title: Remaining unconscious: The burden of traumatic brain injuries in India.
abstract: BACKGROUND
  It is well-known that severe traumatic brain injuries (TBI) have a poor outcome. However, what is not well-known is the outcome for those who survive but remain unconscious at the time of discharge from the hospital.
  
  
  OBJECTIVE
  To assess the outcome of severe TBI patients who have a motor response of M5 or lower on the Glasgow coma score (GCS) at discharge from a single centre in India.
  
  
  METHODS
  In this retrospective study carried at one trauma centre in India, a prospectively maintained neurotrauma registry was queried from May 2010 to February 2013 for patients who had severe traumatic brain injury (GCS ≤ 8) at admission and had a motor response of M5 or lower on the GCS at discharge. Demographic and clinical data were analyzed, and outcome Glasgow outcome scale (GOS) assessed at 6 months using a telephonic questionnaire.
  
  
  RESULTS
  There were a total of 1525 patients with severe TBI in the study period. Of these 166 (10.9%) were unconscious (motor response M5 or lower on the GCS) at discharge from the hospital. 139 were males and 27 females with a mean age of 33.9 years. After a mean hospital stay of 24.31 days, the discharge motor score was M5 in 32 (19.3%), M4 in 44 (26.5%), M3 in 59 (35.5%), M2 in 44 (26.5%), and M1 in 9 (5.4%). Telephonic follow-up was available in 102 (61.4%) of the patients. 54 (52.9%) patients had died and 32 (31.4%) remained unconscious (vegetative) at 6 months. Only 16 patients (15.7%) had a good outcome (GOS 1-2) at 6 months following an injury.
  
  
  CONCLUSIONS
  This is the only study of its kind on patients who remain unconscious at discharge following severe TBI and reveals that around 50% will die and another 30% remains vegetative at 6 months of discharge. Only a small percentage (15% in our study) will become conscious and partially integrated in the society.
authors.affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agrawal
authors.affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: D K
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: G D
authors.initials: GD
authors.lastname: Satyarthee
authors.affiliation: Department of Surgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
keywords: Head injury; mortality; outcome; severe traumatic brain injuries; unconscious; vegetative