http://doi.org/10.33698/NRF0305-Suresh K. Sharma, Ashwini Choudhary, Anurag Choudhary
Abstract : This retrospective study was conducted on 70 consecutive purposively selected patients with traumatic head injury; admitted in selected Neurosurgery units of DMCH, Ludhiana. Majority of patients (88.6%) were males with mean age of 35.07±15.62 years. More than half (58.6%) of the subjects had history of substance consumption. However, 24.3% subjects had head injury under influence of one or another substance. Majority of subjects were consuming alcohol (64.9%) and nicotine (22.1%), where quantity was widely varied between subjects. It is recommended that there is a need of increasing public awareness about this kind of indirect effect of substance abuse and also requires strict reinforcement of law as not to drive when drunk.
Key words :
Substance abuse, high risk factors, traumatic head injury.
Correspondence at :
Suresh K. Sharma,
Lecturer,
College of Nursing, DMCH, Ludhiana.
Introduction
Traumatic injury to the head resulting from a fall or violent blow can be open or closed and may involve a skull fracture or contussion of brain (Keane 1998)1.Trauma involving the central nervous system can be life threatening. Neurologic trauma affects the patients , the family, the health care system and society as a whole because of its major sequelae and the cost of acute and long term care of patients with head injury.
Substance abuse is a major problem throughout the world. People who abuse substances is unable to make healthy decisions and to solve problems effectively. Many individuals who sustain head injuries had history of recreational drug and alcohol abuse and in many cases reveals evidence of consumption of substances immediately prior to their accidents (Boyle, 1991)2.
According to the findings of the study conducted by Nair (1999)3, in North America, every year approximately every year 7 million people sustain some type of head injury admitted to the emergency room, more than 50% have high alcohol or drug level. There is a consistent and significant association between alcohol consumption and injury occurrence. This relationship holds true for both alcohol ingestion at the time of injury and pattern of alcohol consumption during the year before injury. Whereas quantity of drinking per occasion may put the individuals at a greater risk for injury; the frequency of drinking may increase the probability of being at risk of injury. The statistics that alcohol and injury are overwhelming. Alcohol plays a major role in 25% to 60% of all trauma fatalities More specifically, approximately 30% of motor vehicle crashes, 40% – 50% of falls, 40% of near drowning, 12% – 61% of burns and 56% of assaults involve alcohol (Dyehouse & Sommer,1998)4.
Objectives
- To find out substance abuse history among traumatic head injury patients.
Materials and Methods
This retrospective study was conducted on patients admitted in Neurosurgery ward, Neurosurgery I.C.U. and Emergency of DMCH, Ludhiana during months of Jan-Feb, 2007. It is institute of medical education and is well known for its Intensive Care Units services. A total of 70 consequently purposively selected patients were studied in Neurosurgery I.C.U. ,Neurosurgery wards (108 & 109) and emergency ward of DMCH, Ludhiana.
All age group patients with traumatic head injury were included as study A semi structured tool was prepared for data collection. Validity was established by seeking opinion of 5 exper ts from field of Neurosurgery, Nursing education, Nursing research and Clinical nursing to validate the content and language.Selected patients / close relatives were interviewed on first day of admission and observations of patients for outcome of injury and daily follow up was done till discharge / 3weeks. Data were analysed by using descriptive statistics and presented through tables and figures.
Results
Table 1 depicts the sociodemographic characteristics of subjects with traumatic head injury. Nearly fifty percent of the subjects were from 15-30 years of age, whereas only few (07.1%) subjects were above 60 years of age group. Majority of them were males (88.6%). Nearly sixty percent of the subjects were married and rest were unmarried. Sixty percent of subjects were matriculate and very few (4.3%) were post graduates. The unskilled workers were 31.1%, followed by 27.1% skilled workers whereas only 7.1% were professionals. Nearly equal number of urban and rural dewelllers were found in the study findings. In addition, similar pattern was found in family type as nuclear and joint family.
Table 1: Sociodemographic profile of the subjects N = 70 Socio-Demographic Characteristics f(%)
Age (In years)*
< 15 01 (01.4)
15 – 30 36 (51.5)
31 – 45 16 (22.9)
46 – 60 12 (17.1)
> 60 05 (07.1)
Gender
Male 62 (88.6)
Female 08 (11.4)
Marital Status
Unmarried 27 (38.5)
Married 43 (61.4)
Educational Status
llliterate 13 (18.6)
Matric 42 (60.0)
Graduate 12 (17.1)
Postgraduate and above 03 (04.3)
Occupation
| Professionals | 05 (07.1) |
| Skilled | 19 (27.1) |
| Unskilled | 26 (37.1) |
| Not working/ House wives | 09 (12.9) |
| Student | 11 (15.7) |
Habitat
Rural 36 (51.4)
Urban / Slums 34 (48.6)
Type of Family
Nuclear 36 (51.4)
Joint 34 (48.6)
Total Family Income/ mnth (Rs.)
