neurosurgery 2011

DEPTT OF NEUROSURGERY

JPN APEX TRAUMA CENTRE

AUDITJAN 2011- DECEMBER 2011

JPN APEX TRAUMA CENTRE

Clinical workload

0

1000

2000

3000

4000

5000

6000 2008200920102011

2008 3615 1916 1369 60

2009 4488 1978 1070 56

2010 5245 2073 1535 54

2011 5343 1882 1407 54

OPD Admissions Surgery Beds

Total Admns from Jan2011-Dec2011

0

500

1000

1500

2000

Neurosx orthopedics surgeryAdmission 1882 1444 1875

Bed strength 54 48 48

OPERATIONS

Operated cases in NS OT

SURGICAL LOAD

• Total cases Operated in OT:1407

Cranial Spinal Shunt BPI Cranioplasty Others Open Tracheostomy

753 353 82 63 118 51 105

Open Vs Percutaneous Tracheostomy

67

236

105

205

0

50

100

150

200

250

Open tracheostomy (OT) PC Tracheostomy (ICU)

2010

2011

Open Vs Percutaneous ICP monitoring

8

231

5

268

0

50

100

150

200

250

300

Open ICP Montiring (OT) PC ICP Montiring (ICU)

2010

2011

HEAD INJURIES

Age fractional classification

0

500

1000

1500

2000

2500

0-5 6-12- 13-18 19-30 31-40 41-50 51-60 >60

no

of p

atie

nts

age limit

male patients with head injury

(male)


050

100150200250300350400450500

0-5 6-12. 13-18 19-30 31-40 41-50 51-60 >60

no

of p

atie

nts

age limit

females with head injury

females with head …

HEAD INJURIES- 2011

Total Cases Mortality %

Minor HI 10501 17 0.16

Mod HI 254 21 8.26

Severe HI 990 206 20.8

Overall 11745 244 2.07

Data of Head Injury Patients

Total Cases admissions Operated Death (%) NonOperated

Death (%)

Minor HI 10501 408 230 9(3.9%) 178 8(4.49%)

Mod HI 254 170 118 13(11%) 52 8(15.38%)

Severe HI 990 990 547 104(19%) 443 102(23%)

Severe HI mortality in age groups

<12 13-18 18-59 60-80 >80

27 31 111 35 2

32 0.56

0.16

1512

7.98.26

3536

29.9

20.8

23 22

5.7

2.07

0

5

10

15

20

25

30

35

40

Minor HI Mod HI Severe HI Overall

2008

2009

2010

2011

OUTCOME: MORTALITY (%)

SPINE INJURIES


0

20

40

60

80

100

120

140

1-5. 6-12. 13-18. 19-30. 31-40 41-50 51-60 >60

no

of

pat

ien

ts

age limit

males with spinal injury

males with spinal injury


0

5

10

15

20

25

age limit 0-5 6-12. 13-18 19-30 31-40 41-50 51-60 >60

no o

f p

atie

nts

females with spinal injury

females with spinal injury

Cervical Spine Injury (2011)

Total admission Operated Death(%) Non-Operated Death(%)

268 200 159 29(18%) 109 17(15%)

Cervical Spine Injury (2011)

Total complete incomplete Death(%)

268 81 187 47(17%)

Cervical Spine Injury

161

195

268

0

50

100

150

200

250

300

Cervical

2009

2010

2011

Follow up

• Mean Follow up:209.02 daysRange (75-428 days)

Dorsolumbar Spine Injuries

162

109

0

20

40

60

80

100

120

140

160

180

DL Spine Inj

2010

2011

Dorsolumbar Spine Injuries

Total Complete Incomplete Operated Death(%)

109 64 45 87 6 (5.5%)

Follow up

• Mean Follow up:220.47 days(Range 55-415 days)

Brachial Plexus injuries

7276

63

0

10

20

30

40

50

60

70

80

2009 2010 2011

EQUIPMENT

Equipment Audit

Mobile CT• Started functioning; 18 July 2009

• Total No of MCT’s done in 2011: 2086

• Average of 173 MCT/ month or 5 MCT/day• Total MCTs till date:5482

Equipment Audit

Mobile CT• Audit paper accepted in Neurology India

(Pubmed Indexed)

Equipment Audit

O-arm• First case on 14 April

2010• 70 cases in 2010• 120 cases in 2011• 202cases till date

Equipment Audit

O-arm• Audit paper accepted in Neurology India

TEG:ThromboElastoGraphy

• Started functioning on 8th April 2011• Total No of TEG`s done in 2011:977• Average of 102 TEG/month or 3 /day

Nursing informatics specialist

• Started on 1 Feb 2011• Posted round the clock in ED• Link between medical and IT professionals

CPRS Compliance in various departments in ED

0%10%20%30%40%50%60%70%80%90%

% OF CPRS ENTRY

OCT NOV DEC

MONTHS

NEURO

ORTHO

SURG

Computerised store compliance

ED OT TC-1 TC-2 TC-3 TC-4 TC-5 TC-6 TC-70%

20%

40%

60%

80%

100%

120%

1st half (MAY,JUN,JUL,AUG)

