Neurotrauma Audit at Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh

2019 ◽  
Vol 16 (02/03) ◽  
pp. 109-112
Author(s):  
Ambuj Kumar ◽  
Ketan Hedaoo ◽  
Jitin Bajaj ◽  
Mallika Sinha ◽  
Shailendra Ratre ◽  
...  
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Road Traffic ◽  
Spinal Injury ◽  
Care Center ◽  
Clinical Status ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Spine Injury ◽  
Severity Of Injury

Abstract Introduction For the prevention and better management of traumatic brain and spine injury patients, it is mandatory to understand the demographic and clinical profiles of cases of a particular region. This study was aimed at describing the epidemiology, pattern, and outcomes of head and spine injury patients at a tertiary care center in central India. Materials and Methods All the patients with head and spine injury admitted to the Department of Neurosurgery between September 1, 2018, and August 31, 2019 were included in the study. Data of all these patients were collected from the medical record section and analyzed for age, sex, mode of injury, severity of injury, management, and outcomes. Results During the study period, 932 patients with head injury and 241 patients with spine injury were admitted to our department. Around 65% of the patients in both head and spine injury categories fell in the age group of 26 to 55 years. Approximately 80% of all neurotrauma patients were male. The most common mode of injury was road traffic accident followed by fall from height. Mortality for severe head injury was 39% and that for ASIA A (American Spinal Injury Association grade A) cervical spine injury was 65%. Conclusion Even after aggressive treatment strategies, morbidity and mortality are very high, and the ultimate outcome depends mainly on the clinical status immediately after trauma. The data from this study can be helpful in strategy-making for the prevention and management of head and spine injury patients, especially in the central Indian population.

scholarly journals Prevalence of Head Injury of Patients Arriving in a Tertiary Care Center

2020 ◽  
Vol 2 (1) ◽  
pp. 38-41
Author(s):  
Arbindra Kumar Yadav ◽  
Jagat Narayan Rajbanshi ◽  
Saroj Kumar Kushwaha ◽  
Pankaj Raj Nepal
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Emergency Admission ◽  
P Value ◽  
Cross Sectional ◽  
Severity Of Injury

Background and purpose: The prevalence of head injury is increasing with increasing number of automobiles, especially motorbike. With the objective to evaluate the prevalence of head injury and factors that could affect the severity of head injury, this study was performed in a tertiary hospital at far- eastern Nepal. Methodology: This is a cross-sectional study over the duration of one year. Association of age, gender, and mode of injury was checked with severity of injury using Chi-square test where P-value was kept significant at <0.01. Result: Total numbers of patient admitted through the emergency department, during the study period, were 832. Mean age of patient in the study group was 34.59 (SD 18.92) years. Majority of them falls in the category of 20-29 years. Among the different categories of head injuries, mild head injury (76%) was the most common presentation followed by moderate head injury and severe head injury, which were 14% and 10% respectively.  Conclusion: Head injury seems to be the major cause of emergency admission in for eastern part of Nepal. Among them road traffic accidents seems to be the major burden which is more common in young gentlemen with significant number of severe head injury.

scholarly journals SPINE TRAUMA

2018 ◽  
Vol 25 (03) ◽  
pp. 371-375
Author(s):  
Muhammad Sajid Mehmood ◽  
Muhammad Asad Javed ◽  
Muhammad Zafar Elahi ◽  
Sana Sehrish ◽  
Sultan Shah
Keyword(s):  
Lumbar Spine ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Spinal Injury ◽  
Tertiary Care ◽  
Neurological Status ◽  
Spine Injury ◽  
Care Hospital ◽  
Spine Trauma ◽  
Cross Sectional

Objectives: To determine the etiology and level of spine trauma in patientspresenting in tertiary care hospital of Pakistan. Study Design: Descriptive, cross-sectional study.Setting: This study was conducted at the Department of Neurosurgery, Pakistan Institute ofMedical Sciences (PIMS), Islamabad, from September 20th, 2014 to March 20th, 2015. Subjects:The patients in the study were of both genders, between 15 to 80 years of age (N=315, meanage 38.17 years, SD 17.31). Materials and Methods: All 315patientsbetween 15 to 80 yearsof age with spine trauma presenting to the Neurosurgery department of PIMS, Islamabadconsented to participate in the study. All these patients had underwent thorough history andphysical examination after stabilization and initial emergency management. X-ray spine wascarefully reviewed and patient details, bio-data, etiology of trauma, spinal injury type, level,neurological status and diagnosis were recorded. Results: The most frequently affected agegroup presenting with spine trauma were young and between 15 to 30 years of age (17.1%).The most frequent etiologies seen for spine injury were falls; 158 (50.2%) followed by RTA’s;129 (41%). The most common level of spine trauma presentation was at the lumbar spine;142 (45.1%) followed by thoracic spine fractures; 80 (25.4%). Conclusion: Lumbar spine andyounger male people are more prone to spinal injuries in Pakistan. The most frequent reasonfor the trauma was due to falls followed by road traffic accidents.

