Injury patterns in patients who "talk and die"

Despite advances in the quality of and access to cerebral imaging, patients with mild head injuries still deteriorate and die in neurotrauma units. The term "talk and die" was first used by Reilly et al. to describe a subset of patients with head injuries who died following what was initially thought to be only a mild traumatic brain injury. A retrospective review of a database from a major Australian trauma center was performed to identify 25 patients who met the "talk and die" criteria between January 2000 and December 2009. The medical records of these patients and their imaging studies were analyzed to identify potentially preventable factors and injury patterns in this group of patients. The factors analyzed included age, modality of injury, therapeutic narcotic usage, seizures, and hyponatremia. Two groups of patients are described herein based on intracranial pathology, with statistically significant differences in age, mechanism, and coagulopathy identified.