ABSTRACT
Introduction: In patients presenting to Emergency Department(ED) with traumatic brain injury, it is important to evaluate the neurological status to determine the present clinical status and to predict outcome of the patient. GCS is the most widely used score,but it has some drawbacks which led to the development of other scores such as the Full Outline of Unresponsiveness (FOUR) score. In our study, we compared the GCS and the FOUR scores in patients presenting with traumatic brain injury. Aims: 1) To compare the FOUR score with the GCS score in traumatic brain injury (TBI) patients. 2) To understand the effectiveness of FOUR score as an assessment tool. 3) To assess whether FOUR score is an alternative tool in TBI patients or could be complimentary. Methods: We conducted a prospective observational study at a trauma centre of a tertiary care hospital during January 2019 to March 2019 after taking institutional ethical committee approval. All patients presenting with clinical diagnosis of TBI were evaluated and given a GCS and FOUR score by the emergency physician. Relevant investigations were done and findings were noted. We tabulated all information in Microsoft Excel 2019 and statistical analysis was done with SPSS software. Results: The mean age of study population was 38.295+/- 15.33 years. Male patients were 79% and 21% were female patients. Road traffic accidents contributed highest percentages of causes of TBI (60%). By comparing the median value of FOUR score with mortality and the median value of GCS score with the mortality by using the Mann-Whitney test showed a p-value of ?1, which is statistically non-significant. Conclusions: FOUR score is equally reliable with GCS score. Both have their own significance
ABSTRACT
Introduction: Pediatric seizures are a common occurrence and frequent presentation to emergency department (ED). Seizures result from paroxysmal involuntary disturbance of brain function. The history and physical examination guide us to manage and assist in differentiating seizures from nonepileptic disorders. Methodology: This study was carried out to know the trends of paediatric seizures and their management in ED. We had included all patients less than 12 years of age with seizures, admitted to our hospital's pediatric ED between May and August 2012. All demographic findings, seizure characteristics and laboratory findings were recorded. Results: A total of 53 children were enrolled in the study of which 38 (71.7%) children were male and 15 (28.3%) were female. The mean age of presentation was 2.42 years. 66.7% of patients had generalized seizures and 33.3% of patients had partial seizures. Out of total study population, 49% had febrile seizures and 20.8% had afebrile seizures. The majority of seizures (69.8%) lasted less than 10 minutes of which 54% were afebrile. Status epilepticus (SE) was found most commonly in 30.2% children. Out of 16 patients with SE 10 (62.5%) were less than two years of age. The common causes of SE were fever, Central Nervous System (CNS) infection, and epilepsy, accounting for 31.3%, 37.5% and 31.2% respectively. The children with underlying CNS abnormalities (cerebral palsy) had poorer outcomes. Mortality found in SE (9.4%) was related to an acute neurologic insult or a chronic CNS condition. Metabolic abnormalities were detected in 28.3% patients. The frequency of metabolic abnormalities was significantly higher in patients under two years of age (66.7%). 53.7% had hypocalcemia, 33.3% had hypoglycaemia and 20% had hyponatremia. MRI (Magnetic resonance imaging) of brain or EEG (electroencephalogram) or both was carried out in only 13.2% patients. 85% of patients had undergone laboratory investigations. Lumbar puncture was performed in 26.4% patients.