care in Pediatric head injuries –Nursing Neuro surgery ICU

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ABSTRACT care in Pediatric head injuries –Nursing Neuro surgery ICU Anu Antony , Deepak Agrawal Department of Neurosurgery, JPNA Trauma Centre, AIIMS ,New Delhi Background: Nursing assessment of pediatric head injuries is difficult as GCS scoring system is not applicable to this age group. Also managing head injured children in the same ICU with adults is challenging Objectives: To assess outcome of admitted pediatric head injury patients (<12yrs) as a surrogate marker for nursing care in the ICU. Materials &methods: In this prospective study over 9months (Jan2011-Sept2011), the demographic profile ,surgical intervention ,mode of injury and outcome was evaluated for all children with head injury admitted in neurosurgery ICU at JPNA Trauma Center AIIMS. Result: 104 children with head injury were admitted in the ICU during study period. There were 70males & 34 females. The mean age was 6.5yrs (range day1-12yrs) 51 children had severe head injury, 19 had moderate&34had minor head injury. 51(49%) children underwent surgical intervention. The overall mortality rate was 19.23%(n-20).Mortality rate was 33.3% (n-17) in severe head injuries,5.9% (n-2) in minor head injuries and 5.2%(n-1) in moderate head injury group.84 children were discharged .Of these 84.5%(n-71)had improvement in GCS,10.7%(n-9) had same GCS&4(4.7%) children deteriorated. The average hospital stay was 10 days (range2-94 days).2 patients were still hospitalized at the time of this study. Conclusion: The mortality rates compare very favorably with international data. This study shows head inured children can be managed appropriately in neurosurgery ICU with nurses trained in neuro- nursing

Health & Medicine

Anu Antony Department of Neurosurgery JPNATC, AIIMS New Delhi

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MODE OF INJURY OTHERS-2 FALL FROM HEIGHT 82 RTA 20

DISTRIBUTION OF MORTALITY RATE 17 (33.3%) OBSERVATION

Comparison of discharge status Improved same Deteriorated 29(56.9%) 3(5.9%) 1(2%) 15(78.9%) 2(10.5%) 0 27(84.4%) 2(9.4%) 3(6.25%

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Being able to prognosticate in the aftermath of a traumatic brain injury (TBI) is important as it assists with counselling patients and families. Moreover, it helps rationally allocate healthcare resources. However, due to the heterogenous nature of TBI and variable pre brain injury patient factors and post brain injury course, this has proven to be a difficult task. Large cohort studies have enabled improved accuracy in the prediction of 6 month mortality and unfavourable outcome. Furthermore, many of the factors that contribute to long-term outcome have also emerged. However, it is not yet possible to use them in prediction algorithms or mathematical models. There is emerging evidence that pre injury psychosocial and demographic factors may be of more relevance than injury severity. Moreover, that 'outcome' becomes increasingly subjective and complex as the post injury duration increases. We end with three brief vignettes which highlight the fraught nature of long term outcome prediction.

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