Head trauma and nonsurvival--a sample survey

A retrospective survivor study of 42 patients with severe brain and multisystem injury is presented. All patients were treated with vigorous trauma/neurosurgical techniques. Thirty-seven patients in this series had a Glasgow Coma Score of 3 at the initial examination, and none survived. Since all 37 patients at initial emergency room evaluation showed persistent apnea at 40-60 minutes after injury, a diagnosis of dead on arrival (DOA) might have been appropriate. Cost analysis shows that the direct cost for the 37 cases was $27,000 per patient, or $990,000 for the 37 patients with no survivors. A diagnosis of DOA would have been $200 per patient. Many implications can be derived from these figures.