Table of Contents  
Year : 2016  |  Volume : 9  |  Issue : 4  |  Page : 465-468  

Time of admission and outcome in traumatic brain injury patients

1 Department of Neurosurgery, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
2 Scientist C, VRDL Project, National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India
3 Department of Community Medicine and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
4 Department of Pharmacology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
5 Department of Forensic Medicine, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication12-Jul-2016

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-2870.186064

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Introduction: In spite of heterogeneous manifestation of traumatic brain injury (TBI), it is affected by multiple factors at the time of admission. This pilot study aims to detect the effect of admission time, day, and month with outcome at discharge, among patients with TBI. Materials and Methods: It is a prospective study conducted in the Department of Neurosurgery at Narayana Medical Health Hospital, Nellore. The head injury patient data were documented on a standard proforma. FileMaker Pro Advanced 13 was used for electronic data entry interface. The analysis was done using Stats Direct version 3.0.150. The variables in categories and continuous were evaluated with descriptive and frequencies, respectively. Results: In the study, 337 head injury patients were reported with 7.12% (n = 24) mortality. The hospital discharge outcome was significant with age, gender, severity of injury, and seasons. More number of patients were admitted during 9 pm to 7 am, but was not significant. During all the seasons of a year, there was significance with admittance of head injury patients in working days of a week and patients' undergoing intracranial surgery. Conclusion: The pilot study reports that the outcome at discharge of a head injury patient has significance with admission at week, day, and season.

Keywords: Admission time, deaths, discharge outcome, seasons, traumatic brain injury, weekday, weekend

How to cite this article:
Agrawal A, Munivenkatappa A, Rustagi N, Rammohan P, Subrahmanyam BV. Time of admission and outcome in traumatic brain injury patients. Med J DY Patil Univ 2016;9:465-8

How to cite this URL:
Agrawal A, Munivenkatappa A, Rustagi N, Rammohan P, Subrahmanyam BV. Time of admission and outcome in traumatic brain injury patients. Med J DY Patil Univ [serial online] 2016 [cited 2022 Oct 5];9:465-8. Available from:

  Introduction Top

Emergency management of head injury patients is very critical; there are multiple factors that affect the outcome such as the period of admission that includes time, day, and month. It cannot be overemphasized that at any time of the day, the critically ill patients can present to the hospital,[1] and first few hours can be crucial to the patient outcome.[2] A number of studies have correlated the admission time and final outcome of the patients in various systemic disorders in emergency as well as in critical care units.[3],[4],[5],[6],[7],[8] The present study analyzes the data from a pilot study to understand whether there is any significance between the period of admission and outcome at discharge of the patient admitted with the diagnosis of traumatic brain injury (TBI).

  Materials and Methods Top

A total of 337 consecutive head injury patients were admitted to the Emergency of Narayana Medical College and Hospital, Nellore, Andhra Pradesh (India). The data were collected on predesigned proforma. Consent of all patients or patients' relatives was sought. The study was approved by the Institute Ethical Committee and in compliance with institute's requirement. The following clinical injury period and outcome was collected for evaluation: patient's personal data, time, day, and month of injuries sustained, severities of injury assessed with Glasgow coma scale score (GCS), management and outcome at discharge. The data entry was made using FileMaker Pro Advanced 13 (Copyright © 1994-2015, FileMaker, Inc.) and web data entry interface Drupal CMS (

Statistical analysis

A crude analysis of 337 was performed, and discharge outcome at alive and death was compared with time, day, and season of injury. The data were analyzed using StatsDirect version 3.0.150 (Stats Direct Ltd., StatsDirect statistical software. England: StatsDirect Ltd., 2015.). Continuous variables were expressed as mean. Categorical data were expressed as numeric values and percentages. Comparison of categorical data was performed using Chi-square test. P< 0.05 (two-tailed) was considered statistically significant.

  Results Top

During the study period, 337 head injury patients were evaluated. In 2013, 2014, and 2015, there were 77 (22.8%), 220 (65.2%), and 40 (11.8%) patients, respectively. Twenty-four (7.12%) patients expired during the study period. The details of time, day, month, week, and season with outcome are detailed in [Table 1]. Only admission seasons were significant (P< 0.05) with patient outcome. [Table 2] highlights age, gender, and severity as per GCS, which are significant (P < 0.05) with outcome. Seasons were significant (P< 0.05) with week and intracranial surgery [Table 3].
Table 1: Demonstrates time, day, month, week, and season during which head injury patients were evaluated and their outcome

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Table 2: Age, gender, and severity of injury with outcome

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Table 3: Depicts season with gender, week, severity of injury and surgery

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  Discussion Top

The current study is an attempt to explore the momentous between the period of admission and outcome at discharge. The findings from the present study summarize that highest number of head injury patients was recorded between 9 pm and 7 am with more deaths. During mid-week, more patients were documented such as on Tuesday (n = 57) and Wednesday (n = 53), but deaths were more during weekends. In postmonsoon season (n = 90), more patients were admitted with head injury followed by summer (n = 85). During all the seasons, significant number of patients were admitted in weekdays. Patients undergoing intracranial surgery during all seasons were significant. The outcome at discharge was significant with age; as expected, more admittance and deaths were in middle age group. Gender had significance with outcome, but female group had more deaths (15.7%) than male group (5.8%). Severity of injury as per GCS was significant with discharge outcome.

