Evaluation of craniocerebral traumatisms treated at the Mures County Emergency Hospital between 2008-2012 • Author : Duka Ede-Botond • Supervisor : PhD Dr. Madaras Alexandru neurosurgeon, Clinic of Neurosurgery of Targu Mures
Evaluation of craniocerebral
traumatisms treated at the Mures County
Emergency Hospital between 2008-2012
• Author: Duka Ede-Botond• Supervisor: PhD Dr. Madaras Alexandru neurosurgeon, Clinic of Neurosurgery of Targu Mures
INTRODUCTION
• Craniocerebral injury is a well represented pathology in the field of neurosurgery
• Craniocerebral Trauma aka. Traumatic Brain injury is „a leading cause of death and disability worldwide. Injuries to the brain are among the most likely to result in death and permanent disability.” (International Brain Injury Association)
• Caracteristics that define this type of injury are: Trauma to the head, alteration in consciousness,
need for emergency care, secondary injuries and posttraumatic disorders
AIM OF THE STUDY
• Etiological evaluation of TBI
• Distribution of TBI occurrence by gender, age groups, urban or rural enviroment
• Vascular involvement
• Predisposing factors
• Mortality ratio and complications
• To create a baseline statistical evaluation for further studies
MATERIAL AND METHOD• We performed a retrospective study on 1496 patients (1201
male, 295 female) hospitalized with the diagnosis of craniocerebral traumatism at the department of Neurosurgery of Mures County Emergency Hospital between 01.01.2008 - 31.12.2012
• Data processing was made by GraphPad,MedCalc and Microsoft Excel
• Due to statistial purposes, patients were subdivided in multiple categories
RESULTS
2008
2009
2010
2011
2012
0 50 100 150 200 250 300
68
63
62
43
59
237
258
239
230
237
Gender distributionMaleFemale
Number of patients
Year
s
0
100
200
3000%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
80.28%
19.72%
0%
20%
40%
60%
80%
100%
11.56%14.70%
40.97%
32.75%
Distribution acording to social activity
RESULTS• Average age is 45 years• Most affected patients
are between 51-60 and 61-70 years old
0.00%5.00%
10.00%15.00%20.00%25.00%
6.55%9.83%
11.74%12.11%11.29%
18.01%20.12%
10.34%
Age distriburion
Decimal agegroups
Perc
enta
ge
• The most affected patients are between 27-59 years old (the working class )
RESULTS
57,70%(863
cases)
43,30%(633
cases)
Distribution by origin
UrbanRural
A slightly higher percentage of cases comes from urban enviroment
The origin of a patient is important from etiological and diagnostic point of view
RESULTS
61.70%15.57%
16.78%
5.95% EtiologyFalling downTraffic accidentsAccidentsAgression
923 cases
233cases
89cases
251cases
Falls
36.07%
22.75%
41.17%Same level
Higher level
Unde-ter-mined
subdevision of falls
RESULTS
Mild con-cussion; 18.65%
Oedema; 19.38%
Epidural Hematoma;
8.82%
Subdural Hematoma;
29.41%
Subarachnoid hemorrhage;
12.09%
Intracerebral and Intra-ventricular hemorrhage
12%
RESULTS
Chronic alcoholism
Epilepsy
-5% 5% 15% 25%Chronic alcoholism Epilepsy
Percentage 16.71% 9.16%
16,71% (250 cases)
9,16%(137 cases)
Predisposing factors to traumatic brain injury:AgeChronic diseases: Epilepsy
Alcoholism
RESULTS
Male
Female
145
50
1056
245
1201
295Mortality
Number of patients
Gen
der
• Occurance of mortality by gender: (RR=1.0587 ; P = 0.0445 )
• Odds Ratio = 1.4039 ; P= 0.0545• ( 12%/17% -in favor of males )
Sum
0% 20% 40% 60% 80% 100%
13.03 86.95
Percentage of deceased patientsDeceasedSurvivedSum
RESULTSGCS (Glasgow Coma Scale) is an important tool in the diagnosis and projection of potential outcome in high risk patients with Craniocerebral Traumatisms
62%
38%
Low and Moderat Risk
High Risk
46.23%53.7
6%
High RiskDeceasedSurvived
High risk patients with -GCS < 8-9
-Severe head trauma-CT showing sever abnormalities who undervent surgery
RR=1.3677; P < 0.0001 ( survival ) Proportion of post-operative death was
increased by :Cronic alcoholism 35,6% (94 cases)Politrauma 42,8% (113 cases )
With the help of CT, surgical intervention can increase the rate of survivalCronic alcoholism and politrauma
CONCLUSIONSTraumatic Brain Injury afflicts in higher percentage menMost cases fall in the age category of 50-70 years of age, and mostly in
the working class Etiology shows the predominance of Falls and AccidentThere is a high percentage of vascular involvement – any trauma
strong enough to cause a fracture will most likely cause hemorrhage Patients diagnosed with CCT have a moderately high level of mortalityWith the help of CT, surgical intervention can increase the rate of
survivalAlcohol abuse and epilepsy along with age are the main predisposing
factorsPostoperative death is mainly caused by aggravating factors such as:
Politrauma -> heart, lungsChronic alcoholism