A historical analysis of severe head injury

Severe head injury (SHI) is a significant health, social and economic concern rendering a worldwide health problem. This retrospective study was designed to describe the features and outcomes of patients with SHI treated in a single neurosurgical unit (Hospital "12 de Octubre", Madrid, Spain) over a period approaching 13 years. The subjects enrolled were 895 patients (15 years or older) with non-missile SHI treated over the period January 1987 to August 1999, in whom a computerised tomography scan had been performed within the first 6 h of injury. We considered epidemiological, clinical, analytical, radiological and therapeutic data along with final patient outcomes. The overall mortality rate was 46.8% (419 patients). Of these 419 deaths, 177 (42.2%) occurred within the first 48 h of injury rendering an early death rate of 19.8% (177/895 patients). Despite overall mortality showing a clear decreasing trend by the end of the 1990s, proportions of early deaths (within the first 48 h of injury) dramatically rose in the last 3 years of the study. As a whole, an unfavourable outcome was recorded in 62.6% (560 patients). Despite continued efforts to improve the outcome of patients with SHI, the results of our study are pessimistic in that high mortality and unfavourable outcome rates were recorded in this large series of patients. Although overall mortality has diminished over the years, the number of early deaths has increased.