Outcome of "DESTITUTE" Head Injury Patients at a Tertiary Care Neurosurgical Centre: A KGMU Experience of 10 Years

Introduction Many patients are admitted to hospitals as destitute or unknown, after having met with accidents. What happens to these patients after admission is not much reported in world literature. With the ever increasing number of road traffic accidents (RTAs), a significant number of such patients are reported worldwide. Material and Methods We conducted a retrospective analysis of the departmental case records of destitute patients from January 2009 till December 2018 in our institute. The mode of presentation, demographic profile, computed tomography scan findings, hospital course, and outcome at discharge were analyzed. Results Out of 128 patients, there were 114 (89.1%) male patients, maximum being in the 21 to 30 years age group. The mean age was 36.4 years with ages ranging from 10 to 70 years. The average length of stay in hospital was of approximately 6 days with maximum being 37 days. The main cause of head injury was RTA in 66 patients (51.5%). Majority, that is, 84 patients, had a Glasgow Coma Scale score of < 8 at admission. Forty-two head injury patients were operated in all, while the rest were managed conservatively. Forty-nine (38.2%) patients died in hospital, and 44 (34.3%) patients had good recovery. During treatment, 16 (12.5%) patients took discharge against medical advice, while identity of 63 (49.2%) patients could be established out of which 5 (3.9%) patients were either discharged to home while 51 (39.8%) patients were referred to their district hospital. Two patients (1.5%) remained unknown and were sent to destitute homes for rehabilitation. Conclusion Unknown head injury patients are usually neglected and their outcome is poorer in comparison to other patients. Their management is fraught with challenges. They need special care for which staff should be well trained and hospital must have economic resources and a good network of social workers.