Features of injury mechanisms and severity of damage in TBI patients admitted at high level of consciousness (13–15 GCS score)

In the structure of traumatic injuries, the highest risk of mortality and disability is associated with traumatic brain injury. Despite the fact that traumatic brain injury has been a subject of study since the time of Hippocrates, its relevance has not lost its significance. From these positions, the issues of primary injury prevention, early diagnosis and assessment of the severity of injury, and the choice of an effective treatment method are extremely important. With the rapid development of scientific and technological progress and changes in social and economic conditions of life, the nature of injuries has also changed. This applies to both adult and child populations. According to the literature, the main causes of severe TBI are accidents, falls, blows to the head, and crime. Issues of mild and moderate-severe TBI have been studied to a lesser extent. On the other hand, studying the mechanisms of primary injury can become an important tool in the diagnosis of intracranial injuries accompanied by subtle clinical manifestations that pose a serious threat to the victim’s life.

THE PURPOSE OF THE STUDY: to analyze the severity of intracranial injuries according to computed tomography data in victims with traumatic brain injury (children and adults), admitted with a high level of consciousness (13–15 GCS points).

MATERIALS AND METHODS: At the Republican Clinical Hospital in Nalchik, a retrospective analysis of data from 2228 patients (from 2011 to June 2018) with mild and moderate TBI. In all patients, GCS score on admission was 13–15 points. The severity and structure of the damage was verified by brain CT scan in all cases.

RESULTS. The most common mechanism of TBI among both children and adults is falling, mainly from a height of <1 m. Among children, there are also registered headbutting, blows to the head or falls of a heavy object on the head associated with active behavior. Among adults — road accidents and beatings. Head soft tissue injuries, and fractures of the skull are almost twice as common when falling and hit by a heavy object than in a road accident or beating. Depressed fractures of the skull were typical for the mechanism of injury by a direct impact on the head with an object, which happens 3 times more often (13 %) than other mechanisms of injury, such as falls (4 %), beatings (6 %), and road accidents (4 %). Subdural hematomas are mostly found in the mechanism of injury by falling (13 %). Epidural hematomas were less detected with fall of the victim from a height of <1 m, and most often occur when falling from moving objects. Subdural hematomas, intracerebral hematomas and SAH were characteristic of the mechanism of trauma of falling from steps and were more common than in other types of falls. When a TV or other heavy object falls on a child, combined injuries are characteristic, which include about 81 % fractures of the arch and the base of the skull. The average statistical amount for damage in a crash accident was 11 %, and for other types of road accidents like run over or falls from vehicles, was 18 %. All types of damage caused by road accidents like run over or falls from vehicles were detected almost twice as often as in crash accidents, except for depressed skull fractures, which were 3 times more common in crash accidents.

CONCLUSION. The data analysis showed that the pattern of outcomes in victims with TBI with a high level of consciousness (13–15 GCS points) largely depends on the mechanism of injury. Acarefully collected anamnesis, consideration of injury conditions, and indication of injury mechanism can become an additional tool for early detection and diagnosis of intracranial injuries in victims admitted with a high level of consciousness (13–15 GCS points) when clinical manifestations are still latent. A report of the mechanism of injury with high damaging energy may be an indication for brain computed tomography in emergency situations, even in the absence of obvious clinical manifestations of intracranial injuries requiring surgical treatment.

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