Inter observer variability in gcs scoring in a level i trauma centre
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1) There is significant inter-observer variability in Glasgow Coma Scale (GCS) scoring among doctors and nurses assessing patients with head injuries in the emergency room. 2) A study of 100 patients found discrepancies in 42% of GCS scores recorded, with differences of up to 3 points between observers. 3) The variability in GCS scoring means that protocols for managing head injuries based solely on GCS may misclassify patients, necessitating the development of GCS-independent protocols.
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Head injury data at jpnatc nov 2007 october 2008
This document summarizes the results of an audit of 1286 patients with head injuries admitted to the neurosurgery department of a trauma center over one year. The audit aimed to evaluate patient outcomes based on Glasgow Coma Scale scores and identify epidemiological factors. It found that mortality rates increased with more severe injuries, from 3% for minor injuries to 35% for severe injuries. The majority of injuries were due to assaults (30%) or road traffic accidents (69%). Mortality rates compared favorably to other international studies. Post-resuscitation GCS scores were found to be a good predictor of patient outcomes.
Jagid, Jonathan
1. Intracranial pressure (ICP) monitoring is important for managing patients with severe traumatic brain injury. ICP above 20-25 mmHg should be treated to reduce pressure.
2. Maintaining a cerebral perfusion pressure above 70 mmHg is effective, while pressures below 50 mmHg should be avoided. Additional monitoring of cerebral blood flow and oxygenation can help guide treatment.
3. Surgical decompression through craniectomy is an effective treatment for reducing high ICP and may improve outcomes, though results are still controversial. Younger patients and earlier surgery seem to benefit most.
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This document summarizes a study that validated the CRASH calculator for predicting outcomes after traumatic brain injury (TBI). The study reviewed data from 417 TBI patients treated at a hospital in Belgium between 2010-2014. It found the CRASH calculator accurately predicted 14-day mortality and 6-month outcomes based on variables like age, Glasgow Coma Scale, and CT scan findings. A CRASH score cutoff of 31.5% had high sensitivity and specificity for 14-day mortality prediction, while a cutoff of 55.75% accurately predicted 6-month outcomes.
Anesthesia or conscious sedation in mechanical thrombectomy?.pptx
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Intracranial pressure montoring standard of care
This document discusses intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (TBI). It summarizes guidelines from various organizations recommending ICP monitoring for patients with severe TBI based on Glasgow Coma Scale scores and abnormal CT scans. However, it notes that no randomized controlled trials have proven that ICP monitoring and treatment improves outcomes. Some studies have found no difference in outcomes between monitored and non-monitored patients. The document discusses ongoing debates around the risks and benefits of ICP monitoring.
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1. Transcranial Doppler ultrasound (TCD) can be used as a non-invasive method to monitor patients with traumatic brain injury (TBI). TCD allows clinicians to detect posttraumatic vasospasm and increased intracranial pressure, which are major contributors to secondary brain injury in moderate and severe TBI patients.
2. TCD is highly sensitive for detecting abnormally high cerebral blood flow velocities caused by vasospasm and can help guide treatment decisions. Daily TCD monitoring is recommended for managing TBI patients at risk of vasospasm and increased intracranial pressure.
3. TCD can also assess cerebrovascular reactivity as an indicator of brain regulation following TBI
Sex Differences in Clinical Characteristics and Outcomes after Intracerebral ...
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http://www.biomedcentral.com/1471-2377/14/172
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Hartings, Jed - Outcome
Cortical spreading depolarizations are waves of neuronal and astrocyte depolarization that propagate through brain tissue and are associated with worse clinical outcomes after traumatic brain injury. The study found that over 50% of patients with brain injury experienced spreading depolarizations when monitored with electrocorticography. In a multivariate analysis controlling for established prognostic factors, spreading depolarizations remained independently associated with unfavorable six-month outcomes. The results suggest spreading depolarizations are a pathomechanism with adverse effects on the injured brain that could potentially be targeted by new therapies.
