Severe head injury management in a general surgical department.
Sixty-nine severely head-injured patients treated by general surgeons over a 28 month period with admission Glasgow Coma Scale motor scores of 3 to 8 were reviewed retrospectively. Fifty-one patients were comatose on admission with periods from injury to admission exceeding 4 h in 34 patients who were referred from peripheral hospitals. Forty patients with acute intracranial bleeding underwent emergency decompressive surgery with 13 good recoveries and 18 deaths; good recoveries were observed in 11 of 20 patients with extradural haemorrhages, one out of eight patients with subdural haemorrhages, and one of 12 patients with intracerebral and/or combined haemorrhages. Twenty-nine patients with no evidence of acute mass lesions were treated medically with sedation, mechanical ventilation and mannitol infusion for cerebral decompression with seven good recoveries and 16 deaths. There were 15 good outcomes in 40 patients with admission motor scores of 6, 7 or 8 and five good outcomes in 29 patients with scores of 3, 4 or 5. A good outcome of 29% in the study may be improved by (i) better neurosurgical training of surgical and nursing staff; (ii) provision of technologically advanced diagnostic and treatment modalities; (iii) an efficient referral system; and (iv) provision of effective long-term rehabilitation.
Visvanathan
R
R
Department of Surgery, University Hospital (USM), Kota Bharu, Kelantan, Malaysia.
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001929:Brain Edema / Q000517:prevention & control; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000601:surgery; D003128:Coma / Q000000981:diagnostic imaging / Q000601:surgery; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008296:Malaysia; D008297:Male; D009460:Neurologic Examination; D012189:Retrospective Studies; D013503:Surgery Department, Hospital; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome