Outcome of mild traumatic brain injury in the course of 24 hours of observation among patients admitted at Muhimbili Orthopaedic Institute (MOI).

Abstract

Background: Traumatic brain injury is a global health problem with significant mortality and morbidity. The study aimed at determining the outcomes of mild traumatic brain injured patients during 24 hours of observation among patients admitted at Muhimbili Orthopedic, Trauma and Neurosurgical Institute (MOI) - Tanzania. Study design: Prospective – Hospital base d observation study. All consecutive patients with mild traumatic brain injury meeting the inclusion criteria were recruited in the study and followed up in the ward for the first 24 hours after admission. Methods: A total number of 424 patients were included in the study with GCS of 15, 14 and 13. The scores were strengthened by the presence or absence of neurological symptoms like; loss of consciousness, headache, pupillary dilatation, seizures and vomiting. The patients were followed up in the ward and progress was noted. After completion of 24 hours, final remarks of the outcome were noted. The target was three outcomes: 1.Good recovery where patients discharged home 2.Fair or no changes and patients needed more observations 3.Poor progress as the patients were deteriorating. Also influence of long bone fractures on neurological outcomes were determined. Results: Sixty three (14.8%) patients deteriorated, 88(20.7%) patients needed more observation and brain CT scan were inquired, 270(63.4%) recovered well and discharged on instructions of primonitory signs of impending neurological deterioration while 3(0.7%) died. The findings were statistically significant (P=000). Subdural hematoma was the leading cause of deterioration 23(39.7%) while normal CT Scan was found in 8(13.8%) patients despite of their deterioration. Presence of long bone fractures concomitantly with mild TBI has a significant role in neurological deterioration (P=0.043). Conclusion: Inspite of a good score during admission of mild traumatic brain injured patients and high expectations of immediate recovery, still there is a significant possibilities of some of these patients deteriorating. Close monitoring and aggressive intervention measures are needed for the best outcome of patients.