Neurotrauma and its mortality

Head trauma is one of the most challenging injuries a trauma victim can suffer, as it can impair airway patency and complex neurological function. Most of these patients with gunshot head injuries do not reach the hospital alive. We conducted a survey about early mortality, comparing head injuries and their outcome to other injury locations.

All patients admitted between October 2000 and May 2005 to the Trauma Unit at Chris Hani Baragwanath Hospital, Soweto, Johannesburg, South Africa. The criteria for inclusion were an injury to the cerebrocranium or other body locations with a documented evaluation of a) systolic blood pressure on admission; b) inspection of the trauma and - in case of penetrating injury - the weapon type; and c) consciousness on admission (N = 214).

After data analysis, there was a 50% share of penetrating injuries in the emergency department; with half gunshot wounds and half stab wounds occurring. While blunt injuries occurred at 39%, burns were at 4%. As can be deduced, of the three major injury mechanisms of gunshot wounds, stab and blunt injuries, there is a 5% to 6% mortality for gunshot wounds and blunt patients, while stab injuries carry an early 1% mortality. Patients with head injuries die after a longer interval and reach plateau, several hours later than other observed injuries.

In mixed blunt and penetrating trauma injuries, head injuries account for the highest mortality rate; especially gunshot wounds of the head, with an early demise of around 40%.