Management of traumatic intracranial haematoma.

Abstract

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.

Acute Head Injuries Managed in the Intensive Care Unit of Al-Adan Hospital, Kuwait

“…Taking the GCS as a measure of the severi ty of initial neurological damage in a head injury [14], a score of 3 to 5 carried a bad prognosis, with a mortality of 71% in this study, 76% in Leicester [13], and 91% in Lusaka [4], The findings by others that acute subdural haematoma is associated with the highest mortality [15][16][17] and extradural hematoma with the lowest [13,18,19] have been con firmed by this study.…”

The future role of neurosurgery in the care of head injuries

“…This failure of scanning to improve results was because patients were not being referred for scanning until there was a high suspicion of an operable intracranial hematoma requiring surgery -and that was often too late for optimal results. When the transfer policy in Glasgow was deliberately changed, the number of head injuries referred to the neurosurgical unit doubled and the delay before transfer was reduced; more intracranial hematomas were detected and operated on, and reduced mortality and morbidity [24]. No technological advance can yield benefit unless it is used appropriately and that means that the right patients must have access to it without undue delay.…”

Prognostic factors in severely head injured adult patients with epidural haematoma's

“…Prognosis in this group is related to degree and duration of brain compression and consequently entirely depends on early diagnosis and subsequent haematoma evacuation. Protocols on early diagnosis and management of low risk head injured patients have been shown to improve both mortality and morbidity in patients with epidural haematoma and coma, following clinical deterioration [37,41]. Analysis of the overall treatment results in patients in coma with epidural haematoma is complicated by the policy of referral hospitals.…”