title: Characteristics of patients who died from traumatic brain injury in two rural hospital emergency departments in Maharashtra, India, 2007-2009.
abstract: BACKGROUND
  Trauma is one of the leading causes of morbidity and mortality in the world and in India.
  
  
  OBJECTIVE
  To describe 1) selected epidemiological and clinical characteristics of persons with traumatic brain injury (TBI) who died within 24 h after admission to the emergency departments (EDs) of two medical facilities in rural India and 2) the methods used to transport these patients from the locale of the injury incident to the study sites.
  
  
  METHODS
  Medical records of all injured patients regardless of age or sex who died within 24 h after admission to both EDs during January 31, 2007 through December 31, 2009 were reviewed and abstracted. Demographic variables and information on prehospital care, time and mechanism of injury, mode of transport to EDs, and primary hospital resuscitation were abstracted and analyzed.
  
  
  RESULTS
  Of the 113 injured patients in this study, 42 had TBI and died within 24 h of ED admission. All of these TBI patients were transported to the ED by relatives or bystanders in non-ambulance vehicles. Most of the patients with TBI (78.5%) were 21-50-years-old; and overall 90.0% were males. Persons working near or along busy roads struck by vehicles accounted for 80.9% of all TBI cases. Severe TBIs were present in 97.6% of the patients; of these, 92.8% had a Glasgow Coma Scale (GCS) score of 3 on arrival. Other concurrent injuries included superficial lacerations (85.7%), facial injuries (57.1%), and upper (35.7%) and lower (30.9%) extremity fractures. Common lesions recognized on computed tomography (CT) scan were acute subdural hematoma (21.4%), subarachnoid hemorrhage with diffuse cerebral edema (16.6%), and skull base fracture with diffuse cerebral edema (14.2%); in 21.4% of cases, the CT scan were reported normal.
  
  
  CONCLUSIONS
  Most of the TBI patients who died within 24 h after admission to EDs in this study were not transported to EDs in emergency medical vehicles; most were of working age (ages 20-50 years); were male; and were day laborers working on busy interstate roads where they were hit by vehicles.
authors.affiliation: Department of Neurosurgery, Narayana Medical College and Hospital, Chintareddy Palem, Nellore, Andhra Pradesh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.affiliation: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA, United States.
authors.forename: Victor G
authors.initials: VG
authors.lastname: Coronado
authors.affiliation: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, Atlanta, GA, United States.
authors.forename: Jeneita M
authors.initials: JM
authors.lastname: Bell
authors.affiliation: Maharshi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India.
authors.forename: Nitish
authors.initials: N
authors.lastname: Baisakhiya
authors.affiliation: Datta Meghe Institute of Medical Sciences, Acharaya Vinoba Bhave Rural Hospital, Sawangi, Maharashtra, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Kakani
authors.affiliation: Maharshi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India.
authors.forename: Sagar
authors.initials: S
authors.lastname: Galwankar
authors.affiliation: Maharshi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Dwivedi
keywords: Emergency department; head injury; mortality; rural; trauma systems; traumatic brain injury