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This study developed and validated a preoperative acute kidney injury (PO-AKI) risk prediction index called SPARK for noncardiac surgeries. Using data from two Korean hospitals, the study identified preoperative risk factors to stratify patients into four risk classes (A to D). Class A patients had the lowest PO-AKI risk while class D the highest. The simple index uses only preoperative variables and can help clinicians decide which patients need PO-AKI monitoring after surgery. While not perfect, the SPARK index provides a practical tool to predict and prevent PO-AKI.
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PPT Cath GAR 2.pptx
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This document summarizes the annual audit of the blood bank from January 2016 to December 2016. It provides details on blood donation patterns, donor demographics, component preparation, transfusion transmitted infection reactivity rates, donor counseling and notification, cross-matching and issuance of blood products, turnaround times, and reasons for delays. Key findings include that 79% of donors were replacement donors, 98% were male, the HIV reactivity rate was 0.26%, and the average cross-match to transfusion ratio was 3.9:1. Recent developments including new automated equipment for testing and blood typing were also mentioned.
ED audit 2016
This document contains various statistics from the emergency department (ED) audit of 2016 from a hospital:
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MRS audit 2016
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Physiotherapy audit 2016
The document provides statistics from the Physiotherapy unit of JPN Apex Trauma Center AIIMS for the 2016-17 year. It details the total number of physiotherapy sessions at 72810, broken down between outpatient department (OPD) sessions and inpatient department (IPD) sessions. It also provides data on the number of physiotherapy sessions by department, gender and age of patients, types of physiotherapy treatments performed, and more.
Orthopedics audit 2016
This document provides census data and statistics for the orthopedics department of JPNATC, AIIMS from 2013-2016. Some key figures include:
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Wound care surveillance audit 2016
The annual audit report summarizes wound care and surveillance data from 2016. A total of 802 complex wounds were recorded, with the majority (352) occurring on the lower limbs. 99 amputations of the lower limbs were also reported. Risk assessment of patients using the Braden scale found 70 patients at high risk of developing pressure ulcers. A total of 152 pressure ulcers were reported in 2016, with the majority (109) healing successfully. New initiatives in 2016 included group education sessions on wound prevention and individual education to prevent wound infections.
OT audit 2016
1) This document summarizes the neurosurgery cases and ICU census from January to December 2016 at AIIMS, New Delhi. It provides statistics on the number and types of neurosurgery cases, patient demographics, procedures performed, and ICU admissions and outcomes.
2) A total of 1280 neurosurgery cases were performed in 2016, with the highest number in March (140) and the lowest in September (90). The majority were emergency cases (60%) and most patients were male (86%).
3) In the ICU, 1407 patients were admitted in 2016, most from the emergency department (71%). Head injury was the leading cause of admission (78%). The mortality rate was 6.8% compared
TNCS audit 2016
This document provides injury surveillance data from 2016 for the J.P.N. Apex Trauma Centre in AIIMS. Some key details include:
- A total of 66,891 patients visited the emergency department, with 18,172 included in the trauma registry.
- The majority of patients were male (76.95%) and between 21-30 years old (29.45%).
- Road traffic injuries accounted for the highest proportion of causes of injury (48.02%), followed by unintentional/accidental injuries (35.04%).
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Trauma surgery audit 2016
1) This document summarizes trauma census data and surgical procedures from the Division of Trauma Surgery and Critical Care at AIIMS for the year 2016. 2) There was a 2.6% increase in emergency department attendance in 2016 with 71% of patients triaged as green, 23% as yellow, and 6% as red. 3) A total of 1960 patients were admitted under trauma surgery with 73% from the ED and 27% follow up cases. 4) The most common modes of injury were road traffic accidents (52.8%), falls (17.4%), and assaults (13.8%). 5) A total of 1948 surgical procedures were performed, with the most common being for extremities (794), abdomen
Lab medicine audit 2016
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Radiology audit 2016
This document summarizes radiology procedures and statistics from 2014-2016 at a trauma center in New Delhi. It includes the following key points:
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- Fluoroscopy procedures decreased from 227 in 2014 to 100 in 2016.