2nd half (SEPT,OCT,NOV,DEC

WARDS

PE

RC

EN

TA

GE

Patient display system

Patient display system

• Total No of HI in Red area in 2011:3064 • Average disposition time from Red area: 8hrs• No of HI patients who stayed >24hrs in red

area in 2011 :74• Out of 74-retriaged and then discharged :5 -tr.out:12 -admission:13 -ED death:44

E-MLC:launched on 11 Oct 2011

e-Death forms

HIS-Cashering

Pneumatic tube system

• Reduce sample sending time .(average time 1-2mts)

E-blood requisition

Bar code print label

• Accurate & precise data of the patients for labeling.

Awards won by our doctors

• Dr.Avijit Sarkari:Best paper award at NEUROTRAUMA 2011 at Ranchi for minimally invasive spine surgery in acute dorsolumbar trauma.

• Dr.Avijit Sarkari:Best poster award for decompressive craniectomy in paediatric minor head injuries.

Awards cont…

• Dr.Saurabh Sharma:2nd prize in quiz competition in DNACON .

• Dr.Avijit Sarkari & Dr.Kawaljeet Garg:1st prize in quiz competition in DNACON

Awards won by our nurses

• Shiny thomas-First prize in oral presentation DNACON : Effectiveness of mechanical vibrator for chest physiotherapy in ventilated head injury and spinal injury patient

• Shallu chauhan-2nd prize in oral presentation at DNACON:Initial Experience with Mobile CT in Neurosurgery ICU in a level 1 Trauma Centre in India

Awards cont…• Christina Varghese:2nd in quiz

competition at DNACON• Shiny Varghese:best poster at

DNACON• Martin jose:2nd best poster at

DNACON• Anu Antony:2nd in oral presentation at

SINNCON at Bangalore,2nd in quiz competition.

Awards cont…

• Metilda Robin:Best presentation in nursing at ISPN ,Goa

• Anu Susan Mathew :Best presentation in nursing at ISPN ,Goa and best poster in CEUTEH 2011

• Anita george: 2nd in quiz competition in SINNCON at Bangalore and 2nd best poster in CEUTEH 2011

Awards cont…• Yuvaraja:2nd in oral presentation in

CEUTEH2011 for role of empirical antibiotics on clinical infection under culture negative pts. In neurosurgery ICU

• Christina Varghese :3rd in oral presentation in CEUTEH 2011 for concordance between the result of tracheal aspirate using mucus extractor method and by modified non-bronchoscopic BAL techniques

Awards cont…

• Shiny Thomas :3rd in oral presentation in CEUTEH 2011 for effectiveness of mechanical vibrator for chest physiotherapy in ventilated head injury and spinal injury patient

PUBLICATIONS: PUBMED INDEXED• P Ailawadhi,D Agrawal,Ssahoo,GDS,D Gupta,S

Sinha,MC Misra. Use of O-arm for spinal surgery in academic institution in India:experience from JPNATC; Neurol India:2011,4,590-593

• Deepak agrawal,siddhartha sahoo,GD Sathyarthee,Deepak Gupta,Sumit Sinha,MC Misra. Initial experience with mobile CT in neurosurgery ICU in a level 1 trauma center in India. Neurol India 2011/vol59/issue:5/page:739-742

PUBMED INDEX ED

• S P Josua,D Agrawal,BS Sharma,AK Mahapatra:papilloedema as a non invasive marker for raised ICP following decompressive craniectomy for severe head injury

THE INDIAN JOURNAL OF NEUROTRAUMA

• SA Borker,S Sinha,DAgrawal,GD Satyarthee,D Gupta,AK Mahaptra:severe head injury in elderly:risk factor assessment& outcome analysis in a series of 100 consecutive pts in a level 1 trauma centre

• K Garg,D Gupta,N Basheer,AK Mahaptra,GD Satyarthee,Dagrawal,S Sinha:risk factor prognosticating single centre outcome study of cervicodorsal fracture dislocations


• Asarkari,Dgupta,S Sinha,AK Mahaptra:minimally invasive spine surgery in acute dorsolumbar trauma:an experience of 14 cases

• SP Josua,D Agrawal,GD Satyarthee,D Gupta,S Sinha:cranioplasty as surrogate marker for excellent outcome in severe head injury


• S Ahmed,D Agrawal,SS Kale,AK Mahaptra:a comparitive study of treatment of chronic subdural hematoma-burr hole drainage versus continuous closed drainage

• A Singh,N Goyal,D Gupta,AK Mahaptra:an overview of spinal injuries in children:series of 122 cases


• S Sahoo,D Gupta,AK Mahaptra:traumatic paraplegia-outcome study at an apex trauma center

• A Sarkari,D Gupta,S Sinha,SS Kale,AK Mahaptra:post traumatic hydrocephalus-presentation ,management & outcome:an apex trauma centre experience

THANK YOU

neurosurgery 2011

Health & Medicine