mortalityaudit in KiMS nellore bollineni.pptx

Mortalityaudit

1. Neurosurgery department KIMS hospital Nellore Mortality review meeting

2. History A 56 year old female patient came to emergency department with history of sudden onset of unresponsiveness 29/05/2023. Vomiting. Weakness of left side of the body. Mouth deviation towards right side.

3. On examination Patient is drowsy arousable GCS-E1V4M5 Pupils –both sides 3mm RTL Left hemiplegia Vitals PR-120 bpm BP-180/100 mm of Hg Spo2-98% @ Room air

4. BRAIN MRI on admission

5. CT scan brain after 4hrs of admission

6. Post op scan-- immediate day 1 Early rebleeding

7. Post –op CT Brain on 01/06/2023

8. Early rebleeding: Rebleeding (more so in basal ganglion hemorrhages than in lobar hemorrhages) has been documented during the first hour by “ ultra-early ” scanning and repeating CT scans . Rebleeding is usually accompanied by clinical deterioration. The incidence of hematoma enlargement decreases with time, 33 – 38 % in 1 – 3 hrs, 16 % in 3 – 6 hrs, and 14% between 24 hrs of onset .

9. Mortality in patients with hematoma growth was extremely high.The incidence of hematoma growth according to outcome was good recovery, 1.5 %; moderate disability, 6.1%; severe disability, 15.4 %; vegetative state, 20.0%; and death, 34.6%. There was a significant association between hematoma growth and poor clinical outcome.

10. These independent predictors, listed in order of importance, are (1) a short time interval between onset and admission, (2) habitual alcohol consumption , ( 3) consciousness disturbance, (4) an irregularly shaped hematoma shown on initial CT scan, and (5) low levels of fibrinogen .

11. small scattered little hematomas (arrows), each separate from the main hematoma bubble-like or sprout-like small hematomas (arrowheads) that connect with the main hematoma and one separate small hematoma Hypointense areas between the 3 small hematomas and the main hematoma.

12. CT scan brain after 4hrs of admission

13. Risk of early rebleeding is increased in patients with a “ spot sign ” on CTA . Patients with enlarging hematomas were more likely to have larger hematomas and/or coagulopathy , and had a worse outcome. Rebleeding may still occur following surgical evacuation of clot even with satisfactory intraoperative hemostasis . Other risk factors include diabetes and tobacco and alcohol abuse.