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ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 3  |  Page : 210-214

Better outcome of head injuries in a strategically designed trauma care center


Department of Neuro Surgery and Neurology, Guntur Medical College, Guntur, Andhra Pradesh, India

Date of Web Publication10-Oct-2016

Correspondence Address:
Injeti Babji Syam Kumar
3rd Floor, Millennium Block, Government General Hospital, Guntur, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.191841

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  Abstract 

Context: The Govt. of India has established Level II trauma care centers across the country to improve the outcome of patients suffering injuries due to trauma.
Aims: To compare the outcome of head injury patients before and after the establishment of one such center.
Objectives: To study the significance of a well planned neurosurgical centre in improving patient outcomes. To compare the clinical profile and surgical outcomes of head injury patients between an age old Govt hospital setup and a new trauma care centre in the Govt sector.
Settings and Design: In the Govt. General Hospital (GGH), Guntur, we prospectively compared the outcomes of head injury patients.
Materials and Methods: One hundred patients admitted prior to the inauguration of the new trauma care center were classified under Group 1 and 100 consecutive patients admitted after the establishment were classified under Group 2.
Statistical Analysis Used: Comparison of means and percentages.
Results: Clinicodemographic features at admission of patients in both the groups were similar. Ninety percent of patients in Group 2 were discharged in contrast to 68% of patients from Group 1.
Conclusions: A better designed trauma care center showed dramatic improvement in the outcome in head injury patients.

Keywords: Head injury, RTA, trauma care center


How to cite this article:
Kumar IB, Rao TV, Sridhar A, Snehalatha K. Better outcome of head injuries in a strategically designed trauma care center. J NTR Univ Health Sci 2016;5:210-4

How to cite this URL:
Kumar IB, Rao TV, Sridhar A, Snehalatha K. Better outcome of head injuries in a strategically designed trauma care center. J NTR Univ Health Sci [serial online] 2016 [cited 2019 Sep 21];5:210-4. Available from: http://www.jdrntruhs.org/text.asp?2016/5/3/210/191841


  Introduction Top


Road traffic accidents are a major cause of morbidity and mortality after heart attacks, paralytic strokes, lung disease, and human immunodeficiency virus (HIV) in the modern world.[1] In developing countries like India, as the incidence of deaths due to infection and malnutrition decreases, the toll of traumatic injuries on human health is on the rise.[2]

It is estimated that in India there have been 1,41,526 Road Traffic Accidents (RTAs) in the year 2014.[3] Comprehensive trauma care services in India are at a developing stage. There is no organized Trauma care system.[4] There are heterogeneous health care deliverers in different industrial cities, towns, and villages in India. Hence, there is a gross imbalance among trauma services available in various parts of the country.

The Ministry of Health and Family Welfare, Government of India, introduced a scheme for the upgradation and strengthening of the existing trauma care centers along the National High Ways in the country in 2004–2005. Govt. General Hospital (GGH), Guntur, was one of the centers selected for upgradation.

A new trauma care center was built in 2014 with an inbuilt computed tomography (CT) scan (10th May 2015), intensive care unit (ICU) and operation theatres. The Neuro surgery department was shifted into this Center on 17th May, 2015.

A clinical study was undertaken during the period from April 2015 to July 2015 to study and compare the Outcome of head injuries before and after Improvement of Infrastructure in the Trauma Care Centre of GGH.


  Materials and Methods Top


Study design

A cross-sectional, observational, and comparative study of 200 patients with head injury attending to the casualty, GGH, from April 2015 to July 2015.

Inclusion criteria

  • All age groups
  • All head injuries.


Consecutive patients admitted in the Trauma/Neuro Surgical Intensive Care Unit (NSICU) with head injury, 100 of them before the shift to the new trauma care center and 100 patients after the shifts were included.

Exclusion criteria

  • Head injuries with spinal injuries
  • Head injuries with polytrauma
  • Extremity injury
  • Burn injuries
  • Gynecological injury
  • General surgical injuries
  • Patients deceased before admission in the neuro surgery unit.


The patients were classified into two groups as follows:

Group 1 (100 cases): Cases admitted and treated in trauma/NSICU before shifting to the Level II Trauma Care Center. From 1 April 2015 to 6 May 2015.

Group 2 (100 cases): Cases admitted and treated in Trauma/NSICU after shifting to the Level II Trauma Care Center. From 20 May 2015 to 2 July 2015.

All the variables considered for the study were recorded in a pro forma and the data were analyzed.


  Results Top


Clinicodemographic features at admission between the two groups were comparably similar [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7],[Table 8]. The mean age of patients in Group 1 was 39.5 ± 15.5 years and that of patients in Group 2 was 41.0 ± 16.4 years.
Table 1: Comparison of sex distribution between the two groups

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Table 2: Comparison of age distribution between the two groups

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Table 3: Comparison of geographic stratification between the two groups

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Table 4: Comparison of modes of injury between the two groups

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Table 5: Comparison of sub modes of injury between the two groups

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Table 6: Comparison of clinical presentation between the two groups

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Table 7: Comparison of ct findings between the two groups

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Table 8: Comparison of type of management between the two groups

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After the creation of trauma ICU the number of Left Against Medical Advise (LAMA) cases has come down [Figure 1],[Figure 2],[Figure 3]. Among the conservatively treated cases, the mortality rate decreased by 18% and the discharge rate improved by 23%, LAMA cases decreased by 6%. Among the operated group, the mortality decreased by 16% and the discharge rate improved by 16%.
Figure 1: Comparison of outcome of head injuries

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Figure 2: Conservatively managed - patient' s outcome

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Figure 3: Surgically managed - patient' s outcome

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  Discussion Top


The present study shows that the establishment of the intensive trauma care unit played a major role in improving the outcome in head injury patients.

