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South African Medical Journal

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Secondary injury in traumatic brain injury patients - A prospective Study

Anthony R Reed, David G Welsh

Abstract


Objective. Secondary insults of hypotension and hypoxia significantly impact on outcome in patients  with traumatic brain injury (TBI). More than 4 hours' delay in evacuation of intracranial haematomas has  been demonstrated to have an additional impact on outcome. The objective of this study was to document the incidence of these preventable secondary insults in patients admitted with moderate or severe brain  injury.
Methodology. All moderate and severe head injury patients admitted to Groote Schuur Hospital over a  3-month period were studied prospectively. Data were obtained from ambulance dockets, referral letters, patient charts and attending medical staff. Preventable secondary insults (hypotension, hypoxia) and time delay to assessment and surgery were documented. Outcome was assessed using the Glasgow outcome scale (GOS) at discharge or outpatient follow-up.
Results. Ninety-six patients were studied. Forty-nine patients experienced at least one recorded  preventable event of hypoxia or hypotension. Seventeen had an intracranial haematoma requiring  evacuation. The mean time interval between injury and surgery was 455 minutes. No haematoma was evacuated within 4 hours of injury. Patients referred via a primary or secondary care facility experienced a mean additional delay of 70 minutes. These results demonstrated a significant incidence of secondary injury and delay to assessment and surgery. We believe that education and a raised awa reness of the impact of secondary insults may have a positive impact on TBI outcome in our referral area.



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