1. JPNATC Experience On Mortality After Head Injury
Department of Neurosurgery, JPN Apex Trauma Centre, AIIMS, New Delhi
TRAUMA 2008, NEW DELHI

2. 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.
TRAUMA 2008, NEW DELHI

3. AIM OF STUDY
 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.
TRAUMA 2008, NEW DELHI

4. MATERIAL AND METHODS
 Total cases : 1286.
 Study design : Retrospective.
 Duration : Nov 2007- Oct 2008
 Study population : Head injured patients
TRAUMA 2008, NEW DELHI

5. 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
TRAUMA 2008, NEW DELHI

6. MATERIAL AND METHODS
EXCLUSION CRITERIA :
 Poly-trauma patients admitted under other departments.
 Patients managed through OPD or kept under observation at ED.
TRAUMA 2008, NEW DELHI

7. MATERIAL AND METHODS
 Patients were managed as per departmental
protocols
 All death files were analyzed for mortality data
TRAUMA 2008, NEW DELHI

8. OBSERVATIONS
DEMOGRAPHY
SEX
AGE
MALE 907(70.5%)
1-80 yr
FEMALE 379 (29.5%)
TRAUMA 2008, NEW DELHI

9. OBSERVATIONS
7%
> 10 yr
9% 5%
16% 11-20 yr
4% 21-30 yr
31-40 yr
41-50 yr
19% 51-60yr
27% 61-70yr
13%
71-80yr
TRAUMA 2008, NEW DELHI

10. OBSERVATIONS
Hospital arrival time = 2 hrs to 48 hrs.
Time of injury= 3am-6pm(32%)
6pm – 3am (68%)
TRAUMA 2008, NEW DELHI

11. OBSERVATIONS
Mode of injury No.(%)
900 ASSAULT 385(30%)
800 RTA 887 (69%)
700 SUICIDAL 12 (1%)
600
500
400
300
200
100
0
Assult RTA Suicidal
TRAUMA 2008, NEW DELHI

12. OBSERVATIONS
800
SEVERE, 708
700
600
500
400
MINOR, 340
300
MOD, 238
200
100
0
TRAUMA 2008, NEW DELHI

13. OBSERVATIONS
700 699
600
500
400
338 MINOR
300 MOD
235 SEVERE
200
100
0 2 3 9
CL ED HI
OS PENETRATING
TRAUMA 2008, NEW DELHI
HI

14. OBSERVATIONS
PENETRATING HEAD INJURY- ENTRY WOUND
TRAUMA 2008, NEW DELHI

15. OBSERVATIONS
700
636
600
500
400
MINOR
300 MODE RATE
S VE
E RE
216
200 192
124
100
72
46
0
SIMPL HI
E COMPOUND
HI
TRAUMA 2008, NEW DELHI

16. 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
TRAUMA 2008, NEW DELHI

17. OUTCOME
Hospital stay: 2 – 41 days ( mean -15)
DURATION NO. OF MORTALITY TOTAL CASES %
(since arrival)
< 48 hrs. 102 296 34
48 hrs - 1 wk. 140 296 47
> 1 wk. 54 296 19
TRAUMA 2008, NEW DELHI

18. 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
TRAUMA 2008, NEW DELHI

19. 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.
TRAUMA 2008, NEW DELHI

20. 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.
TRAUMA 2008, NEW DELHI

21. 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.
TRAUMA 2008, NEW DELHI