Frequency of Intracranial Hemorrhage among Patients with Skull Fractures in Blunt Head Trauma

Authors

  • Muhammad Shoaib
  • Sajid Khan
  • Naeem Ul Haq
  • Zia Ullah
  • Saad Ali
  • Bakth Jamal
  • Imran Ullah
  • Inayat Shah

DOI:

https://doi.org/10.47672/ajhmn.980
Abstract views: 167
PDF downloads: 206

Keywords:

Intracranial hemorrhage, skull fractures, Head trauma

Abstract

Background: The global incidence of fatal head injuries is greater than the number of non-fatal cases. The presence or absence of a skull fracture, its type and site along with the type of intracranial hemorrhage has immense significance in the final outcome in cases of head injuries.

Objective: To determine the frequency of intracranial hemorrhage and its different pattern in patients presented with skull fracture following blunt head injury in a tertiary care setting.

Material and Methods: The study employed cross sectional study design and was conducted in Neurosurgery Unit of Lady Reading Hospital, Peshawar. The study duration was six months after approval of synopsis (29-06-2019 to 29-12-2019). A sample size of 196 patients was calculated using WHO calculator. Non probability consecutive sampling was used for patient’s selection. Ethical approval and consent forms were taken. Diagnosis of skull fracture and intracranial bleeding were made on the basis of CT brain and per op findings. Data was analyzed using SPSS version 17. Post stratification chi-square test was applied. P value ≤0.05 was considered significant.

Results: Total 196 patients were included in study. There were 129(65.8%) male and 67(34.2%) female. Mean age of patients was 35.7 years±9.9SD. Intracranial hemorrhage was present in 32(16.3%). Type of intracranial hemorrhage was subdural in 10(5.1%), intrcerebral 3(1.5%), subarchnoid 3(1.5%), intraventricular 4(2%), contusion 2(1%), combination 2(1%), and extradural 8(4.1%). Intracranial hemorrhage is significantly associated with GCS, Occupation, cause of injury, location of injury and type of intracranial injury (p<0.001).

Recommendation: According to the findings, frequency of intracranial hemorrhage was relatively high. This study recommend all patients with skull fractures due blunt head trauma be subjected to thorough brain damage check-up. The type and location of skull fracture is an indirect indicator of the severity of force of impact which leads to damage to the underlying brain and results in fatality.

 

Downloads

Download data is not yet available.

Author Biographies

Muhammad Shoaib

Consultant Neurosurgeon, Muhammad Teaching Hospital, Peshawar, Pakistan.

Sajid Khan

Consultant Neurosurgeon, Prime Hospital, Peshawar, Pakistan.

Naeem Ul Haq

Assistant Professor, Neurosurgery Department, MMC Hospital, Mardan, Pakistan.

Zia Ullah

Consultant Neurologist, DHQ hospital, Timergira, Pakistan.

Saad Ali

Assistant Professor, Department of Neurology, LRH, Peshawar, Pakistan.

Bakth Jamal

Assistant Professor, Neurosurgery Unit, Kohat Road Hospital, Peshawar, Pakistan.

Imran Ullah

Consultant Neurosurgeon, Saidu Teaching Hospital, Swat, Pakistan.

Inayat Shah

Junior Registrar, Neurosurgery unit, MMC Mardan Medical Complex, Pakistan.

References

Barnes GD, Lucas E, Alexander GC, Goldberger ZD. National Trends in Ambulatory Oral Anticoagulant Use. Am J Med. 2015;128(12):1300–1305 e1302.4658248 [PMC free article] [PubMed] [Google Scholar]

Kirley K, Qato DM, Kornfield R, Stafford RS, Alexander GC. National trends in oral anticoagulant use in the United States, 2007 to 2011. Circ Cardiovasc Qual Outcomes. 2012;5(5):615–621. [PMC free article] [PubMed] [Google Scholar]

Kim K, Lee TA, Touchette DR, DiDomenico RJ, Ardati AK, Walton SM. Contemporary Trends in Oral Antiplatelet Agent Use in Patients Treated with Percutaneous Coronary Intervention for Acute Coronary Syndrome. J Manag Care Spec Pharm. 2017;23(1):57–63 [PubMed] [Google Scholar]

Karve S, Levine D, Seiber E, Nahata M, Balkrishnan R. Trends in Ambulatory Prescribing of Antiplatelet Therapy among US Ischemic Stroke Patients: 2000–2007. Adv Pharmacol Sci. 2012;2012:846163. [PMC free article] [PubMed] [Google Scholar]

Stuntz M, Bernstein B. Recent trends in the prevalence of low-dose aspirin use for primary and secondary prevention of cardiovascular disease in the United States, 2012–2015. Prev Med Rep. 2017;5:183–186. [PMC free article] [PubMed] [Google Scholar]

Chenoweth JA, Gaona SD, Faul M, Holmes JF, Nishijima DK, Sacramento County Prehospital Research C. Incidence of Delayed Intracranial Hemorrhage in Older Patients After Blunt Head Trauma. JAMA Surg. 2018. [PubMed] [Google Scholar]

