Dr Rajiv Jha MS
M Ch Resident Neurosurgeon
Dept Of Neurosurgery
National Academy of Medical Sciences
Bir Hospital
Introduction
 Bir hospital, first public
sector hospital
 low socioeconomic
status patients
 Unidentified and
unattende...
Objectives
 Demographic parameters
 Causes
 Postoperative care and rehabilitation
 GOS
 Logistical problems
 Medico-...
Methodology
 Prospective case series
 Study period : 2008 April 15th to 2011 January 15th
 Head injury patients
 Unide...
Sources Of Data
 ER records
 Case sheets
 Police reports
Demographics
 Total number of patients admitted :35/1810
 Admissions (1.93%)
Brought By
66%
14%
20%
Police Witness Properator
VALLEY
30(86%)
OUTSIDE
VALLEY
5(14%)
Demographics
30(86%)
5(14%)
Male
Female
Causes
16(45.71%)
8
22.85%
7
20%
4
11.42%
0
2
4
6
8
10
12
14
16
18
RTA Fall Physical assault Not Known
Severity
7
20%
10
28.57%
18
51.42%
0
2
4
6
8
10
12
14
16
18
20
Mild Moderate Severe
CT Findings
3(8.57%)
3(8.57%)
2(5.71%)
7(20%)
10
(28.57%)
10
(28.57%)
Contusion
Intracerebral hematoma
Compound fracture
d...
Treatment
22(63%)
13(37%)
Surgical Non-surgical
Surgical
 Fracture elevation 2
 Evacuation of hematoma 14
Acute subdural hematoma 4
Extradural hematoma 12
 Burr hole E...
31%
69%
Relatives found
Relatives not found
GOS
Good recovery 8 (22.85%)
Moderate disability 7 (20%)
Severe disability 8 (22.85%)
Vegetative 5 (14.28%)
Dead 7 (20%)
Results
17(48.57%)
7
20%
9
25.71%
2
5.71%
0
2
4
6
8
10
12
14
16
18
Discharge Dead Discharge to
social service
Absconded
Severity NO DEAD
Mild 7 1
Moderate 10 0
Severe 18 6
Mortality in unidentified head injury patients is high
Comparative Study
Present study AKM
Total no 35 325
Operative Rx 37% 18%
Mortality 20% 53%
Ref: AK Mahapatra.Neurologyindi...
Discussions
 Medico-legal problems.
 Unknown patients pose special
problems in management.
 Longer duration of stay in ...
Recommendations
 An identification card.
 Provisions should be made to treat such
patients in all medical institutions.
...
Thank you!
EVERY SMILE…….
EVERY GESTURE….
EVERY MIRACLE COUNTS!!
Outcome of Head injury  in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)
Outcome of Head injury  in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)
Outcome of Head injury  in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)
Outcome of Head injury  in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)
Outcome of Head injury  in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)
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Outcome of Head injury in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)

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Dr Rajiv Jha MS
M Ch Resident Neurosurgeon
Dept Of Neurosurgery
National Academy of Medical Sciences
Bir Hospital

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Outcome of Head injury in unidentified patients - Dr Rajiv Jha (Bir Hospital - Neurosurgeon)

  1. 1. Dr Rajiv Jha MS M Ch Resident Neurosurgeon Dept Of Neurosurgery National Academy of Medical Sciences Bir Hospital
  2. 2. Introduction  Bir hospital, first public sector hospital  low socioeconomic status patients  Unidentified and unattended patients  Natural history is mostly unknown  Neurosurgery Department.
  3. 3. Objectives  Demographic parameters  Causes  Postoperative care and rehabilitation  GOS  Logistical problems  Medico-legal issues
  4. 4. Methodology  Prospective case series  Study period : 2008 April 15th to 2011 January 15th  Head injury patients  Unidentified
  5. 5. Sources Of Data  ER records  Case sheets  Police reports
  6. 6. Demographics  Total number of patients admitted :35/1810  Admissions (1.93%)
  7. 7. Brought By 66% 14% 20% Police Witness Properator
  8. 8. VALLEY 30(86%) OUTSIDE VALLEY 5(14%)
  9. 9. Demographics 30(86%) 5(14%) Male Female
  10. 10. Causes 16(45.71%) 8 22.85% 7 20% 4 11.42% 0 2 4 6 8 10 12 14 16 18 RTA Fall Physical assault Not Known
  11. 11. Severity 7 20% 10 28.57% 18 51.42% 0 2 4 6 8 10 12 14 16 18 20 Mild Moderate Severe
  12. 12. CT Findings 3(8.57%) 3(8.57%) 2(5.71%) 7(20%) 10 (28.57%) 10 (28.57%) Contusion Intracerebral hematoma Compound fracture diffuse axonal injury Acute Subdural hematoma Extradural hematoma
  13. 13. Treatment 22(63%) 13(37%) Surgical Non-surgical
  14. 14. Surgical  Fracture elevation 2  Evacuation of hematoma 14 Acute subdural hematoma 4 Extradural hematoma 12  Burr hole Evacuation 6 Mean hospital stay 16.52 days.
  15. 15. 31% 69% Relatives found Relatives not found
  16. 16. GOS Good recovery 8 (22.85%) Moderate disability 7 (20%) Severe disability 8 (22.85%) Vegetative 5 (14.28%) Dead 7 (20%)
  17. 17. Results 17(48.57%) 7 20% 9 25.71% 2 5.71% 0 2 4 6 8 10 12 14 16 18 Discharge Dead Discharge to social service Absconded
  18. 18. Severity NO DEAD Mild 7 1 Moderate 10 0 Severe 18 6 Mortality in unidentified head injury patients is high
  19. 19. Comparative Study Present study AKM Total no 35 325 Operative Rx 37% 18% Mortality 20% 53% Ref: AK Mahapatra.Neurologyindia.
  20. 20. Discussions  Medico-legal problems.  Unknown patients pose special problems in management.  Longer duration of stay in hospital.  Lack of pre-hospital care.  Shortage of rehabilitation.
  21. 21. Recommendations  An identification card.  Provisions should be made to treat such patients in all medical institutions.  Mechanism should be developed to investigate and treat such patients urgently.
  22. 22. Thank you! EVERY SMILE……. EVERY GESTURE…. EVERY MIRACLE COUNTS!!

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