scholarly journals Head injury alert: A new level of trauma activation?

Trauma ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 213-219 ◽  
Author(s):  
Daniel Ricaurte ◽  
Daniel Slack ◽  
Aaron Gilson ◽  
Michael Nowicki ◽  
Monika Nelson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Head Injury ◽  
Injury Severity ◽  
Care Center ◽  
Tertiary Care ◽  
Injured Patient ◽  
Community Hospitals ◽  
Specific Patient ◽  
Head Ct ◽  
Trauma Activation

Introduction Trauma activation requires mobilization of significant resources to be available at short notice. In 2014, the American College of Surgeons Committee on Trauma issued its latest recommendations for care of the injured patient. Amongst trauma activation criteria, elderly patients that fell from any height on anticoagulation were included. We hypothesized that a reduced trauma team could preserve patient safety while reducing time and cost spent. Method A ‘Head Injury Alert’ was created to denote anti-coagulated patients with a GCS > 14 who fell from a height of <20 feet. An ED attending, surgical resident and one nurse evaluate the patient with the goal of obtaining a head CT within 30 min of presentation. Data were prospectively acquired from June 2017 to August 2018, which included age, anticoagulation, injury severity score (ISS), time-to-CT, outcomes, missed injuries, disposition and activations requiring escalation of care. Results Two hundred and seventy-seven head injury activations occurred; 55% of patients were female, while 45% were male. Average age was 78 years old. The most common anticoagulant was Warfarin (31%). 50% of patients were discharged, 47% were admitted, 2% died before disposition and 1% were transferred to a tertiary care center; 7% required admission to the ICU. The average time-to-CT was 25 min and ISS ranged from 0 to 26. Twenty-two patients (7%) presented with positive head CT. Of the five deaths, three patients had intracranial hemorrhage, one pneumonia present on admission and one cardiac arrest. Conclusion This level III evidence, prospective study suggests head injury alert can be safely applied as a new level of trauma activation at community hospitals. It helps identify a specific patient population and injury mechanism that can be safely triaged using limited resources. With this, community hospitals can maximize their resources and minimize cost, while maintaining patient safety.

Traumatic Cervical Spine Injury Pattern– A Snapshot

2012 ◽  
Vol 23 (3) ◽  
pp. 111-116
Author(s):  
M Joshi ◽  
Mahima Agrawal
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Spinal Injury ◽  
Tertiary Care ◽  
Injury Pattern ◽  
Spine Injury ◽  
Rehabilitation Centre ◽  
Cross Sectional

Abstract Study design and subjects Cross-sectional descriptive study of pattern of cervical spine injury at a tertiary care rehabilitation centre in Rajasthan. Objectives To observe the socio demographic profile and injury pattern in cervical spinal cordinjury. Methods One hundred and forty-one clients of traumatic cervical spine injury (CSI) were admitted from 1st December 2010 to 15th October 2011 at the Department of Physical Medicine and Rehabilitation, S.M.S. Medical College and Hospital, Jaipur. Detailed clinical, neurological evaluation as per American Spinal Injury Association Classification (ASIA) and radiological assessment were done along with identification of mechanism of injury, mode of evacuation and presence of associated injuries. Data analysis was done in October 2011 and results were compiled and analysed. Results Mean age in our sample was 35.87 ± 14.38 years that comprised 11 females (7.8%) and 130 males (92.2%) of whom 78 (55.3%) fell in the age group of 25 to 55 years. Majority 64 (45.4%) were illiterate, 80 (56.8%) being farmers and labourers. Greater fraction had road traffic accidents i.e., 66 (46.81%) and fall from height 56 (39.72%) as the mechanism of trauma. Only 69 (49.8%) could arrange an ambulance for transport. Majority of the injured i.e., 84 (59.57%) presented with neurologically complete picture as per ASIA classification and the most common involvement being of 5th and 6th cervical segments i.e., 103 (73.15%). Conclusion This study evaluated the demographic variables of cervical spine injury for better understanding of impact that it has and further for better allocation of our health resources, distribution and planning

scholarly journals Epidemiology and Treatment Outcomes of Head Injury in Bangladesh: Perspective from the Largest Tertiary Care Hospital

