ASSESS THE TRAUMATIC BRAIN INJURY OUTCOMES IN PAKISTANI EMERGENCY

DEPARTMENT: A CROSS SECTIONAL STUDY.

Submitted By

STUDENT NAME: SanaMaqsood

REG NO: 2019- ICN-0050-UHS

In The Partial Fulfillment for the Award of Bachelor Science in Nursing

SUPERVISOR 1: ASSISTANT PROF. MS. SHAHEEN NAZAKAT

PHD (SCH), MS, MPH, CHPE.

SUPERVISOR 2: MS. Sana

(BSN)

INDEPENDENT COLLEGE OF NURSING FAISALABAD

2020-2024
TABLE OF CONTENTS
 Sr.n CONTENTS PAGE
o. NO

1 CHAPTER 1: INTRODUCTION 2

Background

Problem Statement

Significance

Hypothesis

Objectives/Study Questions

5 CHAPTER 2: REVIEW OF LITERATURE

Search Strategy

Flow chart / Prism Chart

Gap Analysis

6 CHAPTER 3: MATERIAL/SUBJECTS &METHODS

Study Design

Study Variables

Operational Definitions

Study Setting

Study Population

Sampling technique/strategy

Sample Size

Study Duration

Inclusion Criteria

Exclusion Criteria

Research Tools

Validity & Reliability

Data collection procedure

 Chapter# 1

Introduction

1.1 Background:
Traumatic brain injury (TBI) is a disorder that impairs regular brain activity and may result in long-term
emotional, cognitive, and neurological impairment. (Pease et al., 2022). Traumatic brain injury (TBI) is
an external mechanical insult to the brain that can range in severity from a slight concussion that leaves
the victim alive and attentive to a severe injury that puts the victim in a vegetative condition or even
causes death. It could affect the brain primarily or more widely, causing edema or even bleeding.
(Yaqoob).

Damage to the brain's structure or function brought on by an abrupt external injury is known as
traumatic brain injury (TBI). Traumatic brain injury (TBI) is categorized as mild, moderate, or severe.
Acute brain injuries that are moderate to severe frequently necessitate hospital care. A traumatic brain
injury (TBI) can produce a wide range of symptoms and issues for patients, such as poor decision-
making, impulsivity, despair, aggressive behavior, slowness, exhaustion, and mental disorders. Although
older persons are also experiencing an upsurge in brain injuries, a significant portion of those affected
are under 25. (Lindon et al., 2023).

Other bodily manifestations Headache, nausea, vomiting, dizziness, blurred vision, and fatigue were all
considered signs of traumatic brain injury (TBI) but were not considered diagnostic criteria. (Hume et
al., 2023).

Traumatic brain injury (TBI) has a catastrophic effect on patients and their families and is the primary
cause of death and disability among young adults globally. With approximately 57 million people
worldwide suffering from neurological disorders brought on by traumatic brain injury, it has grown to be
one of the largest problems in the world today, requiring hospital-based care for 10 million of them. In
terms of genesis, severity, and prognosis, it is a heterogeneous disorder. In terms of etiologies, the
majority of research show that road traffic injury (RTI) is the primary cause of traumatic brain injury
(TBI) across all age groups; however, in some other studies, falling down accidents (FDA) emerge as the
primary cause, with RTI ranking second. Over 10 million people suffer from TBI. (Hagos ET al.2022).

The causes of TBI were classified as follows: hypoxia or intoxication, meningitis or encephalitis, stroke,
brain tumors, and "other. (Allonsius et al., 2023).
A neurological scale called the "Glasgow Coma Scale" (GCS) is used to evaluate a patient's state of
consciousness after they have suffered a brain injury. The three components of a patient's neurological
function that the GCS assesses are verbal response, motor response, and eye opening. Depending on the
response observed, each category is given a score ranging from 1 to 4 or 1 to 5, with a maximum score
of 15. The patient's prognosis improves with a higher GCS score. A severe brain injury is typically
indicated by a score of 8 or lower, a moderate brain injury is indicated by a score of 9 to 12, and a mild
brain injury is indicated by a score of 13 to 15. The GCS is a straightforward but useful tool for
determining a patient's level of consciousness and providing (Bibi et al., 2023).

