JPNATC Experience On Mortality After Head Injury



   Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delh...
INTRODUCTION

   Injury and Trauma are steadily increasing in the third world and becoming
    a major public health prob...
AIM OF STUDY



   To evaluate outcome in patients of head injuries in relation to
    post-resuscitation GCS score and m...
MATERIAL AND METHODS

   Total cases : 1286.

   Study design : Retrospective.


   Duration : Nov 2007- Oct 2008


  ...
MATERIAL AND METHODS

INCLUSUSION CRITERIA :

   All admitted patients of head injury under Deptt of Neurosurgery at JPNA...
MATERIAL AND METHODS

EXCLUSION CRITERIA :

   Poly-trauma patients admitted under other departments.

   Patients manag...
MATERIAL AND METHODS


   Patients were managed as per departmental
    protocols

   All death files were analyzed for ...
OBSERVATIONS



            DEMOGRAPHY




                                    SEX
 AGE
                               MAL...
OBSERVATIONS


                           7%
                                        > 10 yr
           9%                ...
OBSERVATIONS



Hospital arrival time = 2 hrs to 48 hrs.

Time of injury= 3am-6pm(32%)
                6pm – 3am (68%)



...
OBSERVATIONS


                        Mode of injury          No.(%)
900                        ASSAULT             385(3...
OBSERVATIONS

800

                                 SEVERE, 708
700

600

500

400
      MINOR, 340
300
                  ...
OBSERVATIONS
700         699


600

500

400
      338                                     MINOR
300                      ...
OBSERVATIONS
PENETRATING HEAD INJURY- ENTRY WOUND




          TRAUMA 2008, NEW DELHI
OBSERVATIONS
700
           636
600

500

400
                                          MINOR
300                         ...
OUTCOME

  GROUP          NO. OF MORTALITY          TOTAL CASES   %

   Overall               296                  1286   ...
OUTCOME


Hospital stay: 2 – 41 days ( mean -15)

    DURATION        NO. OF MORTALITY           TOTAL CASES   %
  (since ...
OUTCOME


     GROUP             NO. OF MORTALITY          TOTAL CASES   %

Children (> 10 yrs)             67            ...
REVIEW OF LITERATURE



   Kagan RJ et al found that mortality rates were 26.7 per cent, 36.5 per cent,
    and 41.4 per ...
REVIEW OF LITERATURE



   Udekwu P. et al derived that mortality falls steeply between a
    Preresuscitation-GCS score ...
CONCLUSIONS

   Incidence of head injury is increasing.

   Post resuscitation GCS prognosticated outcome.

   Our mort...
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Jpnatc experience on mortality after head injury

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Jpnatc experience on mortality after head injury

  1. 1. JPNATC Experience On Mortality After Head Injury Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi TRAUMA 2008, NEW DELHI
  2. 2. INTRODUCTION  Injury and Trauma are steadily increasing in the third world and becoming a major public health problem.  By 2020 : 3rd largest killer in the developing world (WHO) - TRAUMA.  Traumatic brain injury (TBI) is the leading cause of death.  An estimated cost to society of over dollar 40 billion annually (US).  Evidence-based guidelines for TBI care have been widely discussed, but in-hospital treatment of these patients has been highly variable. TRAUMA 2008, NEW DELHI
  3. 3. AIM OF STUDY  To evaluate outcome in patients of head injuries in relation to post-resuscitation GCS score and mortality.  A secondary objective was to look for epidemiological factors responsible for these head injuries. TRAUMA 2008, NEW DELHI
  4. 4. MATERIAL AND METHODS  Total cases : 1286.  Study design : Retrospective.  Duration : Nov 2007- Oct 2008  Study population : Head injured patients TRAUMA 2008, NEW DELHI
  5. 5. MATERIAL AND METHODS INCLUSUSION CRITERIA :  All admitted patients of head injury under Deptt of Neurosurgery at JPNA Trauma Center.  Age – 1 yr to 80 yrs  Patients group - Minor head injury (GCS 13-15) Moderate head injury (GCS 9-12) Severe head injury (GCS 8 or less)  Simple / Compound head injury  Closed / Penetrating head injury TRAUMA 2008, NEW DELHI
  6. 6. MATERIAL AND METHODS EXCLUSION CRITERIA :  Poly-trauma patients admitted under other departments.  Patients managed through OPD or kept under observation at ED. TRAUMA 2008, NEW DELHI
  7. 7. MATERIAL AND METHODS  Patients were managed as per departmental protocols  All death files were analyzed for mortality data TRAUMA 2008, NEW DELHI
  8. 8. OBSERVATIONS DEMOGRAPHY SEX AGE MALE 907(70.5%) 1-80 yr FEMALE 379 (29.5%) TRAUMA 2008, NEW DELHI
  9. 9. OBSERVATIONS 7% > 10 yr 9% 5% 16% 11-20 yr 4% 21-30 yr 31-40 yr 41-50 yr 19% 51-60yr 27% 61-70yr 13% 71-80yr TRAUMA 2008, NEW DELHI
  10. 10. OBSERVATIONS Hospital arrival time = 2 hrs to 48 hrs. Time of injury= 3am-6pm(32%) 6pm – 3am (68%) TRAUMA 2008, NEW DELHI
  11. 11. OBSERVATIONS Mode of injury No.(%) 900 ASSAULT 385(30%) 800 RTA 887 (69%) 700 SUICIDAL 12 (1%) 600 500 400 300 200 100 0 Assult RTA Suicidal TRAUMA 2008, NEW DELHI
  12. 12. OBSERVATIONS 800 SEVERE, 708 700 600 500 400 MINOR, 340 300 MOD, 238 200 100 0 TRAUMA 2008, NEW DELHI
  13. 13. OBSERVATIONS 700 699 600 500 400 338 MINOR 300 MOD 235 SEVERE 200 100 0 2 3 9 CL ED HI OS PENETRATING TRAUMA 2008, NEW DELHI HI
  14. 14. OBSERVATIONS PENETRATING HEAD INJURY- ENTRY WOUND TRAUMA 2008, NEW DELHI
  15. 15. OBSERVATIONS 700 636 600 500 400 MINOR 300 MODE RATE S VE E RE 216 200 192 124 100 72 46 0 SIMPL HI E COMPOUND HI TRAUMA 2008, NEW DELHI
  16. 16. 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 TRAUMA 2008, NEW DELHI
  17. 17. OUTCOME Hospital stay: 2 – 41 days ( mean -15) DURATION NO. OF MORTALITY TOTAL CASES % (since arrival) < 48 hrs. 102 296 34 48 hrs - 1 wk. 140 296 47 > 1 wk. 54 296 19 TRAUMA 2008, NEW DELHI
  18. 18. 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 TRAUMA 2008, NEW DELHI
  19. 19. REVIEW OF LITERATURE  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.  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. TRAUMA 2008, NEW DELHI
  20. 20. REVIEW OF LITERATURE  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.  AIIMS study ( present series) : Mortality as 3%, 15% ,35% for mild, moderate and severe head injury. This conforms to other study. TRAUMA 2008, NEW DELHI
  21. 21. CONCLUSIONS  Incidence of head injury is increasing.  Post resuscitation GCS prognosticated outcome.  Our mortality rates for head injured patients compare very favorably with international data. TRAUMA 2008, NEW DELHI
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