Head Injury Audit

Deepak Agrawal Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi

AIM OF AUDIT

To evaluate outcome in patients of head injuries in relation to To evaluate outcome in patients of head injuries in relation to

post-resuscitation GCS score and mortality. post-resuscitation GCS score and mortality.

A secondary objective was to look for epidemiological factors A secondary objective was to look for epidemiological factors responsible for these head injuries.responsible for these head injuries.

MATERIAL AND METHODS

Total cases : 1286.

Duration : Nov 2007- Oct 2008

Study population : Head injured patients

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

MATERIAL AND METHODS

EXCLUSION CRITERIA :

Poly-trauma patients admitted under other departments.

Patients managed through OPD or kept under observation at ED.

MATERIAL AND METHODS

Patients were managed as per departmental protocols

All death files were analyzed for mortality data

DEMOGRAPHICS

AGE1-80 yr

SEXMALE 907(70.5%)

FEMALE 379 (29.5%)

OBSERVATIONS

19%

13%27%

16%9%

7%

5%

4%

> 10 yr

11-20 yr

21-30 yr

31-40 yr

41-50 yr

51-60yr

61-70yr

71-80yr

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

MINOR

MOD

SEVERE

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 prognosticateS outcome.

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

REFERENCES

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.

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; discussion 499-500.

Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D : Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma 2004 May; 56(5):1084-9.