The timing of injury is an important factor that affects outcome.[6],[7],[9] Studies have categorized injury timing based on peak traffic hours and office hours and night times.[10],[11] We have categorized the timings based on traffic hours and our results report that highest number of accidents and deaths were reported between 9 pm and 7 am. In a study where pattern of pedestrian head injuries were evaluated in detail, it reveal that the offending vehicle responsible for injury was not known in 41% of night time admissions.[10] During night times, most of the roads are darker due to poor lightning and/or sometimes vehicles are in bad condition without lightning. Damages caused under these circumstances can be a hit and run condition, where accidents are either unnoticed or very severe and can lead to more deaths during night times. Studies have shown that more deaths were reported from night time admitted patients, they have not only reasoned possible injury circumstances, but also the lesser availability of hospital staff.[6],[7],[9]

The days in a week structure are an important aspect in injuries.[4] Our study result reveals that more number of hospital admissions was seen in mid-week such as on Tuesday and Wednesday and also significant number of emergency admittances during weekdays throughout the years. Inside the city, most of the vehicle load is expected in weekdays as public is busy in traveling to job destinations irrespective of seasons. The study reports more adverse outcome in weekends, although the discharge outcome did not appear to differ between week/weekend admissions. This might be due to the fact that patients might have influenced by alcohol or high speed of vehicles as roads are free. In a study, it was observed that patients presenting to the emergency department with upper gastrointestinal bleeding manifested with higher risk of bleeding and deaths in weekends as compared to weekdays.[4]

The literature on brain injury admittance in various seasons from developing countries is meager. Our study reports that higher number of head injuries admitted to emergency was seen in autumn followed by summer season. In a study, analyzing nasal bone fracture has reported higher number of cases from autumn season about 29%, although no significance was observed as compared with other seasons.[12] Another study on maxillofacial injuries reported higher cases in summer season.[13] The probable reasons for higher cases of admittance in autumn are mild temperature conditions and celebration of festivals with huge crowd in public.

There is significance between brain injury patients' gender and discharge outcome.[14] Our study result reports that female gender has higher deaths as compared to males. The same is reflected in a study from Scotland where TBI-induced death at 1 year follow-up was more in female (13.5%) than male (8.5%).[14] And also, an institutional study from India from our group reports that the female (3.4%) deaths are more than male deaths (1.6%) in brain injury patients. Our study has limitations concerning the small sample of patients and the study was carried out in only one center. In our analysis, we have not taken multiple factors that may significantly affect the result.

  Conclusion Top

The current pilot study provides an eloquent insight in brain injury area from a developing country. The period of admission is significant with discharge outcome. Higher numbers of brain injury patients were admitted in mid-week and in autumn and summer season. The worse outcome at discharge was seen among weekend admissions. The present study has many limitations; for example, there were not enough details to analyze the time since injury and to seek the hospital care, location of injury (rural vs. urban), and time taken to seek the definite care. Further studies with larger samples and multi-institutional integration are required to provide better insight in this area and address these limitations.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.  Back to cited text no. 2
Ju MJ, Tu GW, Han Y, He HY, He YZ, Mao HL, et al. Effect of admission time on mortality in an intensive care unit in Mainland China: A propensity score matching analysis. Crit Care 2013;17:R230.  Back to cited text no. 3
de Groot NL, Bosman JH, Siersema PD, van Oijen MG, Bredenoord AJ; RASTA study group. Admission time is associated with outcome of upper gastrointestinal bleeding: Results of a multicentre prospective cohort study. Aliment Pharmacol Ther 2012;36:477-84.  Back to cited text no. 4
Bracco D, Favre JB, Bissonnette B, Wasserfallen JB, Revelly JP, Ravussin P, et al. Human errors in a multidisciplinary intensive care unit: A 1-year prospective study. Intensive Care Med 2001;27:137-45.  Back to cited text no. 5
Laupland KB, Shahpori R, Kirkpatrick AW, Stelfox HT. Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. J Crit Care 2008;23:317-24.  Back to cited text no. 6
Barnett MJ, Kaboli PJ, Sirio CA, Rosenthal GE. Day of the week of intensive care admission and patient outcomes: A multisite regional evaluation. Med Care 2002;40:530-9.  Back to cited text no. 7
Luyt CE, Combes A, Aegerter P, Guidet B, Trouillet JL, Gibert C, et al. Mortality among patients admitted to intensive care units during weekday day shifts compared with “off” hours. Crit Care Med 2007;35:3-11.  Back to cited text no. 8
Uusaro A, Kari A, Ruokonen E. The effects of ICU admission and discharge times on mortality in Finland. Intensive Care Med 2003;29:2144-8.  Back to cited text no. 9
Pruthi N, Ashok M, Kumar VS, Jhavar K, Sampath S, Devi BI. Magnitude of pedestrian head injuries & fatalities in Bangalore, south India: A retrospective study from an apex neurotrauma center. Indian J Med Res 2012;136:1039-43.  Back to cited text no. 10
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Pearse RM, Rhodes A, Grounds RM. Clinical review: How to optimize management of high-risk surgical patients. Crit Care 2004;8:503-7.  Back to cited text no. 11
Zhong Z, Fan X, Lian Z, Cheng Z, Zhuang Y. Clinal analysis of 202 nasal bone fractures cases. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014;28:1842-4.  Back to cited text no. 12
Al-Dajani M, Quiñonez C, Macpherson AK, Clokie C, Azarpazhooh A. Epidemiology of maxillofacial injuries in Ontario, Canada. J Oral Maxillofac Surg 2015;73:693.e1-9.  Back to cited text no. 13
McMillan TM, Teasdale GM. Death rate is increased for at least 7 years after head injury: A prospective study. Brain 2007;130(Pt 10):2520-7.  Back to cited text no. 14


  [Table 1], [Table 2], [Table 3]

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