Transcript the outcome of traumatic brain injury in phramongkutkloa army

พอ.ศุภกิจ สงวนดีกุล
แผนกศัลยกรรมประสาท กศก.รพ.รร.6
•TBI remain the most common problem that challenge all
neurosurgeons
•Many protocols of TBI treatment were developed to decreased
morbidity and mortality
•Traumatic coma databank was initiated and many researchs
were done in U.S.A. and many centers:
•Trauma system were settled &evaluated
•To study the outcome of the TBI treatment in
Phramongkutkloa hospital
•To determine the incidence of talk and deterioration
•To identified the prognostic factor especially :time golden
period
•Retrospective study
• All TBI patients that arrive to PMK hospital between Jan.
2004-Jan.2008 were reviewed
•TBI patients were classified 3 groups depended on levelof
consciousness (GCS):mild,moderate ,severe
•SPSS was used to analized the data
•The outcome was evaluated by Glasskow Outcome Scale(GOS)
at 1 year
•PMK Hospital: Trauma center level 1
:education&training,Standard of Service and resources
• TBI 3450 patients : mild head injury 2000pts.,moderate severe 1450pts
•Moderate-severe TBI were admitted in the hospital and 540 pts
were operated
•Most common cause : Motor vehicle accident
•Male:female 2:1
•Age 1-89years ,most at 20-35years
•Soldier 60%
•Patient that talk and deteriorated o.o5%(1/2000) :EDH&SDH
Death from brain herniation ,Delay treatment
•Diffused Axonal Injury (DAI) 16%,
•EDH 20%
•SDH 50%
•Cerebral contussion 10%
•Depressed skull fx 10%
•Time between admit and operation :35 min-15 hours
Mean 3 hours
•Protocol of treatment
•Maintain normal Internalmileu&CBF
HOB 30° neutral Position,Hyperventilation (PaCO2 3035mmHg.),normovolumia,normoglycemia,normothermia,analg
esic,anticonvulsant,sedative&paralytic drug
Maintain CPP>70 mmHg.,ICP<20mmHg.
High dose Barbiturate : 5%(Life saving 60%)
ICP Monitoring 20%
Craniotomy remove blood clot 30%,
Decompressive craniectomy 70%
Prognostic factor
Post resuscitation GCS <5
Age
Brainstem reflex
Pupillary size&response
Complication:consumptive coagulopathy,hypernatremia
• OUTCOME
GOS1 (DEATH) 11%
GOS2(Severe disability) 10%
GOS3(Moderate disability) 9%
GOS 4(Minimal disability) 20%
GOS 5(Normal)50%
•Mostof TBI patients have better outcome (GOS 4,5 70%)
•Sever e TBI :MR.=11% (Over all MR=1.7%)
•Patient who talk and deteriorated 0.05%(1/2000)
•Event no significant of time between admit and operation most
patient have poor outcome if delay treatment >6 hours
•Golden period depend on severity,age,compliance of
brain,unexpected complication
EPIDERMIOLOGY UNIT
COMPUTER CENTER
EVERY PERSON WHO PARTICIPATE FOR SUCCESSION IN
TBI TREATMENT