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Head Injury Audit Deepak Agrawal Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi
AIM OF AUDIT <ul><li>To evaluate outcome in patients of head injuries in relation to post-resuscitation GCS score and mort...
  MATERIAL AND METHODS <ul><li>Total cases : 1286. </li></ul><ul><li>Duration : Nov 2007- Oct  2008 </li></ul><ul><li>Stud...
MATERIAL AND METHODS <ul><li>INCLUSUSION CRITERIA : </li></ul><ul><li>All admitted patients of head injury under Deptt of ...
MATERIAL AND METHODS <ul><li>EXCLUSION CRITERIA : </li></ul><ul><li>Poly-trauma patients  admitted under other departments...
MATERIAL AND METHODS <ul><ul><li>Patients were managed as per departmental protocols </li></ul></ul><ul><ul><li>All death ...
OBSERVATIONS DEMOGRAPHICS AGE 1-80 yr SEX MALE 907(70.5%) FEMALE 379 (29.5%)
OBSERVATIONS
<ul><li>OBSERVATIONS </li></ul><ul><li>Hospital arrival time = 2 hrs to 48 hrs. </li></ul><ul><li>Time of injury= 3am-6pm(...
  OBSERVATIONS Mode of injury No.(%) ASSAULT 385(30%) RTA 887 (69%) SUICIDAL 12 (1%)
OBSERVATIONS
OBSERVATIONS
OBSERVATIONS PENETRATING HEAD INJURY- ENTRY WOUND
OBSERVATIONS
OUTCOME GROUP NO. OF MORTALITY TOTAL CASES %  Overall  296 1286 23 Minor HI  11 340 3 Moderate HI 36 238 15 Severe HI 249 ...
OUTCOME <ul><li>Hospital stay:  2 – 41 days ( mean -15) </li></ul>DURATION (since arrival) NO. OF MORTALITY TOTAL CASES % ...
OUTCOME GROUP NO. OF MORTALITY TOTAL CASES %  Children (> 10 yrs) 67 248 27 Adult ( 20-50 yrs) 158 761 20 Elderly ( 50-80 ...
  REVIEW OF LITERATURE <ul><li>Kagan RJ et al found that mortality rates were 26.7 per cent, 36.5 per cent, and 41.4 per c...
  REVIEW OF LITERATURE <ul><li>Udekwu P. et al derived that mortality falls steeply between a Preresuscitation-GCS score o...
    CONCLUSIONS <ul><li>Incidence of head injury is increasing. </li></ul><ul><li>Post resuscitation GCS prognosticateS ou...
REFERENCES <ul><li>Kagan RJ, Baker RJ. The impact of the volume of neurotrauma experience on mortality after head injury. ...
THANK  YOU !
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Head injury data at jpnatc nov 2007 october 2008

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Transcript of "Head injury data at jpnatc nov 2007 october 2008"

  1. 1. Head Injury Audit Deepak Agrawal Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi
  2. 2. AIM OF AUDIT <ul><li>To evaluate outcome in patients of head injuries in relation to post-resuscitation GCS score and mortality. </li></ul><ul><li>A secondary objective was to look for epidemiological factors responsible for these head injuries. </li></ul>
  3. 3. MATERIAL AND METHODS <ul><li>Total cases : 1286. </li></ul><ul><li>Duration : Nov 2007- Oct 2008 </li></ul><ul><li>Study population : Head injured patients </li></ul>
  4. 4. MATERIAL AND METHODS <ul><li>INCLUSUSION CRITERIA : </li></ul><ul><li>All admitted patients of head injury under Deptt of Neurosurgery at JPNA Trauma Center. </li></ul><ul><li>Age – 1 yr to 80 yrs </li></ul><ul><li>Patients group - Minor head injury (GCS 13-15) </li></ul><ul><li>Moderate head injury (GCS 9-12) </li></ul><ul><li>Severe head injury (GCS 8 or less) </li></ul><ul><li>Simple / Compound head injury </li></ul><ul><li>Closed / Penetrating head injury </li></ul>
