Clinical versus autopsy diagnosis of cranio-cerebral injury

The accuracy of the clinical diagnoses of the victims who died at the Department of Neurosurgery, Helsinki University Central Hospital in 1975 and 1976 of a lethal injury to the head was investigated. Standard clinical and X-ray means were used without computed tomography whose value as an additional tool will be reported later. Most of the patients were traffic accident victims of which 71% died within 24 h after trauma. The rate of the correct diagnoses of fractures was 87% in the vault, 76% at the base of the skull, and 67% in the facial bones. Of all intracranial lesions, 75% were correctly and 9% partially diagnosed. The discrepancy would have been more marked if such entities as cerebral contusion and laceration and hemorrhage had been presented separately. This study indicates that many head injuries remained undiagnosed by standard clinical means. The value of X-ray examination also appeared small in the postmortem diagnostics of skull fractures and intracranial lesions.