JPNATC Experience On Mortality After Head Injury
Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi
TRAUMA 2008, NEW DELHI
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
AIM OF STUDY
To evaluate outcome in patients of head injuries in relation to post-resuscitation GCS score and mortality. 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.A secondary objective was to look for epidemiological factors responsible for these head injuries.
TRAUMA 2008, NEW DELHI
MATERIAL AND METHODS
Total cases : 1286.
Study design : Retrospective.
Duration : Nov 2007- Oct 2008
Study population : Head injured patients
TRAUMA 2008, NEW DELHI
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
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
MATERIAL AND METHODS
Patients were managed as per departmental protocols
All death files were analyzed for mortality data
TRAUMA 2008, NEW DELHI
DEMOGRAPHY
AGE1-80 yr
SEXMALE 907(70.5%)
FEMALE 379 (29.5%)
OBSERVATIONS
TRAUMA 2008, NEW DELHI
19%
13%27%
16%9%
7%
5%
4%
> 10 yr11-20 yr21-30 yr31-40 yr41-50 yr51-60yr61-70yr71-80yr
OBSERVATIONS
TRAUMA 2008, NEW DELHI
OBSERVATIONS
Hospital arrival time = 2 hrs to 48 hrs.
Time of injury= 3am-6pm(32%) 6pm – 3am (68%)
TRAUMA 2008, NEW DELHI
OBSERVATIONS
0
100
200
300
400
500
600
700
800
900
Assult RTA Suicidal
Mode of injury No.(%)
ASSAULT 385(30%)
RTA 887 (69%)
SUICIDAL 12 (1%)
TRAUMA 2008, NEW DELHI
MINOR, 340
MOD, 238
SEVERE, 708
0
100
200
300
400
500
600
700
800
OBSERVATIONS
TRAUMA 2008, NEW DELHI
OBSERVATIONS
TRAUMA 2008, NEW DELHI
338
235
699
2 3 90
100
200
300
400
500
600
700
CLOSED HI PENETRATINGHI
MINORMODSEVERE
OBSERVATIONS PENETRATING HEAD INJURY- ENTRY WOUND
TRAUMA 2008, NEW DELHI
OBSERVATIONS
TRAUMA 2008, NEW DELHI
216192
636
124
4672
0
100
200
300
400
500
600
700
SIMPLE HI COMPOUNDHI
MINOR
MODERATE
SEVERE
OUTCOME
TRAUMA 2008, NEW DELHI
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
OUTCOME
Hospital stay: 2 – 41 days ( mean -15)
TRAUMA 2008, NEW DELHI
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
OUTCOME
TRAUMA 2008, NEW DELHI
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
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
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
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
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