overview of neurosurgery at jpnatc, aiims, delhi
TRANSCRIPT
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AN OVERVIEW
Deepak AgrawalDepartment of Neurosurgery, JPN Apex Trauma Centre, AIIMS
NEUROSURGERY, JPNATC
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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
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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
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Infrastructure
TC4 (Polytrauma): 6 beds
TC5 (Neurosurgery ward): 24 beds
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Neurosurgery (JPNATC)- staffing
000JR
13114SR
505N Anesth FACULTY
145NS FACULTY
VACANTFILLEDTOTALPOST
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Neurosurgery (JPNATC)- staffing Nursing staff: patient ratio
NS ICU 1:3 NS HDU 1:6 NS ward 1:8
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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
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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.
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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.
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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.
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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
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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
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AUDIT
Duration : Nov 2007- Oct 2008
Total cases : 1286.
Study population : Head injured patients
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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
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MATERIAL AND METHODS
EXCLUSION CRITERIA :
Poly-trauma patients admitted under other departments.
Patients managed through OPD or kept under observation at ED.
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MATERIAL AND METHODS
Patients were managed as per departmental protocols
All death files were analyzed for mortality data
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DEMOGRAPHICS
AGE1-80 yr
SEXMALE 907(70.5%)
FEMALE 379 (29.5%)
OBSERVATIONS
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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
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OBSERVATIONS
Hospital arrival time = 2 hrs to 48 hrs.
Time of injury= 3am-6pm(32%) 6pm – 3am (68%)
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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%)
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MINOR, 340
MOD, 238
SEVERE, 708
0
100
200
300
400
500
600
700
800
OBSERVATIONS
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OBSERVATIONS
338
235
699
2 3 90
100
200
300
400
500
600
700
CLOSED HI PENETRATINGHI
MINOR
MOD
SEVERE
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OBSERVATIONS
216192
636
124
4672
0
100
200
300
400
500
600
700
SIMPLE HI COMPOUNDHI
MINOR
MODERATE
SEVERE
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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
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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
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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
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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.
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THANK YOU