A number of variables, such as GCS, age, gender, intracranial pressure, hypoxia, pupil size and
responsiveness, and computed tomography results, influence the outcomes of head trauma. Every patient
in our region is initially admitted to the emergency room and then moved to the intensive care unit
(ICU). The purpose of the study is to investigate the prevalence and causes of head injuries.
Additionally, it concentrates on identifying and characterizing the predictive variables that can be
applied in the emergency room and serve as markers of a poor prognosis. (Shaikh et al., 2022).

An increase in intracranial pressure is one of the most frequent side effects of moderate to severe
traumatic brain injury (m-s TBI). Increases in intracranial pressure (ICP) can lead to traumatic
intracranial hypertension, which is strongly correlated with poor outcomes and encourages additional
damage to the injured brain. Thus, ICP monitoring and treating tIH with an intensified approach in
response to elevated ICP are essential components of the neuroprotective management of m-s TBI
intensive care unit (ICU). (McNamara et al., 2023).

Over 50 million people experience a traumatic brain injury (TBI) each year, and it's predicted that
roughly half of all people will experience one or more TBIs in their lifetime. (Maas et al., 2022).

Traumatic brain injuries affect over 10 million people annually (TBIs). Even with efforts to enhance
care, traumatic brain injury (TBI) continues to be a public health issue, contributing to high rates of
morbidity and mortality among youth. According to projections by the World Health Organization
(WHO), traumatic brain injury (TBI) is expected to rank third in terms of death and disability by 2020,
making it one of the most urgent and underappreciated public health issues. Road traffic accidents
(RTAs) and violence have been found to be the primary causes of traumatic brain injuries (TBIs) and to
be associated with a high death rate in low- and middle-income countries over the past 17 years.(Dunne
J et al.,2020).
Despite the lack of high-quality prevalence data, it is estimated that 7.7 million people in the European
Union and 5.3 million people in the USA respectively have a disability related to a traumatic brain
injury. TBIs affect 1.7 million people annually. Of these injuries, 1.4 million are being treated in ERs; of
these, about 275,000 are admitted to hospitals and 52,000 die. (Roozenbeek et al., 2013).

Based on information from public sector hospitals, the annual incidence of head injuries in Pakistan has
been estimated to be 50/100,000 population. (Umerani et al., 2014)

Following a thorough evaluation and implementation of all first aid protocols in the emergency room,
TBI patients' immediate prognosis was divided into four groups. "Disposed – immediately discharged"
(n = 3,711; 66.9%) was the most frequent result. A total of 549 (9.9%) patients were admitted, 405
(7.3%) patients were transferred from the ED to another medical facility, and 881 (15.9%) patients were
kept in the ED for intervention and monitoring before being released. (Yaqoob)

While secondary prevention programs are primarily focused on enhancing the trauma care system,
primary prevention programs include interventions that improve workplace safety, vehicle and road
infrastructure safety, and both. Targeting specific risk groups, such as elderly singles, children from
socially disadvantaged backgrounds, and drivers and cyclists, is a useful strategy to increase the
effectiveness of primary prevention programs. Effective national strategies for TBI prevention include
statutory limits on speed limits for users of the road, infrastructure upgrades (such as separating cyclists
and pedestrians from motorized vehicles), and better street lighting. The usage of safety systems in cars
and protective headgear are examples of secondary non-medical preventive techniques. The frequency
and seriousness of head injuries for both men and women are greatly decreased when helmet use is
required ((Fatuki et al., 2020).
1.2 Problem Statement:

A cross sectional study is conducted in Pakistan at Faisalabad. To assess the outcome of traumatic brain
injury. In previous study proper care do not provided to traumatic brain injury patients. That’s way the
patients suffered from life threatening condition. Therefore more complication arises related to the
outcomes of traumatic brain injury. In this study to assess the outcome of traumatic brain injury. It is
important to assess the outcomes of traumatic brain injury to prevent from complications.