2021 ◽  
Author(s):  
Sukriti Das ◽  
Bipin Chaurasia ◽  
Dipankar Ghosh ◽  
Asit Chandra Sarker
Keyword(s):  
Head Injury ◽  
Road Traffic ◽  
Head Injuries ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Acute Subdural Hematoma ◽  
Care Hospital ◽  
Female Ratio ◽  
Mortality And Morbidity ◽  
The Government

Abstract Background Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity. Economic impact is much worse in developing countries like Bangladesh, as victims are frequently male, productive, and breadwinners of the families. Objectives The objective of our study was to highlight the etiological pattern and distribution of varieties of head injuries in Bangladesh and give recommendations regarding how this problem can be solved or reduce to some extent at least. Methods From January 2017 to December 2019, a total of 14,552 patients presenting with head injury at emergency got admitted in Neurosurgery department of Dhaka Medical College and Hospital and were included in this study. Results The most common age group was 21 to 30 years (36%: 5,239) with a male-to-female ratio of 2.6:1. Injury was mostly caused by road traffic accident (RTA [58.3%: 8,484]), followed by fall (25%: 3,638) and history of assault (15.3%: 2,226). The common varieties of head injury were: acute extradural hematoma (AEDH [42.30%: 1,987]), skull fracture either linear or depressed (28.86%: 1,347), acute subdural hematoma (ASDH [12.30%: 574]), brain contusion (10.2%: 476), and others (6.04%: 282). Conclusion RTA is the commonest cause of TBI, and among them motor bike accident is the severe most form of TBI. AEDH is the commonest variety of head injuries. Proper steps taken by the Government, vehicle owners, and drivers, and proper referral system and prompt management in the hospital can reduce the mortality and morbidity from TBI in Bangladesh.

scholarly journals Serum Concentration of Myelin Basic Protein as a Prognostic Marker in Mild-to-moderate Head Injury Patients: A Prospective Study in a Tertiary Care Center

2021 ◽  
Author(s):  
Ashvamedh Singh ◽  
Kulwant Singh ◽  
Anurag Sahu ◽  
R. S. Prasad ◽  
N. Pandey ◽  
...  
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Myelin Basic Protein ◽  
Prognostic Marker ◽  
Outcome Prediction ◽  
Basic Protein ◽  
Care Center ◽  
Tertiary Care ◽  
Gcs Score ◽  
A Prospective Study

Abstract Objective To estimate the level of myelin basic protein (MBP) and look for its validity in outcome prediction among mild-to-moderate head injury patients. Materials and Methods It was a prospective study done at the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University from Jan 2018 to July 2019. All patients who presented to us within 48 hours of injury with mild-to-moderate head injury with apparently normal CT brain were include in the study. The serum sample were collected on the day of admission and 48 hours later, and patients were treated with standard protocols and observed 6 months postdischarge. Results Of the 32 patients enrolled, we observed mean MBP level was higher for severity of brain damage, but not associated with age, mode of injury, and radiological diagnosis. Mean MBP levels were not statistically associated with Glasgow coma scale (GCS) score at admission but was correlated to outcome with p < 0.05, with sensitivity of 50% and specificity 72%, that is, patients with good outcome have lower mean MBP levels. Conclusion MBP as per our analysis can be used as a prognostic marker in patients with head injury. It is not the absolute value rather a trend showing rise in serum MBP levels, which carries a significant value in outcome prediction.

scholarly journals Treatment biases in traumatic neurosurgical care: a retrospective study of the Nationwide Inpatient Sample from 1998 to 2009

2015 ◽  
Vol 123 (2) ◽  
pp. 406-414 ◽  
Author(s):  
Brandon A. McCutcheon ◽  
David C. Chang ◽  
Logan Marcus ◽  
David D. Gonda ◽  
Abraham Noorbakhsh ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Spinal Fusion ◽  
Nationwide Inpatient Sample ◽  
Injury Severity ◽  
Spinal Injury ◽  
Hospital Setting ◽  
Spine Injury ◽  
Intracranial Hematoma ◽  
Uninsured Patients ◽  
Insured Patients

