Practical Challenges in the Management and Outcome of Unknown Patients with Head Injury

Abstract

Abstract Background  Majority of road accidents are treated at nearby private hospitals. Head injury patients whose identity is not established are invariably being treated at government hospitals. The factors influencing the management and outcome of such unknown patients are possible only in government hospitals. Limited studies are available related to these unknown patients. Objective  This study attempted to analyze the management issues in such patients and tried to find solutions that will improve the outcome. Methods  It was an observational study over 2 years. All patients whose identity could not be established at admission were studied. Standard traumatic brain injury protocols were followed. Issues and challenges in managing these patients were noted. Many challenges popped up once patient was shifted out of intensive care unit and were studied. Results  Eighty-five patients were studied with male preponderance. Common age group was 41 to 60 years. The main cause of head injury was road traffic accident. Seventy-six patients were severely injured. Acute subdural hematomas was the most common computed tomography finding (36 patients). Sixty-nine patients were managed conservatively and 16 needed surgery. Forty-nine patients died in hospital, and other patients recovered well. Twenty-two patients were discharged home and 11 took discharge against medical advice after being identified by relatives. None were accommodated into destitute homes even after recovery. Conclusion  Unknown patients usually have poor outcome with more deaths in spite of standard care. Their management is fraught with challenges. They need special care for which staff should be motivated; hospital must have good network to establish identity.