AN OVERVIEW

Deepak AgrawalDepartment of Neurosurgery, JPN Apex Trauma Centre, AIIMS

NEUROSURGERY, JPNATC

Background Department of Neurosurgery became

fully operational on November 26, 2007 when casualty services started in JPNATC.

Since then, the department is one of the biggest and busiest departments in JPNATC

Infrastructure TC3: Dedicated 16 bed NSICU

Became functional in March 2008 12 Ventilators (Taema/ Vela) State of art infrastructure incl centralized

monitoring

TC5: NS HDU (6 beds) 3 ventilators 6 monitors

Infrastructure

TC4 (Polytrauma): 6 beds

TC5 (Neurosurgery ward): 24 beds

Neurosurgery (JPNATC)- staffing

000JR

13114SR

505N Anesth FACULTY

145NS FACULTY

VACANTFILLEDTOTALPOST

Neurosurgery (JPNATC)- staffing Nursing staff: patient ratio

NS ICU 1:3 NS HDU 1:6 NS ward 1:8

CLINICAL LOAD

2405Total (since

2006)

182Dec.08

166Nov.08

138Oct.08

151Sep.08

176Aug.08

150Jul.08

162Jun-08

172Mav-08

153Apr. 08

192Mar.08

135Feb-08

139Jan-08

117Dec.07

67Nov.-07

Admission in NeurosurgeryMonth/ Yr

TYPES OF SURGERIES

CRANIAL (head injuries) All types of surgeries including

decompressive craniectomies, frontal and temporal lobectomies, SDH & EDH evacuations, Elevation of depressed fractures as well as surgical management of missile & gunshot.

TYPES OF SURGERIES Spinal cord injury program

The department of neurosurgery has a spinal cord injury program wherein all patients of spinal cord injury are managed in association with department of physiotherapy.

Spinal Injury management The department has expertise in managing all spinal

injuries including CV junction, cervical, thoracic and lumbar.

All kinds of instrumentation, including percutaneous instrumentation are done in the department.

TYPES OF SURGERIES

Brachial plexus & peripheral nerve Department of neurosurgery at JPNATC is

one of the few centers in India which manages complex brachial plexus and peripheral nerve injuries.

OPERATIONS

1369 Total (SINCE 2006)

116 Dee.O8

108 Nov.08

109 Oct.08

115 Sep.08

106 Aug.08

110 Jul.08

92 Jun-08

117 May-08

107 Apr. 08

107 Mar.08

89 Feb-08

71 Jan-08

70 Dee.07

24 Nov.-07

TOTAL

Month/ Year

OPD

3824 TOTAL

333 Dec.08

270 Nov.08

284 Oct.08

353 Sep.08

405 Aug.08

421 Jul.08

352 Jun-08

382 May-08

210 Apr. 08

176 Mar.08

211 Feb-08

235 Jan-08

95 Dec.07

41 Nov-07

TOTAL

Month/ year

AUDIT

Duration : Nov 2007- Oct 2008

Total cases : 1286.

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

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

COMPARISON WITH PUBLISHED 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.

AIIMS study ( present series) : Mortality as 3%, 15% ,35% for mild, moderate and severe head injury. This conforms to other study.

THANK YOU