outcome of head injury in unidentified patients - dr rajiv jha (bir hospital - neurosurgeon)
DESCRIPTION
Dr Rajiv Jha MS M Ch Resident Neurosurgeon Dept Of Neurosurgery National Academy of Medical Sciences Bir HospitalTRANSCRIPT
Outcome of Head injury in unidentified patients
Dr Rajiv Jha MSM Ch Resident Neurosurgeon
Dept Of NeurosurgeryNational Academy of Medical Sciences
Bir Hospital
Introduction Bir hospital, first public
sector hospital
low socioeconomic status patients
Unidentified and unattended patients
Natural history is mostly unknown
Neurosurgery Department.
Objectives
Demographic parameters Causes Postoperative care and rehabilitation GOS Logistical problems Medico-legal issues
Methodology Prospective case series
Study period : 2008 April 15th to 2011 January 15th
Head injury patients
Unidentified
Sources Of Data
ER records Case sheets Police reports
Demographics Total number of patients admitted :35/1810
Admissions (1.93%)
Brought By
66%
14%
20%
Police Witness Properator
VALLEY30(86%)
OUT-SIDE VAL-LEY
5(14%)
Chart Title
Demographics
30(86%)
5(14%)
MaleFemale
Causes
RTA Fall Physical assault
Not Known0
2
4
6
8
10
12
14
16
1816(45.71%)
822.85% 7
20%
411.42%
Severity
Mild Moderate Severe0
2
4
6
8
10
12
14
16
18
20
720%
1028.57%
1851.42%
CT Findings
Contusion
Intracerebral hematoma
Compound fracture
diffuse axonal injury
Acute Subdural hematoma
Extradural hematoma
3(8.57%)
3(8.57%)
2(5.71%)
7(20%)
10(28.57%)
10(28.57%)
Treatment
22(63%)
13(37%)
Surgical Non-surgical
Surgical
Fracture elevation 2 Evacuation of hematoma 14
Acute subdural hematoma 4
Extradural hematoma 12
Burr hole Evacuation 6
Mean hospital stay 16.52 days.
31%
69%
Relatives foundRelatives not found
GOS
Good recovery 8 (22.85%)
Moderate disability 7 (20%)
Severe disability 8 (22.85%)
Vegetative 5 (14.28%)
Dead 7 (20%)
Results
Discharge Dead Discharge to social service
Absconded0
2
4
6
8
10
12
14
16
1817(48.57%)
720%
925.71%
25.71%
Severity NO DEADMild 7 1
Moderate 10 0
Severe 18 6
Mortality in unidentified head injury patients is high
Comparative Study
Present study AKM
Total no 35 325
Operative Rx37% 18%
Mortality 20% 53%
Ref: AK Mahapatra.Neurologyindia.
Discussions
Medico-legal problems. Unknown patients pose special
problems in management. Longer duration of stay in hospital. Lack of pre-hospital care. Shortage of rehabilitation.
Recommendations
An identification card. Provisions should be made to treat such
patients in all medical institutions. Mechanism should be developed to
investigate and treat such patients urgently.
Thank you!
EVERY SMILE…….
EVERY GESTURE….
EVERY MIRACLE COUNTS!!