Clinical Profile, Management, and Outcomes of Traumatic Brain Injury at a Tertiary Care Center in Western India: A Prospective Observational Study

Abstract

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with a disproportionately high burden in low- and middle-income countries. This study aimed to evaluate the epidemiology, clinical profile, management strategies, and outcomes of head injury patients presenting to a tertiary care center in rural Maharashtra, India.

Methods: A prospective observational study was conducted from June 2023 to May 2025 at a tertiary care hospital. A total of 151 consecutive patients with head injury were enrolled. Data on demographics, mechanism of injury, Glasgow Coma Scale (GCS), radiological findings (non-contrast CT head), management (conservative vs. surgical), and outcomes were collected and analyzed.

Results: The mean age was 38.4 years (range 0–92). Males predominated (78.8%, n=119). Road traffic accidents (RTAs) were the leading cause (74.8%, n=113), followed by falls (15.2%) and assaults (9.9%). Alcohol intoxication was noted in 43.7% of patients. Mild TBI (GCS 13–15) accounted for 64.2% of cases, moderate (GCS 9–12) for 19.2%, and severe (GCS 3–8) for 16.6%. Loss of consciousness was the most common symptom (66.2%). CT findings included contusions (52.3%), subdural hematoma (41.1%), subarachnoid hemorrhage (30.5%), and epidural hematoma (28.5%). Linear skull fracture was the most common fracture type (25.2%). Conservative management was employed in 75.5% of patients, while 24.5% underwent surgery (89.2% craniectomy, 10.8% burr hole). Favorable outcome (minimal/no disability) was achieved in 74.2% of patients, with mortality of 11.9%.

Conclusion: Young to middle-aged males involved in RTAs, often under alcohol influence, constitute the majority of TBI patients in this rural tertiary care setting. While most cases are mild and managed conservatively, a significant proportion require surgical intervention. Mortality remains substantial, underscoring the need for targeted prevention strategies and strengthened trauma care systems.