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ORIGINAL ARTICLE
ABSTRACT
Introduction: Traumatic brain injury is a major cause of morbidity and mortality worldwide, and has been reported to be
one of the risk factors for epileptic seizures. Abnormal blood lactate(LAC) and base deficit(BD) reflects hypoperfusion
and could be used as metabolic markers to predict the outcome. The aim of this study is to assess the prognostic value of
BD and LAC levels for post traumatic convulsion(PTC) in head injury patients.
Materials and Methods: All head injury patients with PTC were studied for the demographics profile, mechanism of injury,
initial vital signs, and injury severity score(ISS), respiratory rates, CT scan findings, and other laboratory investigations.
The data were obtained from the trauma registry and medical records. Statistical analysis was done using SPSS software.
Results: Amongst 3082 trauma patients, 1584 were admitted to the hospital. Of them, 401patients had head injury.
PTC was observed in 5.4%(22/401) patients. Out of the 22 head injury patients, 10 were presented with the head injury
alone, whereas 12patients had other associated injuries. The average age of the patients was 25years, comprising
predominantly of male patients(77%). Neither glasgow coma scalenor ISS had correlation with BD or LAC in the study
groups. The mean level of BD and LAC was not statistically different in PTC group compared to controls. However, BD
was significantly higher in patients with associated injuries than the isolated head injury group. Furthermore, there was
no significant correlation amongst the two groups as far as LAC levels are concerned.
Conclusion: Base deficit but not lactic acid concentration was significantly higher in head injury patients with associated
injuries. Early resuscitation by prehospital personnel and in the trauma room might have impact in minimizing the effect
of post traumatic convulsion on BD and LAC.
Key words: Base deficit, convulsion, head injury, lactic acid, trauma
Background
Studies performed over the past two to three decades have
reported that the incidence of clinical seizure activity after
brain injury ranges from 5 to 15%. Focal and generalized
clinical seizures occur with greater frequency in patients,
who are more severely injured, with a frequency of 8 to
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DOI:
10.4103/1793-5482.145117
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Results
Of the 3082 trauma patients presented to our trauma center,
1584patients were admitted; of them, 401patients had head
injuries. Amongst the head injury patients, 70.8% (284/401)
had GCS > 8 and the remaining 29.2% (117/401) patients had
GCS < 8. During the study period, 22 of 401(5.4%) patients
were identified with post traumatic convulsion. Post traumatic
convulsion occurred at scene in 12patients and in trauma
room in 13patients (three patients had their second attack in
the trauma room).
Average age of the patients was 25years, and majority was
male patients (77%). In thirteen patients, mechanism of
injury was motor vehicle crash (MVC), seven patients were
pedestrian struck by a car, and two had fallen from height.
Seventeen patients (77%) were intubated for low GCS or to
control convulsions and protect airway. ISS was<14 in 7(32%)
patients and>14 in 15(68%) patients.
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Discussion
Traumatic brain injury is a significant cause of morbidity and
mortality worldwide and has been reported to be one of the
major risk factors for epileptic seizures. Posttraumatic epilepsy
following severe head injury characterized by recurrent
Table 1: Diagnostic profile of 22 head injury
patients, based on CT scan
Diagnosis
Concussion
Skull fracture
Skull base fracture
Fracture facial bones
Hematomas
EDH
SDH
SAH
Diffuse axonal injury
Hemorrhagic contusions
Total
Number of lesions*
Operations
7
7 (depressed in 3 patients) 2 bone elevation
3
5
3
5
1 craniotomy
with evacuation
1 craniotomy
with evacuation
3
4
10
22
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0HDQ
*&6
,66
6WXGLHGSDWLHQWV
Figure1: The correlation between GCS and ISS amongst head injury
patients
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%DVHGHILFLW
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6WXGLHGJURXSSDWLHQWV
0HDQ
,VRODWHGKHDGLQMXU\
$VVRFLDWHGLQMXULHV
6WXG\JURXS
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,66
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/DFWDW
2.98
2.67
P value
0.03
0.21
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Conclusion
BD and LAC are still accurate indicators of injury severity in
trauma patients. In our study, population with posttraumatic
149
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