Talked and deteriorated head injury patients: how many poor outcomes can be avoided?

The objective of this study was to assess the effectiveness of head injury management on the incidence and outcome of talked and deteriorated patients. Of 337 severe head injury patients admitted to Songklanagarind Hospital during 1994 to 1997, 30 were identified as 'talked and deteriorated'. Most deterioration was due to intracranial haematomas. The incidence (8.9%) and poor outcome (40%) were lower than those from a previous study in 1990 (incidence 15.8% and poor outcome 50%). The poor outcome in this group should not be more than 10%, which may be achieved by appropriate practice guidelines combined with a multidisciplinary team approach in caring for head injury patients, and the collaboration of hospitals within a regional trauma system.