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. - Average hospital stay durations for head and spinal injury patients varied depending on injury severity but were typically longest for severe injuries. - Common surgeries included craniotomies, ventriculoperitoneal/ventriculoatrial shunts, cranioplasties and tracheostomies.

1. Neurosurgery Department Audit-2016
Dr.Deepak Agrawal
Prof. Neurosurgery
JPNATC,AIIMS
06-04-2017

2. CLINICAL WORKLOAD
YEAR OPD ADMISSION SURGERY BEDS
2013 6384 1661 1304 58
2014 6450 1957 1426 58
2015 6832 1881 1334 58
2016 6660 1760 1385 58
0
5000
10000
20132014 2015 2016
OPD
ADMISSION
SURGERY
BEDS

3. JR -7
SR -15
CONSULTANT- 19
2016
2015
JR -9
SR -15
CONSULTANT- 12

4. 2013 2014 2015 2016
Total HI Total
Mortality
Total HI Total
Mortality
Total
HI
Total
Mortality
Total HI Total
Mortality
Severe HI 590 33.89% 604 29.3% 536 38.4% 476 14.4%
Moderate
HI
208 10.5% 225 7.1% 121 13.2% 174 7.9%
Minor HI 423 2.3% 526 0.95% 456 4.1% 533 0.60%
Total 1221 18.47% 1355 14.61% 1113 22.6% 1183 6.42 %
MORTALITY IN HEAD INJURY

5. 5
2013 2014 2015 2016
Total Total
Mortality
Total Total
Mortality
Total Total
Mortality
Total Total
Mortality
Cervical
Injury
240 35.06% 425 15.52% 254 7.03% 190 8 %
Dorso -
Lumbar Injury
200 4.5% 177 1.12 % 182 2.74 % 145 2.068%
MORTALITY IN SPINAL INJURY

6. 6
2013 2014 2015 2016
Total Total
Mortality
Total Total
Mortality
Total Total
Mortality
Total Total
Mortality
Severe head
injury
94 40.42% 52 32.69 % 86 34.8 % 45 8.8%
Moderate HI 83 6.02% 15 0% 17 5.8 % 11 0%
Minor HI 78 0% 51 0% 69 1.44% 36 0%
HEAD INJURY IN PAEDIATRICS

7. 7
2014 2015 2016
Total Total
Mortality
Total Total
Mortality
Total Total
Mortality
Cervical Spine
injury
35 22.85 28 33% 20 25%
Dorso-lumbar 9 0% 5 0% 9 0%
SPINAL INJURY IN PAEDIATRICS

8. 8
2013 2014 2015 2016
Mi
nimu
m
Stay(
days)
Ma
ximu
m
stay
Me
an
stay
Mi
nimu
m
Stay(
days)
Max
imum
stay
Mea
n stay
Mini
mum
Stay(d
ays)
Max
imum
stay
Mean
stay
Mi
nimu
m
Stay(
days)
Max
imum
stay
Mean
stay
Minor
HI
2 14 6 1 34 7.14 1 52 8.4 1 19 5
MOD
ERATE
HI
3 35 8 3 58 9.21 2 272 11.8 3 37 9.46
SEVE
RE HI
7 60 20 3 96 18.64 1 126 16.3 7 75 20.12
HOSPITAY STAY IN HEAD INJURY ADMISSIONS

9. 9
2013 2014 2015 2016
Mini
mum
Stay(d
ays)
Maxi
mum
stay
Mea
n stay
Mini
mum
Stay(d
ays)
M
axi
mu
m
sta
y
Mean
stay
M
ini
mu
m
Sta
y(d
ays)
Maxi
mum
stay
Mean
stay
Minim
um
Stay(day
s)
Maxim
um stay
Mean
stay
CERVI
CAL
INJURY
5 142 14 3 3
90
16 3 350 15 1 164 14.8
DORSO
LUMBAR
INJURY
4 92 12 3 1
02
10.38 3 45 10.25 3 68 10
HOSPITAY STAY IN SPINAL INJURY ADMISSIONS

10. YEAR De.Cran
iotomy
VP/
TP
Shunt
Crani
oplast
y
Trache
ostomy
BPI Spinal Others
2013 284 68 121 77 96 316 342
2014 364 88 192 81 125 362 214
2015 270 58 112 58 132 319 207
2016 369 64 122 39 171 330 111
0
200
400
2016
2015
2014
2013

11. YEAR ICP
INSERTION IN
OT
ICP
INSERTION IN
ICU
2013 05 342
2014 08 266
2015 06 324
2016 32 318
ICP INSERTION
0
200
400
IN OT IN ICU
2016
2015
2014
2013

12. YEAR OPEN TT PERCUTANEOUS
TT
2013 77 290
2014 81 310
2015 58 317
2016 39 354
0
200
400
2016
2015
2014
2013

13. WARD/IC
U
2016 2015 2014 2013
TC3 1186 1473 1369 1702
TC5 605 592 419 347
0
500
1000
1500
2000
TC3 TC5
2016
2015
2014
2013

14. TEG DONE
2013 1310
2014 985
2015 957
2016 593
Column1
2016
2015
2014
2013

15. Year O arm C-arm
2016 64 115
2015 112 215
2014 115 193
TOTAL O-ARM &C-ARM CASES
0
100
200
300
2016 2015 2014
O-ARM
C-ARM

16. RESEARCHS AND PUBLICATIONS (2015-2016)
1. Agrawal D, Kurwale N, Sharma BS. Leukocytosis after routine cranial
surgery: A potential marker for brain damage in intracranial surgery.
Asian J Neurosurg. 2016;11:109-13.
2. Agrawal D, Ahmed S, Khan S, Gupta D, Sinha S, Satyarthee GD. Outcome
in 2068 patients of head injury: Experience at a level 1 trauma centre in
India. Asian J Neurosurg. 2016;11:143-5.
3. Kamal VK, Agrawal D, Pandey RM. Prognostic models for prediction of
outcomes after traumatic brain injury based on patients admission
characteristics. Brain Inj. 2016;22:1-14.
4. Agrawal D, Saini R, Singh PK, Sinha S, Gupta DK, Satyarthee GD, Misra
MC. Bedside computed tomography in traumatic brain injury:
Experience of 10,000 consecutive cases in neurosurgery at a level 1
trauma center in India. Neurol India. 2016;64:62-5.

17. PUBLICATIONS (2015-2016)
5. Bhoi S, Thakur N, Verma P, Sawhney C, Vankar S, Agrawal D, Sinha T. Does
community emergency care initiative improve the knowledge and skill of
healthcare workers and laypersons in basic emergency care in India? J Emerg
Trauma Shock. 2016;9:10-6.
6. Agrawal D, Singh PK, Sinha S, Gupta DK, Satyarthee GD, Misra MC. Remaining
unconscious: The burden of traumatic brain injuries in India. J Neurosci
Rural Pract. 2015;6:520-2.
7. Kumar A, Verma N, Agrawal D, Sharma BS. Endoscopic lavage for antibiotic
unresponsive severe Acinetobacter baumanii ventriculitis: an unexplored
treatment option. Acta Neurochir (Wien). 2015;157:1225-7.
8. Mishra A, Agrawal D, Gupta D, Sinha S, Satyarthee GD, Singh PK. Traumatic
spondyloptosis: a series of 20 patients. J Neurosurg Spine. 2015;22:647-52.

18. PUBLICATIONS (2015-2016)
12. Agrawal D, Sinha TP, Bhoi S. Assessment of ultrasound as a diagnostic
modality for detecting potentially unstable cervical spine fractures in
pediatric severe traumatic brain injury: A feasibility study. J Pediatr
Neurosci. 2015;10:119-22.
13. Sinha S, Raheja A, Garg M, Moorthy S, Agrawal D, Gupta DK, Satyarthee GD,
Singh PK, Borkar SA, Gurjar H, Tandon V, Pandey RM, Sharma BS.
Decompressive craniectomy in traumatic brain injury: A single-center,
multivariate analysis of 1,236 patients at a tertiary care hospital in India.
Neurol India. 2015;63:175-83.

19. SNo Project Title Funding Agency Start Date Completed
Ongoing Projects
1. Early versus Delayed Decompression for Traumatic
high Cervical Spinal Cord Injury in Acute Spinal Cord
Injury Study
DST September 2014 September 2017
2. “Optic Nerve Ultrasound in Severe Traumatic Brain
Injury”
DBT December 2015 December 2018
Completed Project
1. “Thromboelastometry (TEG): Utility and Cost-
effectiveness in diagnosing of infection in
Neurosurgery Intensive care unit (ICU) as compared to
established biomarkers”
Institute Completed
2. “Determination of the reference range for the elevated
PT/INR with normal coagulation factor level and its
association with plasma transfusion therapy in head
injury patients”
ICMR June 2015 June 2016
3. “Acute thalamic involvement in severe head injury-An
autopsy study with histopathological correlation”
Institute Completed
4. “Matrix Metalloproteinase (MMPS) (MMPS) as
biomarkers for fusion following spinal instrumentation
AOSPINE 2014 2015
5. “Monitoring cognition of healthcare workers in
emergency and intensive care setting and its relation to
medical errors”
DST 2011 2015
6. “Automated assessment of hand hygiene complication
in healthcare settings using Kinect Camera”
DBT 2013 2015
7. “Economic & Social burden of Managing Traumatic
brain injuries (TBI) in adult aged 18-50 years in India”
ICMR 2014 2015

20. INNOVATIONS
DREZ
• Total patients -35
(Male-33 ,Female- 02)
• Pain -31
• Spasticity- 04
O-ARM DRAPE
• 12-15 drape/month till July 2016
• Cloth drape from September 2016
• Total -21 drape in OT (reusable)

21. NURSING STUDIES IN NEUROSURGERY
Title of study Researcher Awards
Role of nurses in Thiamine administration in
alcoholic head injured patients. Mr. Pankaj
Paper presented
NSSICON -2016
Role of Nurses in intracranial pressure monitoring by
ultrasound in patients with severe traumatic brain
injury. Ms. Sumi sunny
Paper presented in
NSSICON -2016
A study to assess the determinants of self extubation
and the predictive factors for reintubation in a tertiary
care Neuro Trauma ICU.
Ms.Ashitha E B
& Ms.Aswathy
Sunil
NSICON-2016 (
first Prize )
Effect of Inj.Midazolam during ET & oral suctioning
Ms.Metilda
Robin
WTC -2016( second
prize)
To compare the setup time and safety of
intraoperative O ARM with traditional intraoperative
Fluoroscopy (C ARM) and nursing implications in
Neurosurgery OT. Ms.Minju
malhotra
WTC-2016( THIRD
PRIZE )

22. Perceptions of Neurotrauma patients family members
on nursing care .
Ms.Aswathy
Sunil
First Prize in Neuro
Trauma symposium -
2016
Outcome following Cranioplasty with bone flap
stored in bone bank or in Abdomen in Severe Head
Injury Patients
Ms.sofia
solomon
&Ms.Aswathy
Sunil
NSSICON-2016(
FIRST PRIZE )
Study to assess the breach in sterility in OT Ms. Minju Ongoing
NURSING STUDIES IN NEUROSURGERY

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