Observational study of “unknown” head injury patients at a tertiary care neurosurgical centre

Context: A large number of patients are admitted to hospitals in large cities without any identification. These “unknown” patients represent a unique problem in developing countries. There is no systematic study in world literature on this subgroup of patients. Aims: to elucidate the natural history and outcome of traumatic brain injury patients admitted in the department of neurosurgery as “unknowns”. Settings and design: retrospective analysis of all traumatic brain injury patients admitted to the department of neurosurgery as “unknowns”, between January 2017 and December 2017. Results: ninety patients were admitted as unknowns over a period of one year. 81 patients were males and 33 patients became known during their hospital stay. 34 patients were discharged from the hospital, whereby 12 with good recovery and 14 with moderate and 6 with severe disability and 2 in vegetative state. 73 patients were managed conservatively and about 17 patients were treated by surgery, most often for cerebral contusion. About 56 patients died inspite of the best possible treatment. 25 patients were discharged to home and 9 patients were sent to destitute home, as they remained unknown, with the help of social worker in our hospital. Conclusions: Unknown head injury patients are usually neglected. Their management from prehospital to treatment and discharge is fraught with challenges. They need special care for which staff should be well trained and hospital must have economic resources. A good network of social workers help in rehabilitating these patients. There is a need to upgrade ourselves in term of taking fingerprints and biometric to improve identification accuracy of unknown patients.