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Moderate head injury: a system of neurotrauma care
1Department of Surgery, University of Sydney, Westmead Hospital, New South Wales, Australia. Michael_Fearnside@compuserve.com
Background:
The aim of the present study was to determine those factors which contribute to a poor outcome and to propose a management plan that is complementary to trauma systems in common use.
Methods:
A prospective study of 110 consecutive patients with moderate head injury (post-resuscitation Glasgow Coma Scale (GCS) 9-13) was carried out.
Results:
A total of 75% of the patients sustained multisystem trauma, generally of minor or moderate grade according to the Abbreviated Injury Scale (AIS). However, the death rate increased with the severity of the injury as measured by the Injury Severity Score (ISS). The initial cranial computed tomography (CT) scan was abnormal in 61% and no patient with a normal scan developed a delayed intracranial haematoma or neurological worsening. Those patients who developed a delayed intracerebral haematoma had a worse outcome. Sixteen patients underwent craniotomy for haematoma. The intracranial pressure (ICP) was measured selectively in 20 patients and exceeded 20 mmHg in half, requiring treatment. Nine patients died, four as a result of head injury and all those had an intracranial haematoma. As a group, those who died were older and had a higher ISS.
Conclusions:
A plan for care of patients with moderate head injury is proposed, complementary to the Early Management of Severe Trauma (EMST) protocol and the Neurosurgical Society of Australasia guidelines for neurotrauma management in rural and remote locations.