head injury data at jpnatc nov 2007 october 2008
TRANSCRIPT
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Head Injury Audit
Deepak Agrawal Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi
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AIM OF AUDIT
To evaluate outcome in patients of head injuries in relation to To evaluate outcome in patients of head injuries in relation to
post-resuscitation GCS score and mortality. post-resuscitation GCS score and mortality.
A secondary objective was to look for epidemiological factors A secondary objective was to look for epidemiological factors responsible for these head injuries.responsible for these head injuries.
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MATERIAL AND METHODS
Total cases : 1286.
Duration : Nov 2007- Oct 2008
Study population : Head injured patients
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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
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MATERIAL AND METHODS
EXCLUSION CRITERIA :
Poly-trauma patients admitted under other departments.
Patients managed through OPD or kept under observation at ED.
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MATERIAL AND METHODS
Patients were managed as per departmental protocols
All death files were analyzed for mortality data
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DEMOGRAPHICS
AGE1-80 yr
SEXMALE 907(70.5%)
FEMALE 379 (29.5%)
OBSERVATIONS
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19%
13%27%
16%9%
7%
5%
4%
> 10 yr
11-20 yr
21-30 yr
31-40 yr
41-50 yr
51-60yr
61-70yr
71-80yr
OBSERVATIONS
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OBSERVATIONS
Hospital arrival time = 2 hrs to 48 hrs.
Time of injury= 3am-6pm(32%) 6pm – 3am (68%)
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OBSERVATIONS
0
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Assult RTA Suicidal
Mode of injury No.(%)
ASSAULT 385(30%)
RTA 887 (69%)
SUICIDAL 12 (1%)
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MINOR, 340
MOD, 238
SEVERE, 708
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OBSERVATIONS
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OBSERVATIONS
338
235
699
2 3 90
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700
CLOSED HI PENETRATINGHI
MINOR
MOD
SEVERE
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OBSERVATIONS PENETRATING HEAD INJURY- ENTRY WOUND
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OBSERVATIONS
216192
636
124
4672
0
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SIMPLE HI COMPOUNDHI
MINOR
MODERATE
SEVERE
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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
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OUTCOME
Hospital stay: 2 – 41 days ( mean -15)
DURATION(since arrival)
NO. OF MORTALITY TOTAL CASES %
< 48 hrs.
102 296 34
48 hrs - 1 wk. 140 296 47
> 1 wk. 54 296 19
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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
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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.
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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.
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CONCLUSIONS
Incidence of head injury is increasing.
Post resuscitation GCS prognosticateS outcome.
Our mortality rates for head injured patients compare very favorably with international data.
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REFERENCES
Kagan RJ, Baker RJ. The impact of the volume of neurotrauma experience on mortality after head injury. Am Surg. 1994 Jun;60(6) : 394-400.
Fakhry SM, Trask AL, Waller MA, Watts DD : Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges. J Trauma 2004 Mar; 56(3):492-9; discussion 499-500.
Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D : Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma 2004 May; 56(5):1084-9.
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