الفهرس 
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Abstract
Traumatic brain injury (TBI) is a major public health concern and a leading cause of death worldwide. Complications after TBI known as second insults can worsen neurologic and patient outcomes. patients with head trauma may have a variety of electrocardiographic changes which may be disturbance of rate , rhythm , P wave , QRS complex , PR interval , T wave , ST segment , QT interval or ischemic like changes. Early ECG may serve as an inexpensive test to screen for cardiac dysfunction prior to ordering more expensive and potentially more invasive testing. So, ECG should be a mandatory investigation for all patients with isolated traumatic brain injury.
We are aiming in our study To determine if there are ECG changes with isolated traumatic brain injury and if these changes are related to certain type of head injury.
The present study involved 50 adult patients conducted in the I.C.U at Ain shams university hospitals and El-Helal Hospital, Cairo, Egypt during 2017-2019, 12 lead ECG was done on admission and after 24 hours.
(36 of them (72%) were male and 14 (28%) were females), their mean age 44.6 ± 12.62 years.
The majority of patients were with subdural hemorrage (30%), brain edema (20%), Subarachnoid hemorrhage (16%), contusion (14 %), Intracerebral hemorrhage (14%), skull fractures (12%) , Intraventricular hemorrhage (10%) and bullet injury(2%) . Patients with severe chest trauma or preexistent cardiac disease were excluded.
The results of study showed that:
40 patients (80%) had sinus rhythm ,10 patients (20%) had various dysrythmia, 40 patients (80%) had prolonged PR interval, 7 patient (14%) had prolonged QRS, 11 patient (22%) had prolonged QTC, 6 patients(12%) had ST depression, 3patients (6%) had ST elevation and 6 patients (12%) had inverted T wave .
LVEF is low in 8 patients (16%) ,42 patients (84%) had normal LVEF, 7 patients (14%) had diastolic dysfunction ,6 patients (12%) had WMA and the rest with normal wall motion significant ECG changes were in the form of Long QRS with p-value<0.037, Long QTc with p-value<0.038, Inverted T-wave with p-value<0.000, ST elevation with p-value<0.013, ST depression with p-value <0.015, Morphologic end-repolarization abnormalities with p-value<0.018 and Q wave with p-value<0.031.
ECG changes showed statistically significant p-value with certain types of isolated traumatic brain injury as intracerebral hemorrhage with p-value <0.031, subarachnoid hemorrhage with p-values all <0.038 in different ecg changes and extradural hemorrhage with p-value<0.018 comparison of patients with ECG disturbances and without showed significant impcat on icu stay with p value < 0.015 but not on mortality.
So, We recommend that a 12-lead ECG may be an important and inexpensive screening tool to evaluate isolated TBI patients for cardiac dysfunction prior to further diagnostic studies or interventions, which will be useful in managing these cases and in selection and adjusting medication and may minimize ICU stay for TBI patients