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Table of Contents    
Year : 2020  |  Volume : 68  |  Issue : 3  |  Page : 545-546

Expert Commentary On Pearls From Past - “Mortality In Acute Head Injuries”

National Brain Research Centre, Manesar, Gurugram, Haryana, India

Date of Web Publication6-Jul-2020

Correspondence Address:
Prof. Prakash N Tandon
National Brain Research Centre, Nainwal Mode, Manesar, Gurugram - 122 051, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.289024

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How to cite this article:
Tandon PN. Expert Commentary On Pearls From Past - “Mortality In Acute Head Injuries”. Neurol India 2020;68:545-6

How to cite this URL:
Tandon PN. Expert Commentary On Pearls From Past - “Mortality In Acute Head Injuries”. Neurol India [serial online] 2020 [cited 2021 Jun 13];68:545-6. Available from:

First, a few words about Professor Dayanand Rao, one of my seniors and a personal friend, whom I had met 10 years before this paper was published. He was then on a visit to Oslo, after completing his training under Mr. G. F. Row Botham, a renowned neurotraumatologist at Newcastle upon Tyne and I was in the beginning of the training at Ulleval Hospital under Professor Kristiansen. It so happened that the head injuries became a subject for both of us. Besides other things, this strengthened the bond of our friendship. This is not the place to write about the unique traits of his head and heart which made him initiate and develop neurosciences at the Osmania General Hospital at Hyderabad.

Coming to his paper, “Mortality in Acute Head Injuries,” the subject remains as important today as when it was published, more than a half century ago.[1]

This paper deals with more than 3,000 cases of head injury admitted under care of the authors between 1959 and 1964. Unlike most other hospitals, all patients with acute head injury were admitted directly into the neurosurgical unit of the Osmania General Hospital. Going through the paper, it is obvious that not only state-of-art care was provided to these patients but careful records were maintained. The authors used the data published from his mentor's unit for comparison and contrast. Two hundred seventy-one fatal cases constituting 8.5% of total cases, admitted have been analyzed in details with respect to age, sex, clinical state, specially the state of consciousness, the finding at surgery or autopsy, etc.

At the time of this publication, there were no modern imaging techniques available, nor were the Glasgow Coma Scale or the so-called ICU based “aggressive treatment” introduced as a therapeutic strategy. The data provided could thus be used to compare the results of new therapeutic regimes. There is, however, a major drawback, that is, the overall mortality of 8.5% obviously includes a large number of mild and moderate injuries. The primary concern, no doubt the mortality of severe head injury (currently accepted as Glasgow Coma Scale <8) cannot be assessed from the data provided. There is however a statement that there were only three patients who were conscious at the time of admission who later died. But we still do not know how many were conscious at the time of admission.

Nevertheless, there is valuable information regarding the state of consciousness, the nature of pathology, the presence or absence of associated injuries and outcome. Around this period, there were a few other papers on a large series of head-injured patients providing similar mortality rates, not taking into consideration the clinical status.[2],[3],[4]

Over the years, several advances in the management strategy of severe head injury raised our hopes of achieving a significantly better result for this vulnerable group. Unfortunately, until today, we do not have statistically reliable data to permit developing a “consensus regime” to be adopted generally for the treatment of severe head injury patients.[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15] I have recently summarized the current status on the outcome of the severe head injury (Tandon 2020 in press). This only indicates that the subject of Prof Rao's paper is still relevant.

This brings me to illustrate that Prof Rao's interest in head injury did not end with the paper under discussion. There have been with me some readily available references of his other publications on the subject as given below.

  Annexure Top


[Additional file 1]

  References Top

Rao Dayananda B, Subrahmanian MV, Reddy Raghava MV, Naidu VBS. Mortality in acute head injuries. Neurol India 1967;15:1-5.  Back to cited text no. 1
Jennette B, Teasdale G, Galbraith S. Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 1977;40:291-5.  Back to cited text no. 2
Kalyanaraman S, Ramamurthi B. An analysis of two thousand cases of head injury. Neurol India 1970;18(Supple 1):3-11.  Back to cited text no. 3
Jain SP, Kankanady VP. A study of 1500 cases of head injury in Delhi. J Indian Med Assoc 1969;52:204-11.  Back to cited text no. 4
Devdiga KV, Jain SP. An analysis of analytical study of acute head injury. Indian J Surg 1969;31:197.  Back to cited text no. 5
Langfitt JW, Gennarelli TA. Can the outcome from head injury be improved? J Neurosurg 1982;56:19-23.  Back to cited text no. 6
Tandon PN. Management of head injury: Fads, fashion and facts. Neurol India 1986;34:1-30.  Back to cited text no. 7
Colohan A, Alves WM, Gross CR, Torner JC, Mehta VS, TandonPN, et al. Head injury mortality in two centers with different emergency medical services and intensive care. J Neurosurg 1989;71:202-7.  Back to cited text no. 8
Narayan RK, Michel ME, Ansell B, Baethmann A, Biegon A, Bracken MB, et al. The clinical trials in head injury study group. J Neurotrauma 2002;19:503-57.  Back to cited text no. 9
Tandon PN. Head injury management: Future trends. In: Ramamurthi B, Tandon PN, editors. Textbook of Neurosurgery 2nd ed. 1996. p. 377-80.  Back to cited text no. 10
Tandon PN. Head injury management (1960-1995). In: Khosl VK, Kak VK, Sharma BS, editors. Brain Protection and Neurol Neural Trauma. New Delhi: Narosa Publishing House; 2000. p. 92-7.  Back to cited text no. 11
Mass AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A,et al. Traumatic brain injury: Integrated approaches to improve prevention, clinical care and research. Lancet Neurol 2017;16:987-1048.  Back to cited text no. 12
Stein,et al. The results of a systematic review of TBI: Mortality over the past 150 years. J Neurotrauma 2010;27:1343-53.  Back to cited text no. 13
Tandon PN. Unsolved problems of brain trauma: Sir Graham Teasdale Oration. (In press).  Back to cited text no. 14
Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J,et al. Trial of decompressive craniectomy for traumatic intracranial hypertension. New Engl J Med 2016;375:1119-30.  Back to cited text no. 15

Some other publications of Prof Rao on Head-Injury
1. Rao BD, Reddy DR, Subramanyam MV, et al. Extradural haematoma source clinical aspects. Indian J Surg 1971;33:340.
2. Rao BD. Extradural haematoma. Neurol India 1977;25:83-94.
3. Rao BD, Rao KS, Subrahmanyan MV, Tirupathiah K. On the incidence of Cranio-cervical injuries. Neurol India 1969;17:73-5.
4. Rao BD. Skeletal defects in the floor of the anterior cranial fossa. Neurol India 1969;17:1-10.
5. Rao BD, Subramanyan MV. Traumatic malacia of bone in skull fracture of the childhood. Indian J Surg 1963;25:641.
6. Divakar I, Rao B. Post Traumatic brain abscess. J Postgrad Med 1971;17:137-41.
7. Subramanian MV, Rajendra Prasad GB, Rao BD. Bilateral extradural haematoma. Br J Surg 1975;5:397-400.


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