PREVELANCE OF TRAUMATIC BRAIN INJURY (TBI) IN SUMMER MONTHS OF 2017 IN HAIL, KSA.

……………………. Background and objective: Traumatic brain injury (TBI) is one the most dangerous injuries worldwide. The effects of TBI can be profound and may result in long-term unresponsive states. Tell now there is no enough conductive studies in Hail region regarding it. The current study aimed to report the importance of head injuries in Hail region and correlate the incidence with age, sex, occupation, cause and types. Material and Method: The database registry was retrospective study, hospital-based to any head trauma referred to neurosurgery department, KKH, Hail. Results: 121 patients were attending the neurosurgery department of KKH. The prevalence of head trauma among patients was 76%. The highest age group was 12 years and less (38.0%), (45,7%) of them were diagnosed as brain trauma. RTA was the leading cause of TBI

568 Figure3:-Gender distribution. The highest route of patient's admission was Emergency department (83.5%.) ( Figure 4).    CT brain showed that mild head trauma was highest diagnosis observed (33.7%), skull fracture in 12% of cases, and then subdural hematoma (7.6%). Findings showed that normal CT brain was seen in 20.7% of patients who had head trauma (TableVII).

Discussion:-
The present work was a retrospective study that aimed at spotting light on the importance of TBI in Hail region. The present work is the first research in Hail region to report the prevalence of TBI, in the summer months of 2017.The study was also correlating the prevalence with age, sex, cause and types.
In summer months (June, July and August) of 2017, the highest prevalence was recorded in age group of 12 years and less. (38.0%) . The second high prevalence was seen in adolescence age (24%) of patients aged 19 to 30 years old. The lowest percentage (6.6%) was in elderly patients over 60 years old. Similarly, Alhabdan et al (7) in 2013 in Riyadh government , capital of KSA, reported that 32.1% suffered head injury with mean age 8.6 years. They concluded that preschoolers and elementary school students were mostly affected. They also added that Head injury is a major cause of mortality, morbidity and disability in children.
A lower prevalence of 7.4% of total injury of patients less than 14 years in USA (8 ) . Also, a report by Ivan et al showed a head injury rate of 8.8% among pediatric emergency admissions in a Canada. (9 ) The difference in prevalence rate may be explained by the application of different injury prevention programs that can reduce morbidity and mortality specially in children. The use of seatbelts, helmets for motorcycles and bicycles and babies seats can reduce the incidence of cranial and non-cranial injuries. (10,11,12 ) According to The GCS scale evaluation, the present study found that there's a significant relationship between age and the GCS scale. The most affected patients have a mild GCS scale of 69.6%. This finding is in agreement with study conducted in Tabuk ( Sara M. Elsiddig et al-tabuk) (13) that reported (44.9%) presented with mild injury (GCS; 13 -15). The disparity between the two percentage might be due to the larger number of patients (551) in their study. They also observed a strong correlation between patient's fatality outcome and their GCS scale. In contrast with similar study in the capital city of KSA, Riyadh (14) which approved that highest percent (56.7%) had a severe THI (GCS 3-8) followed by 30.3% with mild THI (GCS13-14). It may reflect the aggressive leading cause in riyadh city which is MVC.
In the present work, in Hail region, the most common cause of TBI was road traffic injuries 55.4% Followed by fall down 44.6% especially in children which is similar to other studies in the Gulf Cooperation countries such as Qatar and United Arab Emirates. AymanEl-Menyar et al (15) explained that it's due to the fact that only 5% were using a seatbelt/restraint system. Underutilization of seatbelt among people in KSA is strongly associated with higher morbidities and mortality. We noticed that most TBI patients are non-surgically managed 79.3% as most of the traumas were mild and most commonly admitted to the wards. In the United States, approximately 95 per 100 000 have severe head injuries to require hospital admission every year (16) .
The present study found that the percent of patients who have had complications due to TBI was 15.2% while other study in Riyadh reported that 19.6% of trauma patients developed complications which might be due to several factors: first, the rate may influenced by patient's condition which is highly different from one another (17) . Second: hospital quality, quality is a critical and essentially required especially in relation to practicing and complication development. Finally, unmeasured factors could influence the rate. (18,19,20) During the 3-month study period, in the present study, 76.0% of neurologic patient had a traumatic head injury; only 28.3% of them had a loss of consciousness. A lower percentage was reported by Abdullah AL-Kuwaiti et al 572 (2012) (21) who found in his research done in United Arab Emirates that only 22.9%patients had Traumatic brain injury (21) . The difference may be due to difference in age, gender or accompanying lesions. Also it might be due to the fact that Saudi Arabia has more population than UAE which means more traffic (21) .
In the present work, the majority 76% of patients were Saudis, in another study conducted in Tabuk (2017) (13) , Saudi Arabia also reported that the majority of their patients were also Saudis 78.8% (13) . This could be explained by the fact that the majority of populations were Saudis. Also the high risk of car accidents was more in Saudis.
The present study also discovered that 83.5% from the total patients were males. This could be due to the fact that in Saudi Arabia women are not allowed to drive at the time of the research. Also, a study was done in Saudi Arabia in 2013 (7) , males were more affected than females 78.4% vs. 21.6%. (7) In the present work, the diagnosis of the type of injury was according to CT brain finding. CT brain showed that mild head trauma was the highest diagnosis observed 33.7%, skull fracture in 12% of cases, and then subdural hematoma 7.6%. Contrary, a higher results of another study done in Qatar were 61.70% skull fracture ,24% subdural hematoma. (15) This might be due to different causes since car accidents increase the risk of these signs.
In the present study, 90.2% of all cases were hospitalized. However, a study done in United States, 2002-2006 (22) showed that 15.1% of all injuries were hospitalized and 0.7% of all visits were hospitalized (22) .In USA there are lots of traffic rules and lows to control and prevent car accidents . Other major reasons for the increase were more fall-related TBIs and overall population growth. It is also likely that the public's awareness of TBI contributed to increased treatment (22) .
The present research clarified that the majority of patients had multiple injuries. The most commonly injured body region was the chest (7.6%). Other finding was abdominal injury in 2.2% and upper limb 4.3%. However, in a study conducted in the United Arab Emirates, the most commonly injured body region in association with hospitalized head-injured patients was the upper limbs 28.4%, chest injury 21.7% and abdomen injury with 4.8% (21) . The higher percentages of associated lesions could be due to vehicle accidents which resulted in multiple severe lesions in their patients. Also, the explanation of another paper done in Arar Saudi Arabia, was that the most frequent occurrences of RTC were angle collision (40.8%), back collision (19.9%), and hitting a fixed object (13.3%)which in mechanism could lead to multiple injury . (23) Our present study had shown that the 84.8 %of the patients have been improved and discharged, and the mortality was 7.6% who died in the hospital. A study carried out in United Arab Emirates showed that more than one-third of their patients were discharged within 48 hours and the overall mortality in their study was about 6%, which is nearly similar to the present research (21) .

Conclusion and Recommendations:-
During the period of summer months of 2017, children ,12 years and less, were the mostly affected of TBI in Hail region (38.0%). Males were more common than females. Although the mortality was only 7.6%, yet TBI in Hail region necessitates more care, observation, preventive programs and firm action packages of traffic laws to improve the health and reduce the risk from remarkable increasing in the following years.