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Outcome in head injured patients indian experience

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Outcome in head injured patients indian experience

  1. 1. <ul><li>Traumatic brain injury (TBI) is the leading cause of death and most are due to RTA </li></ul><ul><li>By 2020 : 3rd largest killer in the developing world (WHO) </li></ul><ul><li>On India's roads, 1 person dies every 6 min; 70% deaths are due to head and spinal injury </li></ul><ul><li>THERE IS LACK OF EPIDEMIOLOGICAL & OUTCOME DATA ON HEAD INJURY IN INDIA </li></ul>OBSERVATIONS AIMS & OBJECTIVES <ul><li>To evaluate outcome in patients of head injuries in relation to post-resuscitation GCS and GOS </li></ul><ul><li>A secondary objective was to look for associated epidemiological factors for head injured patients admitted in JPNATC, AIIMS </li></ul>BACKGROUND <ul><li>Study design : Retro-prospective </li></ul><ul><li>Duration : Nov 2007- Apr 2009 (Single, Level 1 trauma centre) </li></ul><ul><li>INCLUSION CRITERIA </li></ul><ul><ul><li>All patients of head injury admitted in department of Neurosurgery at JPNATC, AIIMS </li></ul></ul><ul><ul><li>PATIENTS GROUPS </li></ul></ul><ul><ul><ul><li>Minor head injury (GCS 13-15) </li></ul></ul></ul><ul><ul><ul><li>Moderate head injury (GCS 9-12) </li></ul></ul></ul><ul><ul><ul><li>Severe head injury (GCS 8 or less) </li></ul></ul></ul><ul><li>EXCLUSION CRITERIA </li></ul><ul><ul><li>Poly-trauma patients admitted under other departments </li></ul></ul><ul><ul><li>Patients managed through OPD or kept under observation at ED </li></ul></ul><ul><li>Patients were initially resuscitated at emergency room and then shifted to either operation theater or neuro ICU </li></ul><ul><li>Patients were managed as per departmental protocols </li></ul><ul><li>Outcome was assessed at discharge/ death using GOS </li></ul>Ouch! One big bikes accident. It happened in 2008 in Matamoros, in Mexico at a family bicycling tour. According to newspapers, the driver was on drugs when it happened. PEDIATRIC (< 12 YR)= 328 ( 15 %) ELDERLY (>60 YRS)= 181 ( 8 %) MINOR HI - 29% MOD. HI - 18% SEVERE HI - 53% <ul><li>This is THE LARGEST study from India which shows mortality rates and outcome in head injured patients </li></ul><ul><li>The study gives valuable epidemiological data based on which various guidelines can be established </li></ul><ul><li>Our mortality rates for head injured patients compare very favorably with international data </li></ul>LITERATURE REVIEW <ul><li>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. </li></ul><ul><li>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. </li></ul>MATERIALS & METHODS Deepak Agrawal, Shameem Ahmed, Shabbir Khan, GD Satyarthee, S Sinha, D Gupta, BS Sharma, AK Mahapatra Department of Neurosurgery, JPN Apex Trauma Centre, All India Institute of Medical sciences, New Delhi Outcome in Head Injured patients: Indian Experience 2068 PATIENTS IN 18 MONTHS CONCLUSIONS References Mode of injury No. (%) ASSAULT 558 (26%) RTA 1328 (64%) FALL 165 (7.5%) OTHER 17 (2.5%) GROUP NO. OF IN-HOSPITAL MORTALITY TOTAL CASES % Overall 454 2068 22 Minor HI 14 598 2 Moderate HI 45 380 12 Severe HI 395 1090 36 Glasgow Outcome Score (In severe HI) % 1 Death 36% 2 Vegetative 19% 3 Severe disabled 13% 4 Mod. disabled 17% 5 Good recovery 28% PATTERN OF DEATHS MORTALITY (NO.) % EARLY DEATHS (<48 hours of admission) 178 39 Within 2 – 7 days of admission 187 42 LATE DEATHS (> 7 days of admission) 89 19 Author MORTALITY OVERALL MINOR MODERATE SEVERE Kagan RJ 1994 26.7% - - 41.4% Fakhry SM 2004 28.8% - - - Udekwu P 2004 21% - - 31.5% AIIMS 2008 22% 2% 12% 36% GROUP NO. OF MORTALITY TOTAL CASES % Children (< 12 yrs) 118 305 38 Adult ( 20-50 yrs) 191 1118 17 Elderly ( 50-80 yrs) 126 339 37

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