Risk During the First Hours After Severe Head Injury

Abstract

In spite of numerous publications from Gordon, Gothenburg [7], Karimi, Cologne [10], Vigouroux, Marseille [15], and many other authors, objective figures for the survivors of the first hours after severe head injury are rare and differ widely (Fig. 1). In 578 cases of head injury treated in 1984/85 in a large general hospital in Ravenna, Servadei et al. [14] reported 3% (19 cases) deaths at the site of accident and during transport. Another 3% (17 patients) died in the emergency room, and 7 out of 542 patients (1.2%) died in hospital later. In Paris, among 1157 neurosurgical emergency trauma patients, Charpentier et al. [2] recorded a mortality of 25% in 1972, which they reduced to 12% in 1983/84. Dautheribes et al. [3] in Bordeaux had 70% survivors. Hernesniemi et al. [9] in Helsinki reported in 1986 that out of 223 severely head-injured patients (excluding suicides) 68 patients, i.e. 30%, died at the site of accident, leaving 70% survivors. Bouillon (1982, personal communication), one of the organizers of first aid in Cologne, reported on 130 comatose head-injured patients at the site of accident. In those who needed cardiopulmonary resuscitation, the mortality even reached 90%, like in patients with other causes of cardiac arrest [4, 11, 13]. Both Hernesniemi et al. [9] and Bouillon found that 10%–20% of initially comatose head-injured patiends died during transport, another 17% in the emergency room, and finally of the remaining patients 30% died in spite of neurosurgical treatment.