Franko J, Kish KJ, O’Connell BG, Subramanian S, Yuschak JV. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma. 2006;61(1):107–110 [PubMed] [Google Scholar]

Jones K, Sharp C, Mangram AJ, Dunn EL. The effects of preinjury clopidogrel use on older trauma patients with head injuries. Am J Surg. 2006;192(6):743–745 [PubMed] [Google Scholar]

Howard JL, 2nd, Cipolle MD, Horvat SA, et al. Preinjury warfarin worsens outcome in elderly patients who fall from standing. J Trauma. 2009;66(6):1518–1522; discussion 1523–1514 [PubMed] [Google Scholar]

van den Brand CL, Tolido T, Rambach AH, Hunink MG, Patka P, Jellema K. Systematic Review and Meta-Analysis: Is Pre-Injury Antiplatelet Therapy Associated with Traumatic Intracranial Hemorrhage? J Neurotrauma. 2017;34(1):1–7 [PubMed] [Google Scholar]

Peck KA, Calvo RY, Schechter MS, et al. The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J Trauma Acute Care Surg. 2014;76(2):431–436 [PubMed] [Google Scholar]

Jagoda AS, Bazarian JJ, Bruns JJ Jr., et al. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52(6):714–748 [PubMed] [Google Scholar]

Clinical NIfHa, Excellence. Head injury: assessment and early management. Clinical Guideline 2014; https://www.nice.org.uk/guidance/cg176 . Accessed May 31, 2018. [Google Scholar]

Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391–1396 [PubMed] [Google Scholar]

Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343(2):100–105 [PubMed] [Google Scholar]

Mower WR, Hoffman JR, Herbert M, et al. Developing a decision instrument to guide computed tomographic imaging of blunt head injury patients. J Trauma. 2005;59(4):954–959 [PubMed] [Google Scholar]

Nishijima DK, Gaona SD, Waechter T, et al. The incidence of traumatic intracranial hemorrhage in head-injured older adults transported by EMS with and without anticoagulant or antiplatelet use. J Neurotrauma. 2017. [PMC free article] [PubMed] [Google Scholar]

Ganetsky M, Lopez G, Coreanu T, et al. Risk of Intracranial Hemorrhage in Ground-level Fall With Antiplatelet or Anticoagulant Agents. Acad Emerg Med. 2017;24(10):1258–1266 [PubMed] [Google Scholar]

Mower WR, Gupta M, Rodriguez R, Hendey GW. Validation of the sensitivity of the National Emergency X-Radiography Utilization Study (NEXUS) Head computed tomographic (CT) decision instrument for selective imaging of blunt head injury patients: An observational study. PLoS Med. 2017;14(7):e1002313. [PMC free article] [PubMed] [Google Scholar]

Mower WR, Hoffman JR, Herbert M, et al. Developing a clinical decision instrument to rule out intracranial injuries in patients with minor head trauma: methodology of the NEXUS II investigation. Ann Emerg Med. 2002;40(5):505–514 [PubMed] [Google Scholar]

Stiell IG LH, Vandemheen K. et al. Obtaining consensus for the definition of “clinically important” brain injury in the CCC Study Acad Emerg Med 2000;7:572 [Google Scholar]

Yokoyama S, Tanaka Y, Nakagita K, Hosomi K, Takada M. Bleeding Risk of Warfarin and Direct Oral Anticoagulants in Younger Population: A Historical Cohort Study Using a Japanese Claims Database. Int J Med Sci. 2018;15(14):1686–1693. [PMC free article] [PubMed] [Google Scholar]

Vinogradova Y, Coupland C, Hill T, Hippisley-Cox J. Risks and benefits of direct oral anticoagulants versus warfarin in a real world setting: cohort study in primary care. BMJ. 2018;362:k2505. [PMC free article] [PubMed] [Google Scholar]

Makam RCP, Hoaglin DC, McManus DD, et al. Efficacy and safety of direct oral anticoagulants approved for cardiovascular indications: Systematic review and meta-analysis. PLoS One. 2018;13(5):e0197583. [PMC free article] [PubMed] [Google Scholar]

de Jong LA, Koops M, Gout-Zwart JJ, et al. Trends in direct oral anticoagulant (DOAC) use: health benefits and patient preference. Neth J Med. 2018;76(10):426–430 [PubMed] [Google Scholar]

Downloads

Published

2022-04-07

How to Cite

Shoaib, M. ., Khan, S. ., Ul Haq, N. ., Ullah, Z. ., Ali, S. ., Jamal, B. ., Ullah, I. ., & Shah, I. . (2022). Frequency of Intracranial Hemorrhage among Patients with Skull Fractures in Blunt Head Trauma. American Journal of Health, Medicine and Nursing Practice, 7(5), 8 - 17. https://doi.org/10.47672/ajhmn.980

Issue

Section

Articles