[Severe craniocerebral injuries: northwestern Switzerland 1984-1989]

Data from 561 severely head-injured patients treated in a Surgical Intensive Care Unit between 1984 and 1989 are analyzed. Age and sex distribution of the patients was comparable to findings in other studies. More than half of the patients were injured in road accidents, accidents involving cars representing the greatest risk. In 90% of all patients, severe head injury was the primary diagnosis. 60% of the patients were intubated within 30 minutes at the scene of the accident, as opposed to 17% of patients intubated in the emergency room within the same time interval. Patients resuscitated at the scene of the accident and admitted directly by helicopter arrived at the emergency room on average one hour after the accident; for those transported directly by ambulance, without intubation prior to admission, the average time interval was half an hour. Since the time interval between accident and onset of resuscitation is crucial, this difference in transportation times is not considered to be of major importance. Half of the patients who died in the Surgical Intensive Care Unit died within the first 48 hours, usually from primary severe brain damage. In 50% of the 446 patients from the first 4 years of this study the recoveries ranged from good to complete and 28% died. Only 3 (less than 1%) out of 446 patients were alive in a vegetative state, and 8% severely handicapped one year after the accident. Aggressive primary treatment did not increase the number of patients surviving in a vegetative or severely handicapped state.