Jpnatc experience on mortality after head injury

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.


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.


MATERIAL AND METHODS

Total cases : 1286.

Study design : Retrospective.

Duration : Nov 2007- Oct 2008

Study population : Head injured patients



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



EXCLUSION CRITERIA :

Poly-trauma patients admitted under other departments.

Patients managed through OPD or kept under observation at ED.



Patients were managed as per departmental protocols

All death files were analyzed for mortality data


DEMOGRAPHY

AGE1-80 yr

SEXMALE 907(70.5%)

FEMALE 379 (29.5%)

OBSERVATIONS


19%

13%27%

16%9%

7%

5%

4%

> 10 yr11-20 yr21-30 yr31-40 yr41-50 yr51-60yr61-70yr71-80yr

OBSERVATIONS


OBSERVATIONS

Hospital arrival time = 2 hrs to 48 hrs.

Time of injury= 3am-6pm(32%) 6pm – 3am (68%)


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%)


MINOR, 340

MOD, 238

SEVERE, 708

0

100

200

300

400

500

600

700

800

OBSERVATIONS


OBSERVATIONS


338

235

699

2 3 90

100

200

300

400

500

600

700

CLOSED HI PENETRATINGHI

MINORMODSEVERE

OBSERVATIONS PENETRATING HEAD INJURY- ENTRY WOUND


OBSERVATIONS


216192

636

124

4672

0

100

200

300

400

500

600

700

SIMPLE HI COMPOUNDHI

MINOR

MODERATE

SEVERE

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

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

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

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.


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.


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.


Health & Medicine

Jpnatc experience on mortality after head injury