were males and females were 66 (19.6%). Their ages range from 4 to 83 years with mean age of 36.26 ± 15.86 years. The variables that affect discharge outcome either alive or dead were tested for significance. Twenty-four (7.12%) patients expired during the study period. The details of location, place, reason, mechanism and details of vehicle causing injury with outcome are detailed in [Table 1]. The only mechanism of injury was significantly associated with patient outcome. Age (P = 0.001), gender (P = 0.022) and severity as per GCS (P < 0.001) is significant with outcome [Table 2].
Table 1: Demonstrates injury location and its cause with outcome variables

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Table 2: Age, gender, and severity of injury with outcome

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  Discussion Top

This study result reports that nearly three fourth of head injury patients are from rural areas (73%), but deaths are more from urban areas (8%). The male (urban - 17%; rural - 83%) and female (urban - 15%; rural - 85%) percentages in urban and rural areas is all most same (P = 0.74), although overall male is four times more than female population (male:female, 4:1). Place of the accident was high in roadside (56%) followed by street and home site each accounting for 14%, the interestingly majority of deaths were from victims injured at home (10%). No deaths were reported among patients presenting with self-inflicted or assault history. The mechanism of injury like road traffic accident (RTA), fall, hit by a blunt object, the penetrating injury was significant with the outcome at discharge. Nearly 80% of patients were two-wheeler users followed by pedestrians (6%). One among three patients injured by auto rickshaw expired. Patient's age, gender, and severity was significant with discharge outcome.

This study reports that majority of head injuries are from rural area and high deaths from an urban area. The majority of our country is composed of rural area. This study report from the tertiary hospital were most of the cases are reported from surrounding semi-urban and villages. In a study TBI patients were more from urban area 58% where the hospital is in the center of the city, but still 43% of cases are from the rural area. [3] A study from India regarding TBI mortality survey from 1.1 million populations has reported that deaths in urban is more than rural areas. [9] The busy life schedule in an urban area and improper safety precaution with violating road rules may be reasons for higher mortality rates.

This study reports that majority of accidents were reported from road side which is obvious. The roads are occupied by different types of vehicles which are responsible for injuries. [1],[2],[3],[4],[5],[6],[7],[8] Interesting is that home accounts for 14% of TBI admittance and 10% of deaths. All the age groups are affected in the current study with deaths in severe to moderate GCS group. Studies have reported that pediatric and elderly patients are more prone to injuries at home. [10],[11] An epidemiological study has reported that TBI from the nonmetropolitan city has higher mortality as compared to the metropolitan city. [11] This study has majority cases from rural setup and most affected individuals in pediatric and elderly age group are due to fall and middle age group are due to quarrelling. Although the percentage of death is higher in home admittance it is not significant.

Mechanism of injury plays a very significant role in outcome among brain injury patients. [12],[13] There are different ways that head can be affected due to an external force. The various modes can be in the form of vehicle collision, fall, hit, or weapon penetration to head which cause imbalance in the brain and its surroundings areas leading to damage. The extent of imbalance and damage plays an important role in the outcome. [13] This study reports that the head impacted by various modes of external forces has significance with discharge outcome.

RTA is the lead cause for TBI in India followed by pedestrian injuries, among RTA two wheeler accounts for 50% of total injuries. [6],[14] The present study results are similar to literature that two-wheeler is main cause followed by pedestrian injuries. The vehicular load, especially two-wheeler is drastically increasing every year and most of the people use two wheeler does not follow safety precaution and road rules. This is the most probable reason for high RTAs. Government should be strict in implementing safety rules among two-wheeler users like mandatory helmet wearing, following correct road rules, etc.

There are few limitations in this study. The study sample size is small. The study is from a single center where the generalization of results to TBI population is challenging. The study focus on few variables, however, the mentioned variables have a significant role with TBI outcome. The statistics used are only basics, higher statistics are not used. There are some missing data for almost all variables mentioned. The reason is either data was not entered, or while importing excel to analysis, some data have been lost due to change in version from system to system.

  Conclusion Top

This study from a developing country reports that mechanism of injury is significant with discharge outcome. Studies in future with larger samples and multi-institutional integration need to explore on details of injury mechanism and their relationship with outcome. This helps the government to enforce the safety precautions and guidelines.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Chiu WT, Huang SJ, Tsai SH, Lin JW, Tsai MD, Lin TJ, et al. The impact of time, legislation, and geography on the epidemiology of traumatic brain injury. J Clin Neurosci 2007;14:930-5.  Back to cited text no. 1
Leonhard MJ, Wright DA, Fu R, Lehrfeld DP, Carlson KF. Urban/rural disparities in oregon pediatric traumatic brain injury. Inj Epidemiol 2015;2:32.  Back to cited text no. 2
Sharda P, Haspani S, Idris Z. Factors prognosticating the outcome of decompressive craniectomy in severe traumatic brain injury: A Malaysian experience. Asian J Neurosurg 2014;9:203-12.  Back to cited text no. 3
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Maier D, Njoku I Jr., Schmutzhard E, Dharsee J, Doppler M, Härtl R, et al. Traumatic brain injury in a rural and an urban Tanzanian hospital - a comparative, retrospective analysis based on computed tomography. World Neurosurg 2014;81:478-82.  Back to cited text no. 4
Feigin VL, Theadom A, Barker-Collo S, Starkey NJ, McPherson K, Kahan M, et al. Incidence of traumatic brain injury in New Zealand: A population-based study. Lancet Neurol 2013;12:53-64.  Back to cited text no. 5
Pruthi N, Ashok M, Kumar VS, Jhavar K, Sampath S, Devi BI. Magnitude of pedestrian head injuries and fatalities in Bangalore, south India: A retrospective study from an apex neurotrauma center. Indian J Med Res 2012;136:1039-43.  Back to cited text no. 6
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WHO | Global Status Report on Road Safety; 2013. Available from: [Last accessed on 2016 Apr 11].  Back to cited text no. 7
Seid M, Azazh A, Enquselassie F, Yisma E. Injury characteristics and outcome of road traffic accident among victims at adult emergency department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: A prospective hospital based study. BMC Emerg Med 2015;15:10.  Back to cited text no. 8
Hsiao M, Malhotra A, Thakur JS, Sheth JK, Nathens AB, Dhingra N, et al. Road traffic injury mortality and its mechanisms in India: Nationally representative mortality survey of 1.1 million homes. BMJ Open 2013;3:e002621.  Back to cited text no. 9
Harvey LA, Close JC. Traumatic brain injury in older adults: Characteristics, causes and consequences. Injury 2012;43:1821-6.  Back to cited text no. 10
Reid SR, Roesler JS, Gaichas AM, Tsai AK. The epidemiology of pediatric traumatic brain injury in Minnesota. Arch Pediatr Adolesc Med 2001;155:784-9.  Back to cited text no. 11
Monsef Kasmaei V, Asadi P, Zohrevandi B, Raouf MT. An epidemiologic study of traumatic brain injuries in emergency department. Emerg (Tehran) 2015;3:141-5.  Back to cited text no. 12
Nortje J, Menon DK. Traumatic brain injury: Physiology, mechanisms, and outcome. Curr Opin Neurol 2004;17:711-8.  Back to cited text no. 13
Agrawal A, Galwankar S, Kapil V, Coronado V, Basavaraju SV, McGuire LC, et al. Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India 2007-2009. Int J Crit Illn Inj Sci 2012;2:167-71.  Back to cited text no. 14
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  [Table 1], [Table 2]

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