Prior to the development of the new trauma care center, CT scan was situated almost half a kilometer away from casualty/emergency department on the ground floor in separate blocks. NSICU and emergency OT were situated on the first floors of different blocks [Figure 4]. The patient with a serious head injury in a comatose state had to be carried by a stretcher trolley all the way from casualty to the CT scan room and NSICU. The patients were exposed to the weather in transit, be it in the scorching sun or the pelting rain, as there were no roofed corridors. The casualty and radiology departments were located on the ground floor and the ICU was on the first floor. The elevator in the hospital from the ground floor to first floor was often under repair and the unconscious patients were literally carried by the nursing orderly in their arms. As such disastrous situations, vomiting and aspiration and episodic seizures were frequent, all of which are known to increase the morbidity and mortality in head injury patients.[5],[6]
Figure 4: Schematic diagram depicting spatial distribution of Old Casualty, NSICU, CT Scan and Emergency OT and New Trauma Care Center

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The survival rate improved in Group 2 when compared to Group 1 studied, because of availability of the new infrastructure with inbuilt CT scan and ICU in same complex [Figure 4] (the design of trauma care center played a major role) in addition to better experienced and trained personnel attending to the cases.

Installation of CT scan in trauma care center facilitated prompt diagnostic services just beside the casualty. Previous studies show that this modification can improve the prognosis of the patients. For example, in an elegant study to identify “where does delay occur in the process of transfer to neurosurgical care” by Marsh et al., it was clearly shown that a trauma care center equipped with a CT scanner linked to a neurosurgical unit can provide optimum outcome in head injury management.[7]

The strategical design of the new trauma care center with a casualty and critical care unit within the sterile zone of trauma care improved the efficiency of patient management. It helped in the faster and safer intrahospital transport of patients.

During the transfer of the trauma care center, the resident doctors were trained to handle seriously injured patients by means of emergency endotracheal intubation, emergency cricothyroidotomy, and treatment of shock and status epilepticus thus supporting the existing trauma care man power. The training of the resident doctors also contributed to the better outcome as was shown earlier by Olson et al. in their study that the training in trauma management improves the outcome of injured patients.[8]

The study is limited by its sample size and also by the short duration of the follow-up. As the study contains data from the new trauma care center immediately after establishment, the results might not adequately reflect the full potential of a well-designed trauma care center, the results might not adequately reflect the full potential of a well-designed trauma care center. As the new trauma care center protocols and practices need understanding and acceptance by the staff, the complete picture of the change brought about by the new trauma care unit may not be deduced from our study.


  Conclusion Top


From this study, it was observed that the establishment of a well-designed trauma care center has improved the survival rate of the head injured patients and served effectively in reducing the trauma-related morbidity and mortality.

Acknowledgment

We thank Dr. G Saila Bala, Principal, Guntur Medical College and Dr. G Parvateesam, Professor, department of Radiodiagnosis, Guntur Medical College, for their academic support. We thank Mr. T Madhu Babu for his support in drafting the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
WORLD RANKINGS-TOTAL DEATHS [Internet]. World Life Expectancy. Available from: http://www.worldlifeexpectancy.com/world-rankings-total-deaths. [Last accessed on 2016 Feb 16].  Back to cited text no. 1
    
2.
Heart, lung diseases now leading killers in India-Times of India [Internet]. The Times of India. Available from: http://timesofindia.indiatimes.com/india/Heart-lung-diseases-now-leading-killers-in-India/articleshow/46843861.cms. [Last accessed on 2016 Feb 16].  Back to cited text no. 2
    
3.
ACCIDENTAL DEATHS IN INDIA [Internet]. Available from: http://www.academia.edu/16343312/ACCIDENTAL_DEATHS_IN_INDIA. [Last accessed on 2016 Feb 16].  Back to cited text no. 3
    
4.
Joshipura MK, Shah HS, Patel PR, Divatia PA, Desai PM. Trauma care systems in India. Injury 2003;34:686-92.  Back to cited text no. 4
[PUBMED]    
5.
Marion DW. Complications of head injury and their therapy. Neurosurg Clin N Am 1991;2:411-24.  Back to cited text no. 5
[PUBMED]    
6.
Compagnone C, d'Avella D, Servadei F, Angileri FF, Brambilla G, Conti C, et al. Patients with moderate head injury: A prospective multicenter study of 315 patients. Neurosurgery 2009;64:690-7.  Back to cited text no. 6
    
7.
Marsh H, Maurice-Williams RS, Hatfield R. Closed head injuries: Where does delay occur in the process of transfer to neurosurgical care? Br J Neurosurg 1989;3:13-9.  Back to cited text no. 7
[PUBMED]    
8.
Olson CJ, Arthur M, Mullins RJ, Rowland D, Hedges JR, Mann NC. Influence of trauma system implementation on process of care delivered to seriously injured patients in rural trauma centers. Surgery 2001;130:273-9.  Back to cited text no. 8
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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Abstract
Introduction
Materials and Me...
Results
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