1. JPNATC Experience On Mortality After Head Injury
Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi
TRAUMA 2008, NEW DELHI
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. 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. MATERIAL AND METHODS
Total cases : 1286.
Study design : Retrospective.
Duration : Nov 2007- Oct 2008
Study population : Head injured patients
TRAUMA 2008, NEW DELHI
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. 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. MATERIAL AND METHODS
Patients were managed as per departmental
protocols
All death files were analyzed for mortality data
TRAUMA 2008, NEW DELHI
8. OBSERVATIONS
DEMOGRAPHY
SEX
AGE
MALE 907(70.5%)
1-80 yr
FEMALE 379 (29.5%)
TRAUMA 2008, NEW DELHI
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
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. 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. 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. 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. 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. 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. 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