Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines.

• 发表时间: Sep 2020 6
• 来源期刊: BMJ Case Rep
• DOI: 10.1136/bcr-2019-233197
• PMID: 32895250
• 文章类型: Case Reports
• 作者列表: Samitinjay A,Karri SR,Khairkar P,Biswas R

关键词: adult intensive care; coma and raised intracranial pressure; neurosurgery; psychiatry; trauma

Mesh: Accidents, Traffic; Brain Injuries, Traumatic / economics therapy; Clinical Reasoning; Coma; Glasgow Outcome Scale; Guideline Adherence; Hematoma, Subdural / economics therapy; Humans; India; Male; Treatment Outcome; Young Adult

Abstract

Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity with a significant loss of functional capacity and a huge socioeconomic burden. Road traffic accidents are the most common (60%) cause followed by falls and violence in India and worldwide. This case discusses the story of a 23-year-old man with severe TBI-subdural haematoma, who presented in a comatose state. The patient was a purported candidate for emergency decompressive surgery as per Brain Trauma Foundation (BTF) guidelines but was managed conservatively. This case questions the plausibility of the BTF guidelines for severe TBI, particularly in rural hospitals in India and how such cases are often managed with clinical judgement based on the review of literature. The patient recovered well with a perfect 8/8 on Glasgow Outcome Scale Extended Score.