1.3 Problem Significance:

Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality in both adults and
children. As with other sever injuries, the outcome of TBIs is also gravely related to the quality of
emergency care .Effective emergency care significantly contributes to reduces morbidity and mortality.
An area of injured brain visualized over computer tomography (CT) scan also helps understand the
severity of the injury and its outcome. As with other severe injuries, the outcome of TBIs is also gravity
related to the quality of emergency care.

1.4 Hypothesis formulation

 Null hypothesis:

Emergency department cannot lead towards patient with brain traumatic injury.

 Alternative hypothesis:

Outcome of patient can lead towards with patient of brain traumatic injury.

1.5 Objective of the study:

To assess the emergency department outcome of patients with traumatic brain injury.
 Chapter: 2

Literature review

2.1 Search Strategy

This literature review focus on processing, evaluating, synthesizing & summarizing information to
assess the relevance of examined literature efficiently. The database searched included Google
Scholar .Term used to initiate the search: outcome of patients through traumatic brain injury .This search
was limited to English. Thirty articles retrieved out of which only twenty five were relevant

2.2 Literature review

A cross-sectional hospital-based survey was conducted about outcome of patients regarding traumatic
brain injury Abet at Hospital. 304 traumatic brain injury patients were selected in this study .The tool
used for data collection was structured questionnaires from the trauma registry and patient chart .The
collected data were entered, cleaned, edited, and analyzed using SPSS 25.0 version statistical software
descriptive analyses of independent variables were reported as numbers like percentages, and mean ±
standard deviation .Study finding show 201 patients had mild traumatic brain injury the rest had
moderate to severe traumatic brain injury. The mortality rate of severe, moderate, & mild TBI were
25%, 8.0% & 2.0%.On the basis of finding the researcher showed that road traffic injury was the
commonest cause of traumatic brain injury which affected young age groups.( Hagos, A et al.,2022).

In previous study conducted about clinically diagnosed with mild head injury with a head CT scan
performed at the emergency department of Malaga National Referral Hospital (MNRH) in Uganda.259
adult patients were selected in this study. A clinically validated method called the Canadian CT head
rule (CCHR) is used to predict which individuals with moderate head injuries will have a head CT scan
that reveals a clinically significant intracranial injury. Epi data software version 3.1 was used to double
enter the structured questionnaire data, which was then exported into STATA software version 14.0 for
cleaning and analysis The Canadian CT head rule (CCHR) should be used by the emergency department
to assess whether head CT scans of patients with mild traumatic head injuries are suitable. These
patients' most common clinical symptoms were headache, bleeding from the injury site, and loss of
consciousness. The major CT scan findings included comminuted and depressed skull fractures. The
results showed that, according to the CCHR, 70.7% of patients with mild head injuries had appropriate
head CT scans performed; this means that, when the CCHR is used, about one-third of the head CT
scans that these patients had at the ED were inappropriate and could have been avoided.( Babied, D et
al.,2022).

A retrospective study was conducted about outcome after decompressive craniotomy (DC) of patients
regarding traumatic brain injury at Aga Khan University, Karachi in Pakistan. Total of 98 patients who
underwent DC during the study period were included in this study. Statistical Package for Social
Sciences (SPSS) version 20.0 was used for performing statistical analysis. While mean (standard
deviation) or median (interquartile range [IQR]) were computed for quantitative variables. Statistical
tests included Chi-square or Fisher’s exact test for comparison of proportions, Student’s t-test for
comparison of means, and Wilcoxon signed rank-sum test for comparison of median rank .On the basis
of findings the researcher suggests the primary DC afforded an acceptable functional outcome (GOSE
score ≥5) in 45.9% of patients. Young age and lower GCS at presentation were associated with worse
survival. GCS score on discharge was a strong predictor of functional outcome. (Khan, F et al., 2018).

