Effect of head positioning on outcome after burr hole craniostomy for chronic subdural haematoma.

OBJECTIVE: To determine the effect of position of the patient's head after burr hole craniostomy on the outcome of chronic subdural haematoma, in terms of haematoma efflux, hospital stay and recurrence rate. STUDY DESIGN: Quasi experimental. PLACE AND DURATION OF STUDY: Combined Military Hospital, Rawalpindi, from February 2007 to February 2008. METHODOLOGY: Sixty patients were divided in two equal groups of 30 patients each. Group A patients were kept flat after the burr hole craniostomy and group B patients were kept with head end of bed elevated by 30 degrees. The results were statistically analysed through software SPSS 14. RESULTS: The mean age was 59.98 +/- 13.7 years. There was predominance of males (M:F=3.2:1). The location of haematoma was frontoparietal in majority (72%), right sided in 31 (51.6%), left sided in 20 (30%) and bilateral in 9 (15%) patients. Average daily output was 152 ml in group A and 142 ml in group B. Haematoma efflux was found to be sufficient in 26 (86.6%) patients of group A and 27 (90%) of group B. Wound infection occurred in 2 patients of group A and 1 in group B. Seizures occurred in 2 patients of group A and 3 of group B. Although, there was longer hospital stay for group A vs. group B (p=0.002), recurrence rate was insignificant amongst the two groups as 10% vs. 13% (p=0.688). CONCLUSION: Assuming a 30 degrees head up position soon after operation in cases of chronic subdural haematoma does not significantly affect the outcome and recurrence.

Head trauma due to earthquake October, 2005 - experience of 300 cases at the Combined Military Hospital Rawalpindi.

OBJECTIVE: To assess the spectrum and management of head injuries among earthquake victims. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The study was conducted at Surgical Ward II, Combined Military Hospital, Rawalpindi, from October 2005 to December 2006. PATIENTS AND METHODS: Three hundred consecutive cases of head injury, secondary to earthquake were included in the study. Plain X-rays of skulls were undertaken in clinically stable patients with head injuries. Cases with altered level of consciousness and compound depressed fractures were advised CT scan of head. Pus swabs were taken from open wounds. Proformas were maintained for every patient. Head injury was classified as mild, moderate and severe, and each patient was treated accordingly. RESULTS: One hundred and twenty three (41%) patients were children under 10 years of age. Adults below 55 years were 69 (23%) and above 55 years were 108 (36%). Mean age was 32.2 years (SD + 6.7). Female to male ratio was 1.1:1. One hundred and sixty five (55%) cases were of mild head injury, 103 (34.3%) patients had moderate head injury and 32 (10.7%) patients had severe head injury. Majority (48.7%) of patients was managed conservatively. Minor surgeries were done in 17% of patients and major surgeries were done in 34.3% of patients. Glasgow Outcome Scale assessment was made at the end of 6 months and 1 year. Mortality increased from 3.3% to 7% in one year time. CONCLUSION: Patients at the extremes of age are more vulnerable to trauma and should be given timely attention in disaster management plans. General and trauma surgeons should be well-versed with the techniques and indications of burr hole evacuation of life threatening intracranial haematomas in situations, where early evacuation is unattainable.