Incidence of extracranial injuries in fatal head injury patients

The clinical notes of 148 patients who were admitted with head injuries and died were studied retrospectively and compared with the results of a postmortem examination. Risk factors predicting the presence of extracranial injuries were sought. Fourteen per cent of patients admitted with head injuries died. Two risk factors predicted the presence of extracranial injuries: 67% of the patients with an associated injury had been involved in a motor vehicle accident (MVA), compared with 32% of those with a head injury only. Shock was five times as common in the group with associated injuries than in those without. Associated injuries were present in 45% of patients, and 37% of these injuries were not diagnosed on admission. In 7% these injuries were the final cause of death. This study re-emphasises the fact that multi-organ trauma is common after MVA, and shock due to hypovolaemia is an unusual complication of head injury. Searching for associated injuries is mandatory in the head-injured patient. Since clinical examination is inaccurate, special investigations, such as peritoneal lavage or computed tomography, should be utilised for this purpose.