TO EVALUATE THE FREQUENCIES OF POST-TRAUMATIC CEREBROSPINAL FLUID LEAK IN PATIENTS PRESENTING WITH TRAUMATIC BRAIN INJURY

Abstract

Background: Traumatic brain injury (TBI) is a major public health issue, leading to significant morbidity and mortality. One of the serious complications following TBI is the occurrence of post-traumatic cerebrospinal fluid (CSF) leaks. These leaks can exacerbate the patient's condition by increasing the risk of infections such as meningitis, complicating the recovery process.

Objective: The primary objective of this study was to evaluate the frequency of post-traumatic CSF leaks in patients presenting with TBI at Department of Neurosurgery, Hayatabad Medical Complex, Pakistan, and to identify the associated factors.

Methods: This prospective cohort study was conducted at Department of Neurosurgery, Hayatabad Medical Complex, Pakistan from April 2023 to March 2024. The study included 347 patients aged 18 years or older with a confirmed diagnosis of TBI, who presented to the Accident and Emergency Department of Department of Neurosurgery, Hayatabad Medical Complex, Pakistan. Standard clinical care for TBI was administered, including neurological assessment and imaging studies. The primary outcome was the incidence of post-traumatic CSF leak, identified through clinical signs, symptoms, and imaging studies such as CT scans or MRI. Secondary outcomes included the duration of hospital stay and the requirement for surgical intervention. Statistical analysis involved descriptive statistics, t-tests, chi-square tests, and logistic regression analysis using SPSS software.

Results: The study found that 15% of the TBI patients developed post-traumatic CSF leaks. Patients with severe TBI had a significantly higher frequency of CSF leaks (45.7%) compared to those with moderate (14.0%) and mild TBI (7.1%) (p<0.001). The mean hospital stay for patients with CSF leaks was significantly longer (15.3 days, SD 7.8) compared to those without CSF leaks (8.5 days, SD 4.2) (p<0.001). Logistic regression analysis identified severe TBI (Odds Ratio [OR] 6.2, 95% CI 3.4-11.2, p<0.001) and male gender (OR 1.8, 95% CI 1.1-2.9, p=0.02) as significant predictors of CSF leaks.

Conclusion: The findings highlight the need for routine screening for CSF leaks in TBI patients, especially those with severe injuries. Early detection and management of CSF leaks can prevent complications such as meningitis and improve patient outcomes. Future research should focus on long-term outcomes and the effectiveness of different diagnostic and therapeutic approaches.