OBJECT This study was designed to assess the relationship between insurance status and likelihood of receiving a neurosurgical procedure following admission for either extraaxial intracranial hemorrhage or spinal vertebral fracture. METHODS A retrospective analysis of the Nationwide Inpatient Sample (NIS; 1998–2009) was performed. Cases of traumatic extraaxial intracranial hematoma and spinal vertebral fracture were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Within this cohort, those patients receiving a craniotomy or spinal fusion and/or decompression in the context of an admission for traumatic brain or spine injury, respectively, were identified using the appropriate ICD-9 procedure codes. RESULTS A total of 190,412 patients with extraaxial intracranial hematoma were identified between 1998 and 2009. Within this cohort, 37,434 patients (19.7%) received a craniotomy. A total of 477,110 patients with spinal vertebral fracture were identified. Of these, 37,302 (7.8%) received a spinal decompression and/or fusion. On multivariate analysis controlling for patient demographics, severity of injuries, comorbidities, hospital volume, and hospital characteristics, uninsured patients had a reduced likelihood of receiving a craniotomy (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.71–0.82) and spinal fusion (OR 0.67, 95% CI 0.64–0.71) relative to insured patients. This statistically significant trend persisted when uninsured and insured patients were matched on the basis of mortality propensity score. Uninsured patients demonstrated an elevated risk-adjusted mortality rate relative to insured patients in cases of extraaxial intracranial hematoma. Among patients with spinal injury, mortality rates were similar between patients with and without insurance. CONCLUSIONS In this study, uninsured patients were consistently less likely to receive a craniotomy or spinal fusion for traumatic intracranial extraaxial hemorrhage and spinal vertebral fracture, respectively. This difference persisted after accounting for overall injury severity and patient access to high- or low-volume treatment centers, and potentially reflects a resource allocation bias against uninsured patients within the hospital setting. This information adds to the growing literature detailing the benefits of health reform initiatives seeking to expand access for the uninsured.

scholarly journals Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center

2021 ◽  
Author(s):  
Rahul Singh ◽  
Ravi Shankar Prasad ◽  
Ashvamedh Singh ◽  
Kulwant Singh ◽  
Anurag Sahu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Sagittal Plane ◽  
Care Center ◽  
Tertiary Care ◽  
International Standards ◽  
Surgical Approaches ◽  
Severity Of Injury ◽  
Cord Injury

Abstract Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.

scholarly journals An Experience with Management of Hemoperitoneum in Blunt Injury of Abdomen at Tertiary Care Center of Western Nepal

2019 ◽  
Vol 7 (1) ◽  
pp. 37-41
Author(s):  
Santosh Mishra ◽  
Kailash Chandra ◽  
Kumar Paudel
Keyword(s):  
Hospital Stay ◽  
Road Traffic Accident ◽  
Traffic Accident ◽  
Road Traffic ◽  
Care Center ◽  
Tertiary Care ◽  
Operative Management ◽  
Blunt Injury ◽  
Physical Assault ◽  
Non Operative Management

INTRODUCTION: Blunt abdominal trauma results in huge burden of morbidity and mortality among all age groups caused mainly by road traffic accident, fall from height and physical assault. This study was designed to evaluate the outcome of management of hemoperitoneum in blunt injury of abdomen. MATERIAL AND METHODS: This is a prospective observational study involving 100 cases of blunt abdominal injury during the period from 1st December, 2014 to 13th  March 2016 in UCMS-TH, Bhairahawa, Nepal. Documentation of the patients which included identification, history, clinical findings, diagnostic tests, operative findings, operative procedures, complications during hospital-stay was done. The decision regarding operative or non- operative management was made by specialist surgeon. RESULTS: The majority of the patients belonged to 21- 30 years age group. 72 cases were male while 28 were female. 93 patients were managed conservatively while 7 patients were operated. Most common mode of injury was road traffic accident (RTA) (74%) followed by fall form height (20%). Most common organ to be injured was spleen (65%) followed by liver (26%). 93 % patients underwent non-operative management while 7 % were operated. Mortality rate was 0% among the  non- operative and 14.29% in operative cases. CONCLUSION: Non operative management in patient with hemoperitoneum with regular monitoring of vitals and repeated clinical assessment can reduce the operative need , morbidity and length of hospital stay. Non-operative Management (NOM) for blunt abdominal injuries was found to be highly successful in 93% of the patients in this study.

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