Management of traumatic intracranial haematoma.

Deciding which head-injured patients should be transferred to a neurosurgical unit can be difficult. Traditional criteria emphasise the development of deteriorating responsiveness but lead to delayed diagnosis and to avoidable mortality and morbidity. To discover if a more liberal admission policy improved results a study was conducted analysing data collected prospectively from 683 patients who had a traumatic intracranial haematoma evacuated in the Glasgow neurosurgical unit between 1974 and 1980. In the first four years, before the change in policy, mortality was 38% but decreased to 29% afterwards. This reflected a reduction in the proportion of patients who talked after injury but who deteriorated into coma before operation--that is, 31% before the change in policy, 16% afterwards. If the potential benefits of CT scanning in the management of head injuries are to be realised patients must be scanned sooner than in the past. This will usually mean that more patients should go to a neurosurgical unit and that simple criteria for transfer should be established.

[1]  I. A. Baker.  Availability of computed tomography for the management of head injuries in England and Wales. , 1982, British medical journal.

[2]  R. Jeffreys,et al.  The use of the CAT scanner in the management of patients with head injury transferred to the regional neurosurgical unit. , 1982, Injury.

[3]  P. Weston.  Admission policy for patients following head injury , 1981, The British journal of surgery.

[4]  R. Jeffreys,et al.  AVOIDABLE FACTORS CONTRIBUTING TO THE DEATH OF HEAD INJURY PATIENTS IN GENERAL HOSPITALS IN MERSEY REGION , 1981, The Lancet.

[5]  G. Teasdale,et al.  Predicting the need for operation in the patient with an occult traumatic intracranial hematoma. , 1981, Journal of neurosurgery.

[6]  J. Miller,et al.  Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. , 1981, The New England journal of medicine.

[7]  B. Jennett,et al.  Head injuries in three Scottish neurosurgical units. Scottish head injury management study. , 1979, British medical journal.

[8]  F. Hart,et al.  Extradural haematoma: effect of delayed treatment. , 1979, British medical journal.

[9]  J. Bartlett,et al.  A clinical study of the EMI scanner: implications for provision of neuroradiological services. , 1978, British medical journal.

[10]  B. Jennett,et al.  Avoidable factors contributing to death after head injury. , 1977, British medical journal.

[11]  S. Galbraith.  Misdiagnosis and delayed diagnosis in traumatic intracranial haematoma. , 1976, British medical journal.

[12]  J. Ambrose,et al.  E.M.I. SCAN IN THE MANAGEMENT OF HEAD INJURIES , 1976, The Lancet.

[13]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[14]  G. Teasdale,et al.  Acute Traumatic Intracranial Hematomas. , 1981, Progress in neurological surgery.

[15]  B. Jennett,et al.  Preventable mortality and morbidity after head injury. , 1979, The Medical journal of Australia.

[16]  B Jennett,et al.  Assessment of outcome after severe brain damage. , 1975, Lancet.