The cross-sectional study was conducted at the intensive care unit of Pak Emirates military hospital in
Rawalpindi. A total of 58 patients were admitted in the intensive care unit with head injury during the
study period and the sampling was done through non probability consecutive sampling technique .Data
collected were analyzed using SPSS 24.0 in this study. On the basis of finding the researcher suggests
that twenty-nine patients (50%) survived and were shifted to the wards or High Dependency Unit while
29(50%) patients died in the critical care-unit. Low Glasgow-Coma-Scale (GCS) score at the time of
presentation and severe Kampala-Trauma-Score (KTS) class was associated with the presence of poor
outcome in our sample population. (Khan, J et al., 2023).

Previously, retrospective study was conducted about the patients with delayed presentation after head
trauma can lead to missed traumatic brain injury a t a tertiary care hospital in Karachi in Pakistan .All
types of patients were selected in this study. The tool used for data collection was predesigned
questionnaire. Data collected were analyzed using SPSS 21.0.Study finding show that 52% of early and
late presenters had severe injuries, and 2.3% died. 32.2% of patients with head trauma had CT after 24 h.
Early presenters were 46.7% traumatized, while late presenters were 63%.On the basis of finding the
researcher suggests that a sizable fraction of patients who arrive after 24 hours and have experienced a
brain injury. The NICE standards are not very sensitive when it comes to individuals who present more
than 24 hours after suffering a head injury. These patients make up a sizable fraction of trauma patients,
and if a CT scan is not done, injuries may go undetected (Khan, M et al. 2023).
A prospective cross-sectional study was conducted about outcome of surgically treated regarding Acute
Subdural Hematoma in the Department of Neurosurgery, Ayyub Teaching Hospital Abbottabad.82
patients were selected in this study .Data collected were analyzed using SSP IBM-24. The results
indicate that falls from a height account for 47.6% of all causes. There is frequently an association
(28%). Mortality overall: 39.2%. 29.2% of men and 9.7% of women die of illness. After surgery, the
death rate was greater (18.2%) compared to 12. Compared to normal pupils (7.3%), those with abnormal
pupils had a greater mortality rate (31.9%). No fatalities when the hematoma was 16 mm thick. When
the midline shift was greater than 11 mm, 25/29 people died .On the basis of findings the following
variables are predictive of a surgically treated traumatic acute subdural hematoma: time to operation,
pupils, midline shift, hematoma thickness, and GCS at presentation. Better results are linked to
hematoma width, normal pupils, and GCS > 9. (Khalid, S et al., 2023).

Previously cross sectional study conducted about prevalence of intracranial bleeding in head traumas
Faisal Hospital, Faisalabad in Pakistan.165 patients were selected by a convenient sampling technique.
After gaining assent, data was gathered using closed-ended self-modified questionnaires, and statistical
software such as SPSS version 22 was used for analysis. A computed CT scan revealed acute intracranial
hemorrhage in 25 (15.3%) of the 165 patients with head injuries. Nine (36%) subdural hemorrhages, five
(20%) subarachnoid hemorrhages, seven (28%) epidural hemorrhages, and four (16%) intraparenchymal
hemorrhages were found in the twenty-five individuals. The 165 patients had a history of 39 (23.6%)
falls, 71 (43.1%) traffic accidents, and 55 (33.33%) other traumatic injuries. The age group of 16 to 30
years was shown to have the highest incidence of brain hemorrhage. Men suffered intracranial bleeding
at a higher rate than women (72%).On basis of findings researcher suggests that a 15.3% of patients with
head injuries had intracranial hemorrhages detected by CT scan. In this investigation, subdural
hemorrhages were the most common form. When compared to other types of traumatic injuries,
automobile accidents were the most common cause of cerebral bleeding (Khichari, A et al., 2023).