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- CT scans increased slightly from 17445 in 2014 to 19364 in 2016, with most done in casualty on adults focusing on the head.
- MRI scans slightly increased from 10
Neurosurgery audit 2016
This document provides an audit summary of the Neurosurgery Department from 2013-2016. Key points include:
- Clinical workload including OPD visits, admissions, surgeries and beds remained steady from 2013-2016. Staffing included junior residents, senior residents and consultants.
- Mortality rates from head and spinal injuries generally decreased from 2013-2016, especially for severe head injuries.
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Community emergency initiative
The document outlines the Community Emergency Care Initiative run by the All India Institute of Medical Sciences in New Delhi, which aims to train one billion people in emergency medical care. It provides details on programs held in various Indian states and countries to train groups like doctors, nurses, teachers, students, and members of defense and paramilitary forces in emergency preparedness and response. The program is directed by Dr. Sanjeev Bhoi and coordinated by Ms. Nirmal Thakur.
JPNATC Newsletter may 2016
The newsletter highlights achievements of the past year at Jai Prakash Narayan Apex Trauma Centre (JPNATC) in New Delhi, India. Key accomplishments include implementing several new IT systems like online indenting, file tracking, inventory management, and blood bank and emergency department modules. The trauma centre continues to serve as a model for other facilities and has received several awards. Upcoming events include the World Trauma Congress in August and a conference on cost-effective healthcare technology in September.
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The audit report summarizes medical record information and statistics for JPNATC from 2015 to 2013. In 2015, there were 67,044 casualty cases, 36,383 follow-up OPD cases, and 5,192 admissions. The gross death rate was 11% and net death rate was 6%. The bed occupancy rate was 83% and average length of stay was 11 days. With dedicated teamwork, the medical record section provides better treatment, decisions, and trauma care. The section requests conducting more research, education, and training to further promote health record science.
scientific paper on Role of MRD in Hospital Functioning
The document discusses the role of the Medical Record Department (MRD) in hospital functioning. The MRD collects patient information from different departments to compile vital statistics about admissions, discharges, procedures, deaths, and more. This information is provided to hospital administration, government agencies, courts, and other organizations. In 2014, the MRD of a specific hospital collected data on over 62,000 patient visits, 9.3% requiring admission. Surgery and orthopedics saw the most procedures. The MRD also issues medical records to researchers and courts. In summary, the MRD plays a key role in patient care, administration, and legal/research functions through comprehensive collection and reporting of medical record data.
scientific paper on emr
This document summarizes the findings of a study on the status of electronic medical records (EMRs) across various centers at AIIMS hospital in India. A questionnaire was distributed to different medical record departments to assess the digitization of 30 key documents. The results found that the JPNATC center had digitized 67% of documents, qualifying it as semi-digitalized, while the main hospital had 60% digitized. Other centers like IRCH and RPC had lower levels of digitization. Overall, AIIMS had initiated the process of digitizing patient health records but several areas were still pending transformation from paper to digital formats. The study highlights the need to further improve digitization efforts for better patient care delivery and hospital management.
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- 1. Vivek Tandon, Deepak Agrawal Dept of Neurosurgery. JPNATC AIIMS – New Delhi Inter-observer variability in GCS scoring in a Level I Trauma Centre Do we now need GCS independent protocols?
- 6. Results Total no. of patients 100 GCS score - <8 24 GCS score - <9 - 13 32 GCS score - 14 - 15 44
- 7. Results Total no. of patients with discrepancy 42 % Discrepancy in score =1 15 35% Discrepancy in score =2 11 26% Discrepency in score =3 9 22% Discrepency in score = >4 7 17%
- 9. Results Scoring discrepancies Scoring difference in eye score 15 Scoring difference in verbal score 28 Scoring difference in motor score 24
- 10. Results continued Mean year of experience of JR Difference in score , compared with S/R neurosurgery % less than 1 year 25 59.5% More than one year 17 40.5%