Outcome of Head injury in unidentified patients

Dr Rajiv Jha MSM Ch Resident Neurosurgeon

Dept Of NeurosurgeryNational Academy of Medical Sciences

Bir Hospital

Introduction Bir hospital, first public

sector hospital

low socioeconomic status patients

Unidentified and unattended patients

Natural history is mostly unknown

Neurosurgery Department.

Objectives

Demographic parameters Causes Postoperative care and rehabilitation GOS Logistical problems Medico-legal issues

Methodology Prospective case series

Study period : 2008 April 15th to 2011 January 15th

Head injury patients

Unidentified

Sources Of Data

ER records Case sheets Police reports

Demographics Total number of patients admitted :35/1810

Admissions (1.93%)

Brought By

66%

14%

20%

Police Witness Properator

VALLEY30(86%)

OUT-SIDE VAL-LEY

5(14%)

Chart Title

Demographics

30(86%)

5(14%)

MaleFemale

Causes

RTA Fall Physical assault

Not Known0

2

4

6

8

10

12

14

16

1816(45.71%)

822.85% 7

20%

411.42%

Severity

Mild Moderate Severe0

2

4

6

8

10

12

14

16

18

20

720%

1028.57%

1851.42%

CT Findings

Contusion

Intracerebral hematoma

Compound fracture

diffuse axonal injury

Acute Subdural hematoma

Extradural hematoma

3(8.57%)

3(8.57%)

2(5.71%)

7(20%)

10(28.57%)

10(28.57%)

Treatment

22(63%)

13(37%)

Surgical Non-surgical

Surgical

Fracture elevation 2 Evacuation of hematoma 14

Acute subdural hematoma 4

Extradural hematoma 12

Burr hole Evacuation 6

Mean hospital stay 16.52 days.

31%

69%

Relatives foundRelatives not found

GOS

Good recovery 8 (22.85%)

Moderate disability 7 (20%)

Severe disability 8 (22.85%)

Vegetative 5 (14.28%)

Dead 7 (20%)

Results

Discharge Dead Discharge to social service

Absconded0

2

4

6

8

10

12

14

16

1817(48.57%)

720%

925.71%

25.71%

Severity NO DEADMild 7 1

Moderate 10 0

Severe 18 6

Mortality in unidentified head injury patients is high

Comparative Study

Present study AKM

Total no 35 325

Operative Rx37% 18%

Mortality 20% 53%

Ref: AK Mahapatra.Neurologyindia.

Discussions

Medico-legal problems. Unknown patients pose special

problems in management. Longer duration of stay in hospital. Lack of pre-hospital care. Shortage of rehabilitation.

Recommendations

An identification card. Provisions should be made to treat such

patients in all medical institutions. Mechanism should be developed to

investigate and treat such patients urgently.

Thank you!

EVERY SMILE…….

EVERY GESTURE….

EVERY MIRACLE COUNTS!!