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 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 (PaCO mmHg.),normovolumia,normoglycemia,normothermia,analg esic,anticonvulsant,sedative¶lytic 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