A prospective observational study was conducted about management and outcomes of patients regarding
severe traumatic brain injury at the Department of Neurosurgery of a tertiary care hospital.279 patients
were selected in this study .Data collected were analyzed using SPSS 24.0.Study finding shows that At
three months, 118 (42.3%) of the patients with severe traumatic brain injury had good results, while 161
(57.7%) had poor results. Arrival pupillary reactivity and arrival GCS were statistically significant
outcome factors in our study (p = 0.040 and 0.010, respectively). At three months, the overall death rate
was 35.13% (98).On basis of findings researcher suggests that Severe TBI patients have a high
morbidity and fatality rate. Arrival GCS and pupillary response were crucial variables that considerably
changed the result. (Passim, A et al.,2023).

A retrospective study was conducted about outcome of patients regarding traumatic brain injury at
Chandka Medical College/ Civil Hospital Larkana.198 patients were selected in this study.The
radiological, clinical, basic demographical, and biological data were collected in this retrospective
study.Data collected were analyzed in univariate form. Study finding shows that the 42 patients died in
this study and the deaths of these individuals were largely caused by the presence of low Glasgow coma
scale values, bilateral mydriasis, shock, high injury severity scores, and cardiac arrest. Meningeal
hemorrhage, subdural hematoma, and cerebral hematoma were linked to poor outcomes. A correlation
was observed between a poor prognosis and both brain hematoma and cardiac arrest.On the basis of
findings researcher suggests revealed meningeal hemorrhage, intracranial hematoma, and subdural
hematoma were linked to death. Prehospital treatment must be enhanced if the prognosis for severe
traumatic brain injury is to be improved. Avoiding pointless resuscitations is also advised. Additionally,
it is critical to obtain a head CT scan as soon as feasible in order to identify any operable mass lesions
(Shaikh, M et al.,2022).

The cross-sectional study was conducted at the neurosurgery trauma unit of the Lady Reading Hospital,
a tertiary care hospital of Peshawar, Pakistan.5047 patients were seiected in this study.Data collected
analysis were done on SPSS v.23. Frequency and percentages were calculated for age groups, gender,
mode, and severity of the injury, and outcomes .Study findings shows that there were 1358 (26.9%) girls
and 3689 (73.1%) boys. The age groups that were most frequently impacted were 0–10 years old
(25.6%) and 21–30 years old (20.1%). The most common cause of injury (38.8%, n = 1960) was traffic
accidents, followed by falls (32.7%, n = 1649). The majority of TBIs (93.6%, n = 4710) were moderate.
Following the comprehensive initial assessment and workup, as well as the completion of all first-aid
management, the immediate results were categorized into four groups. The most common group (67.2%,
n = 3393) was classified as "disposed (discharged)," while 9.3% (n = 479) were admitted for additional
care.On the basis of findings the researcher suggests that a generally accepted picture of Pakistani
epidemiological data about the prevalence of traumatic brain injury. We need further research on mild
traumatic brain injury (TMBI) in population-based studies because a significant number of patients
experienced mild TBIs and there is a high likelihood that mild TBIs are not properly diagnosed (Khan,
M et al.,2021).
A cross sectional study was conducted about characteristics and outcome of patients regarding traumatic
brain injury at Intensive Care Unit of a Public Sector Hospital in Karachi, Pakistan.127 patients were
selected in this study .Data collected were analyzed using descriptive statistics like mean and standard
devitation .Study findings show that there were 116 (91.3%) men and a mean age of 30.9 ± 13.6 years.
72 individuals (56.7%) acquired a CNS infection. Out of the 72, 29 (40%) had a positive CSF culture,
and 28 (38.8%) harbored multidrug-resistant Acinetobacter spp. that were only susceptible to colistin. In
63 (87.5%) of the patients, intravenous colistin combined with meropenem was given as part of an
antibiotic therapy. Age (p-value 0.047), kind of operation (p-value 0.001), duration of ER stay (p-value
0.047), and cerebrospinal fluid (CSF) leak at presentation (p-value 0.045) were revealed to be
significantly associated with CNS infection. Sixty-three (65.4%) patients died. Low Glasgow coma scale
(GCS) at presentation (p-value 0.031) and CSF leak at presentation (p-value 0.031) were observed to
significantly correlate with death .On basis of findings researcher suggests that there was a high death
rate among traumatic brain injury patients. Strict infection management and prevention strategies are
necessary since there is a high correlation between intracranial infection and death (Naz, A et al., 2021).

