Prevalence and pattern of ECG abnormalities in patients with craniocerebral trauma

Background: A silent epidemic of traumatic brain injury (TBI) has been prevalent in low and middle-income countries, especially those undergoing widespread socioeconomic changes. TBI is neurosurgical emergency and timely intervention is critical to favorable outcomes. In peripheries, radio-imaging is generally not available easily. In those situations, we need some other portable and quick investigation to rule out severe TBI. Methods: The study was conducted on TBI patients in the trauma center of a tertiary care hospital. The patients underwent Electrocardiogram (ECG) at the time of arrival, at 24 h, 48 h, 72 h, and 120 h. All the patients included in the study underwent clinical examination and noncontrast computed tomographic scan. Then the diagnostic and prognostic performance of the ECG in detection of severity of TBI was compared to various other modalities with reference to the gold standard noncontrast computed tomography scan. Results: Hundred patients ranged from 18 years to 60 years were included. At the time of arrival, ECG abnormalities were observed in 63% of patients which reduced to 13% after 120 hours. ECG changes found were abnormalities in rate/rhythm, sinus arrhythmia, repolarization abnormalities, and morphological changes. There was significant positive correlation of ECG changes with severity of brain injury (<0.05). Conclusion: This study depicts that serial ECG recordings are useful in assessment of severe TBI by primary care physicians. Early detection of ECG changes assessed as severe leads to timely referral to apex neurosurgical facility.