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

QUESTIONS?

THANK YOU FOR YOUR ATTENTION!