A cross sectional study was conducted about the Frequency of Low Serum Cortisol Level of patients
regarding traumatic brain injury at department of Neurosurgery, Ayub Medical Institute, Abbottabad.264
patients were selected in this study .The tool used for data collection by consecutive (non-probability)
sampling technique. Data collected were analyzed using by SPSS 26.0.Study findings show that The age
range of the bulk of patients (42%) was 26 to 50. 77% of patients were men, more than females. 63% of
cases had a GCS between 9 and 12. Moreover, the cortisol levels of 88% of the patients were higher than
300 nm/L. Thirteen adults between the ages of 26 and 50, twelve between the ages of 2 and 25, and just
seven between the ages of 51 and 70 had hypocortisolemia. The group consisted of seven ladies and
twenty-five men. GCS varied from 3 to 8 in 12 individuals and from 9 to 12 in 86 instances .On the basis
of finding researcher suggests that the majority of patients recovered, early hypopituitarism was
common in severe TBI. It is required to identify concealed pituitary dysfunction in the course of the
rehabilitation process of TBI patients (Khan, A et al., 2022).

2.3 Gap analysis

In a recent study, researcher wanted to understand the outcomes of TBI in a specific group of people.
They collected data from medical record and looked at things like how well people recovered, their
abilities, and their quality of life. The study found that there were gaps in the outcomes of TBI. Some
individuals faced significant challenges in their daily lives, while other showed impressive resilience and
recovery. These findings highlight the need for more research and targeted intervention to improve
outcomes and support individuals with TBI on their journey to recovery.
 Chapter#3

Research Methodology

3.1 Study design

Cross sectional descriptive study design will be study used to assess the emergency department outcome
of patients with traumatic brain injury at Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

3.2 Study variable

The variables of this study are outcome and emergency departments.

3.3 Study setting

Data will be a study to assess the outcome of the traumatic brain injury among the Jinnah Postgraduate
Medical Centre, Karachi, Pakistan.

3.4 Study population

Patients of Jinnah Postgraduate Centre, Karachi, Pakistan will be recruited for the study.

3.5 Sampling techniques

Purposive random sampling technique will be used in this study.

3.6 Sample size

150 patients will be used in this study.

3.7 Study duration

Data will be collected between September, 2024 to November, 2024 at selected hospitals.

3.8 Inclusion criteria

 Patients with Traumatic brain injury.

 Age Limitation: 20 To 40 Years.
 Voluntary Participate and Give Consent.

3.9 Exclusion criteria

  Non Traumatic brain injury Patients.
 Age Limitation: Below 20 and Above 40 Years.
 Refuse to Participate in study.

3.10 Research Tools

For Data collection A structured Questionnaire Adopted by the Research, after the permission from
author by Email. And the Questionnaire will be filling from the patients of Traumatic brain injury after
the permission from the Medical Superintendent and Head Nurse of the ward .The consent will be taken
from the patients of Traumatic brain injury.

3.11 Validity and Reliability

Validity of data collection tools was done to ensure that, the study contents cover all assessment items
related to the study, and each tool contain assessment item that cover aim of the study and research
questions. The content validity was established by a panel of five expertise’s who reviewed the tool for
clarity, relevance, comprehensiveness, understanding, applicability and ease for implementation and
according to their opinion minor modification were applied.