< 5000 27 (38.6)
5001-10000 30 (42.9)
10001-15000 09 (12.9)> 15000 04 (05.7)
Findings revealed that majority of head injuries occurred during evening hours (41.42%) and night hours (25.71%). Whereas, only 32.9% injuries occurred during morning hours. As per mode of injury, nearly three fourth injuries (71.4%) occurred due to road side traffic accidents while fall and assaults
injury patients. Higher numbers i.e. 64.9% subjects consumed alcohol, followed by nicotine (22.1%) and drugs (15.3%) like opiates, amphetamines and cocaine.
Table 2: History of type of substance abuse n=41
Type of Substance Abuse * f %)
had contributed 17.1% and 11.4%
|
respectively.
Figure 1 shows the distribution of subjects as per their history of substance abuse. More than half (58.6%) of subjects were consuming one or other type of substance and rest of the subjects i.e. 41.4% maintained abstinence from substances
Fig1: Subjects as per history of substance
abuse. N=70
* Some of the subjects here consuming more than one type of substance.Table 2 depicts history of type of substances consumed by traumatic head
Table 3 shows history of substance consumed immediately before injury. Only 24.3% of subjects had head injury under influence of one or another substance, among them maximum subjects (94.2%) had consumed within proceeding < 5 hours before injury. Majority of subjects had head injury under influence of alcohol (82.4%); followed by Nicotine (17.7%); opiates 01 (05.9%), Amphetamines (05.9%).
Table 3: History of substance consumed immediately before injury.
N=70
Consumption of substance f(%)
Absent 43 (61.4)
Not known 10 (14.3)
Present 17 (24.3)
Time (before injury) (n=17)
< 5 Hrs 16 (94.2)
6-12 Hrs 01 (05.8)
Type* (n=17)
Alcohol 14 (82.4)
Nicotine 03 (17.7)
Opiates 01 (05.9)
Amphetamines 01 (05.9)
consumption history, 29.2% with nicotine consumption; only 8.5% had opiates consumption history and 3.4% each with history of amphetamine and cocaine consumption. The findings of study were supported by one of the study conducted by Carrigon et al (1995)5 on 238 subjects, where 80% of victims of accidents found were males with an average age of 27.3 years.
In relation to time of injury, most of the injuries occurred during evening (41.43%) and night hours (25.7%), whereas 32.85% injuries occurred in morning hours. It was found that nearly three fourth of subjects (71.43%) were injured due to road side accidents, 17.2% were injured due to fall and rest (11.4%) due to assault.
Nearly one fourth of subjects (24.3%) had accidents under the influence of the substance abuse. Majority of the subjects
* Some of subjects had consumed more than one substance.
Discussion
This Retrospective study was conducted on 88.6% males and 11.4% females with mean age 35.07+ 15.6 years (all age groups) belonged to urban (48.6%) and rural (51.4%) area. Subjects were interviewed on the day of admission and observed for outcome of injury till discharge/ 3 weeks follow up. More than half of subjects (58.6%) were consuming one or other type of substance whereas rest of subjects (41.43%) showed abstinence from substances. Out of 41 subjects having history of substance abuse, 64.9% had alcohol (82.4%) had consumed alcohol at the time of injury. These findings of the study were suppor ted by Chan-Jeffrey et al (1999)6 indicates that between 44% – 79% of head injury victims had history of alcohol consumption. Taylor-Laura et al (1992)7 studied 520 patients admitted to emergency department for acute traumatic brain injury and found that approximately 37% of patients were intoxicated on admission.
Conclusion
As the study was conducted to find out substance abuse history among traumatic head injury patients. It was found that nearly 60% traumatic head injury patients had history of substance abuse. Majority of subjects were consuming alcohol (64.9%) and nicotine (22.1%). Nearly one four th subjects had consumed one or other substance immediately before injury. About 95% subjects consumed substances within 5 hours before injury and alcohol was the substance of choice (82.5%) consumed immediately before injury.
References
- Miller – Keane Encyclopaedia & Dictionary of medicine and nursing allied 6th ed. : 693.
- Boyle M J, Vella L, Moloney E, Role of drugs and alcohol in patients with head Journal of the Royal Society of Medicine, 1991 Oct; 84(10):608-10
- c Nair Norma Traumatic brain injury. The nursing clinics of north America. 1999 Sep, 34(3): 637-38.
- Dyehouse J.M., Sommers Marilyn. Substance abuse interventions in general nursing practice. The nursing clinics of north America. 1998 March; 33(1): 93-4.
- Corrigon JD et A program of intervention for substance abuse following brain injury 1995;9(3):221-36.
- Chan Jeffrey, Hudson Colin,Kolakowsky et. al. An exploratory study of crime and brain injury: Implications for mental health Australian e-journal for advancement of Mental Health, 2004 April;3(1):1446-60.
- Taylor Laura A, et Traumatic head injury and substance abuse; A review and analysis of literature. Neuro psychological rehabilitaion. 2003 March; 13(1-2): 165-88.