  5. 5. MATERIAL AND METHODS <ul><li>EXCLUSION CRITERIA : </li></ul><ul><li>Poly-trauma patients admitted under other departments. </li></ul><ul><li>Patients managed through OPD or kept under observation at ED. </li></ul>
  6. 6. MATERIAL AND METHODS <ul><ul><li>Patients were managed as per departmental protocols </li></ul></ul><ul><ul><li>All death files were analyzed for mortality data </li></ul></ul>
  7. 7. OBSERVATIONS DEMOGRAPHICS AGE 1-80 yr SEX MALE 907(70.5%) FEMALE 379 (29.5%)
  8. 8. OBSERVATIONS
  9. 9. <ul><li>OBSERVATIONS </li></ul><ul><li>Hospital arrival time = 2 hrs to 48 hrs. </li></ul><ul><li>Time of injury= 3am-6pm(32%) </li></ul><ul><li>6pm – 3am (68%) </li></ul>
  10. 10. OBSERVATIONS Mode of injury No.(%) ASSAULT 385(30%) RTA 887 (69%) SUICIDAL 12 (1%)
  11. 11. OBSERVATIONS
  12. 12. OBSERVATIONS
  13. 13. OBSERVATIONS PENETRATING HEAD INJURY- ENTRY WOUND
  14. 14. OBSERVATIONS
  15. 15. OUTCOME GROUP NO. OF MORTALITY TOTAL CASES % Overall 296 1286 23 Minor HI 11 340 3 Moderate HI 36 238 15 Severe HI 249 708 35 Compound HI 62 242 25 Closed HI 292 1272 22 Penetrating HI 4 14 29
  16. 16. OUTCOME <ul><li>Hospital stay: 2 – 41 days ( mean -15) </li></ul>DURATION (since arrival) NO. OF MORTALITY TOTAL CASES % < 48 hrs. 102 296 34 48 hrs - 1 wk. 140 296 47 > 1 wk. 54 296 19
  17. 17. OUTCOME GROUP NO. OF MORTALITY TOTAL CASES % Children (> 10 yrs) 67 248 27 Adult ( 20-50 yrs) 158 761 20 Elderly ( 50-80 yrs) 71 277 25 Male 204 907 30 Female 92 379 24
  18. 18. REVIEW OF LITERATURE <ul><li>Kagan RJ et al found that mortality rates were 26.7 per cent, 36.5 per cent, and 41.4 per cent respectively for severe head injured patients in different input level 1 set up. </li></ul><ul><li>Fakhry SM, Trask AL, Waller MA, Watts DD in their study found overall mortality rate in a reducing pattern 1991-94 to 1997-2000 (17.8% vs. 13.8%), although this was not statistically significant. </li></ul>
  19. 19. REVIEW OF LITERATURE <ul><li>Udekwu P. et al derived that mortality falls steeply between a Preresuscitation-GCS score of 3 and 7 followed by a shallow fall. Although P-GCS score is related to mortality in head-injured patients, its relationship is nonlinear, which casts doubt on its use as a continuous measure or an equivalent set of categorical measures incorporated into outcome prediction models. </li></ul><ul><li>AIIMS study ( present series) : Mortality as 3%, 15% ,35% for mild, moderate and severe head injury. This conforms to other study. </li></ul>
  20. 20. CONCLUSIONS <ul><li>Incidence of head injury is increasing. </li></ul><ul><li>Post resuscitation GCS prognosticateS outcome. </li></ul><ul><li>Our mortality rates for head injured patients compare very favorably with international data. </li></ul>
  21. 21. REFERENCES <ul><li>Kagan RJ, Baker RJ. The impact of the volume of neurotrauma experience on mortality after head injury. Am Surg. 1994 Jun;60(6) : 394-400. </li></ul><ul><li>Fakhry SM, Trask AL, Waller MA, Watts DD : Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma 2004 Mar; 56(3):492-9; discussion 499-500. </li></ul><ul><li>Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D : Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma 2004 May; 56(5):1084-9. </li></ul>
  22. 22. THANK YOU !
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