OBSERVATIONS

Traumatic brain injury (TBI) is the leading cause of death and most are due to RTA

By 2020 : 3rd largest killer in the developing world (WHO)

On India's roads, 1 person dies every 6 min; 70% deaths are due to head and spinal injury

THERE IS LACK OF EPIDEMIOLOGICAL & OUTCOME DATA ON HEAD INJURY IN INDIA

AIMS & OBJECTIVESTo evaluate outcome in patients of head injuries in relation to post-resuscitation GCS and GOS

A secondary objective was to look for associated epidemiological factors for head injured patients admitted in JPNATC, AIIMS

BACKGROUND

Study design : Retro-prospective

Duration : Nov 2007- Apr 2009 (Single, Level 1 trauma centre)

INCLUSION CRITERIA

■ All patients of head injury admitted in department of Neurosurgery at JPNATC, AIIMS

■ PATIENTS GROUPS Minor head injury (GCS 13-15) Moderate head injury (GCS 9-12) Severe head injury (GCS 8 or less)

EXCLUSION CRITERIA

■ Poly-trauma patients admitted under other departments

■ Patients managed through OPD or kept under observation at ED

Patients were initially resuscitated at emergency room and then shifted to either operation theater or neuro ICU

Patients were managed as per departmental protocols

Outcome was assessed at discharge/ death using GOS

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 %)

Mode of injury No. (%)

ASSAULT 558 (26%)

RTA 1328 (64%)

FALL 165 (7.5%)

OTHER 17 (2.5%)

MINOR, 598

MOD, 380

SEVERE, 1090

0

200

400

600

800

1000

1200

MINOR HI - 29%MOD. HI - 18%SEVERE HI - 53%

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

This is THE LARGEST study from India which shows mortality rates and outcome in head injured patients

The study gives valuable epidemiological data based on which various guidelines can be established

Our mortality rates for head injured patients compare very favorably with international data

Author MORTALITY

OVERALL MINOR MODERATE SEVEREKagan 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

LITERATURE REVIEW

1. 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.

2. 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.

MATERIALS & METHODS

Deepak Agrawal, Shameem Ahmed, Shabbir Khan, GD Satyarthee, S Sinha, D Gupta, BS Sharma, AK MahapatraDepartment of Neurosurgery, JPN Apex Trauma Centre,

All India Institute of Medical sciences, New Delhi

2068 PATIENTS IN 18 MONTHS

CONCLUSIONS

References