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Overview of neurosurgery at JPNATC, AIIMS, Delhi

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Overview of neurosurgery at JPNATC, AIIMS, Delhi

  1. 1. AN OVERVIEW Deepak Agrawal Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS NEUROSURGERY, JPNATC
  2. 2. Background <ul><li>Department of Neurosurgery became fully operational on November 26, 2007 when casualty services started in JPNATC. </li></ul><ul><li>Since then, the department is one of the biggest and busiest departments in JPNATC </li></ul>
  3. 3. Infrastructure <ul><li>TC3: Dedicated 16 bed NSICU </li></ul><ul><ul><li>Became functional in March 2008 </li></ul></ul><ul><ul><li>12 Ventilators (Taema/ Vela) </li></ul></ul><ul><ul><li>State of art infrastructure incl centralized monitoring </li></ul></ul><ul><li>TC5: NS HDU (6 beds) </li></ul><ul><ul><li>3 ventilators </li></ul></ul><ul><ul><li>6 monitors </li></ul></ul>
  4. 4. Infrastructure <ul><li>TC4 (Polytrauma): 6 beds </li></ul><ul><li>TC5 (Neurosurgery ward): 24 beds </li></ul>
  5. 5. Neurosurgery (JPNATC)- staffing 0 0 0 JR 13 1 14 SR 5 0 5 N Anesth FACULTY 1 4 5 NS FACULTY VACANT FILLED TOTAL POST
  6. 6. Neurosurgery (JPNATC)- staffing <ul><li>Nursing staff: patient ratio </li></ul><ul><ul><li>NS ICU 1:3 </li></ul></ul><ul><ul><li>NS HDU 1:6 </li></ul></ul><ul><ul><li>NS ward 1:8 </li></ul></ul>
  7. 7. CLINICAL LOAD 2405 Total (since 2006) 182 Dec.08 166 Nov.08 138 Oct.08 151 Sep.08 176 Aug.08 150 Jul.08 162 Jun-08 172 Mav-08 153 Apr. 08 192 Mar.08 135 Feb-08 139 Jan-08 117 Dec.07 67 Nov.-07 Admission in Neurosurgery Month/ Yr
  8. 8. TYPES OF SURGERIES <ul><li>CRANIAL (head injuries) </li></ul><ul><ul><li>All types of surgeries including decompressive craniectomies, frontal and temporal lobectomies, SDH & EDH evacuations, Elevation of depressed fractures as well as surgical management of missile & gunshot. </li></ul></ul>
  9. 9. TYPES OF SURGERIES <ul><li>Spinal cord injury program </li></ul><ul><ul><li>The department of neurosurgery has a spinal cord injury program wherein all patients of spinal cord injury are managed in association with department of physiotherapy. </li></ul></ul><ul><li>Spinal Injury management </li></ul><ul><ul><li>The department has expertise in managing all spinal injuries including CV junction, cervical, thoracic and lumbar. </li></ul></ul><ul><ul><li>All kinds of instrumentation, including percutaneous instrumentation are done in the department. </li></ul></ul>
  10. 10. TYPES OF SURGERIES <ul><li>Brachial plexus & peripheral nerve </li></ul><ul><ul><li>Department of neurosurgery at JPNATC is one of the few centers in India which manages complex brachial plexus and peripheral nerve injuries. </li></ul></ul>
  11. 11. OPERATIONS 1369 Total (SINCE 2006) 116 Dee.O8 108 Nov.08 109 Oct.08 115 Sep.08 106 Aug.08 110 Jul.08 92 Jun-08 117 May-08 107 Apr. 08 107 Mar.08 89 Feb-08 71 Jan-08 70 Dee.07 24 Nov.-07 TOTAL   Month/ Year
  12. 12. OPD 3824 TOTAL 333 Dec.08 270 Nov.08 284 Oct.08 353 Sep.08 405 Aug.08 421 Jul.08 352 Jun-08 382 May-08 210 Apr. 08 176 Mar.08 211 Feb-08 235 Jan-08 95 Dec.07 41 Nov-07 TOTAL   Month/ year
  13. 13. AUDIT <ul><li>Duration : Nov 2007- Oct 2008 </li></ul><ul><li>Total cases : 1286. </li></ul><ul><li>Study population : Head injured patients </li></ul>
  14. 14. 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>
  15. 15. 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>
  16. 16. 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>
  17. 17. OBSERVATIONS DEMOGRAPHICS AGE 1-80 yr SEX MALE 907(70.5%) FEMALE 379 (29.5%)
  18. 18. OBSERVATIONS
  19. 19. <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>
  20. 20. OBSERVATIONS Mode of injury No.(%) ASSAULT 385(30%) RTA 887 (69%) SUICIDAL 12 (1%)
  21. 21. OBSERVATIONS
  22. 22. OBSERVATIONS
  23. 23. OBSERVATIONS
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. COMPARISON WITH PUBLISHED 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>AIIMS study ( present series) : Mortality as 3%, 15% ,35% for mild, moderate and severe head injury. This conforms to other study. </li></ul>
  28. 28. THANK YOU

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