Mechanisms of Secondary Brain Damage in Severe Head Injury: A Clinical Perspective
Severe head injury with and without peripheral trauma is the most frequent cause of death and morbidity within the age bracket of up to 45 years [1,2]. The medical and psychosocial consequences for the patient and family, together with the burden on society, are extraordinary. Victims of accidents with head injury are often young persons, requiring in many cases life-long care. Expenses are incurred not only for the medical treatment and subsequent rehabilitation, but also through financial losses, e.g., from the futile investments in education and professional training and those concerning the expected income. The significance of the problem in Germany can be deduced from data obtained by the Federal Bureau of Statistics, Wiesbaden for the Year 1993  reporting all cases with head injury admitted to a hospital. The sampling efficiency was no less than 96.3%. Altogether, more than 270000 patients were referred to hospitals with (a) intracranial injuries (n = 220393), or (b) skull fractures (n = 52781). Although the diagnosis of head injury was not utilized, it can be concluded that a poor outcome in patients with either intracranial injuries or skull fracture is attributable to severe head injury. In total 10584 patients died in 1993 from severe head injury. Estimates concerning the frequency of cases with severe head injury according to the internationally accepted definition of a Glasgow Coma Score of 8 points (or less) for at least 6 h (or longer) approach 20000–30000 cases per year, of which probably 2400–4800 survive with severe disabilities, requiring life-long care as dependants in nursing homes.
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