Reliability of data collection tools was done by using Cronbach’s alpha test.Cronbach’s alpha test is a
reliability coefficient that provides a method of measuring internal consistency of test and measures.

3.12 Data collection procedure

I will approach selected participants after taking informed written consent after explaining the certain
benefits, purpose and other necessary information about the study and registration process. Data will be
collected through a self-developed structured questions and list of observational check. Participants will
be understand properly and answer the questions they have asked. Participants will be asked to answer
each questions based on their opinion and understanding. Participants will give 15-20 minutes to fill the
questioner. Participant’s anonymity will be respected during data collection. Confidentiality will be
insured. Ethical regulations will be strictly followed.

3.13 Data analysis plan

Data will be analyzed using computer software SPSS version 24. The analysis will include descriptive
and inferential statistics to answer the research questions. The test in this study will be used Z-test.
3.14 Ethical consideration

 Permission for data collection will be obtained from faculty of Jinnah Postgraduate Centre,
Karachi, Pakistan.
 Data will be collected from patients of Jinnah Postgraduate Centre, Karachi, who will work in
emergency departments and who will voluntarily participated in this study after getting approval
from the Medical Superintendent of Jinnah Postgraduate Centre, Karachi and signed consent
from participants.
 Subject will be informed that they have a right to participate or not to participate and will explain
that there information will be kept confidential.

PRISMA CHART:
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 CONSENTFORMS
CONSENT FORM IN ENGLISH

Description of the Research and Your Participation

You are invited to participate in a research study conducted by Sana Maqsood. The
purpose of this research is to evaluate the “Traumatic brain injury outcome in
Pakistani emergency department”.

Risks and Discomforts

Mention if there will be any known risks associated with this research.

Potential Benefits
Mention if there will be benefits to the participant that would result from their participation in
this research.

Protection of Confidentiality
We will do everything we can to protect your privacy. Your identity will not be revealed in any
publication resulting from this study.

Voluntary Participation
Your participation in this research study is voluntary. You may choose not to participate and you
may withdraw your consent to participate any time. You will not be penalized in any way should
you decide not you participate or to withdraw from this study.

CONSENT

I have read this consent form and have been given the opportunity to ask questions.
I give my consent to participate in this study.

Participant’s Signature _ Date:

A copy of this consent form should be given to the participant.
 Questionnaires/tools

Age…..?

 10-20
 20-30
 30-40
 40-50

Gender…..?

 Male
 Female

What type of Trauma?

 RTA
 Fall
 Gunshot
 Other

What type of Severity of traumatic brain injury based on Glasgow coma score?

 Mild (13-15)
 Moderate (8-12)
 Severe (3-7)

What Immediate outcome?

 Admissions
 Detained
 Disposed
 Referred

Is the diabetes mellitus causes traumatic brain injury?

 Yes
  No

Is the hypertensive causes traumatic brain injury?

 Yes
 No

Is trauma cause mortality?

 Yes
 No

Is IHD (Ischemic heart disease) cause traumatic brain injury?

 Yes
 No

What is need for ICU admission?

 Yes
 No

What is need for mechanical ventilation?

 Yes
 No

Have you taken any neurological surgery performed?

 Yes
 No

Is a contusion a trauma?

 Yes
 No

Is subarachnoid hematoma (SDH) cause traumatic brain injury?

  Yes
 No

Is skull fracture cause traumatic brain injury?

 Yes
 No

Is there any pupillary related abnormalities?

 Normal
 One full dilated& non- reactive
 One mid dilated but non- reactive
 One mid dilated but reactive

Intubation…..?

 Yes
 No

Additional medical diagnosis?

 Yes
 No

Multisystem injury?

 Yes
 No

Complications?

 Yes
 No