Skip to main content
PMC home page
Journal of Accident & Emergency Medicine logoLink to Journal of Accident & Emergency Medicine
. 1999 May;16(3):182–185. doi: 10.1136/emj.16.3.182

Outcome after severe head injury treated by an integrated trauma system.

T J Coats 1, C J Kirk 1, M Dawson 1
PMCID: PMC1343330  PMID: 10353043

Abstract

OBJECTIVES: To describe outcome after treatment of severe head injury within an integrated trauma system. METHODS: A retrospective analysis of all patients with severe head injury admitted to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) between 1991 and 1994. Type of injury was defined on initial computed tomography of the head and outcomes assessed 12 months after injury using the Glasgow outcome score. RESULTS: 6.5% of HEMS patients had long term severe disability (severe disability or persistent vegetative state on the outcome score); 34.5% made a good recovery. CONCLUSIONS: The concern that a large number of severely disabled long term survivors might result as a consequence of this system of trauma management is not confirmed. The case mix of severity of extracranial injuries in these patients makes comparison with other published series difficult, but these data fit the hypothesis that pre-hospital correction of hypoxia and hypotension after head injury improves outcome.

Full text

PDF
182

Images in this article

183Figure 3
on p.183
184Figure 4
on p.184

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker S. P., O'Neill B., Haddon W., Jr, Long W. B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974 Mar;14(3):187–196. [PubMed] [Google Scholar]
  2. Botha A. J., Earlam R. J., Wilson A. W., Dalton A. M., Spalding T. J., Warren C., Hodkinson S. The Royal London Hospital Helicopter Emergency Medical Service: first phase 1990. Ann R Coll Surg Engl. 1992 Sep;74(5 Suppl):130–134. [PubMed] [Google Scholar]
  3. Chesnut R. M., Marshall L. F., Klauber M. R., Blunt B. A., Baldwin N., Eisenberg H. M., Jane J. A., Marmarou A., Foulkes M. A. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993 Feb;34(2):216–222. doi: 10.1097/00005373-199302000-00006. [DOI] [PubMed] [Google Scholar]
  4. Ishige N., Pitts L. H., Hashimoto T., Nishimura M. C., Bartkowski H. M. Effect of hypoxia on traumatic brain injury in rats: Part 1. Changes in neurological function, electroencephalograms, and histopathology. Neurosurgery. 1987 Jun;20(6):848–853. doi: 10.1227/00006123-198706000-00005. [DOI] [PubMed] [Google Scholar]
  5. Jennett B., Snoek J., Bond M. R., Brooks N. Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981 Apr;44(4):285–293. doi: 10.1136/jnnp.44.4.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kirk C. J., Earlam R. J., Wilson A. W., Watkins E. S. Helicopter Emergency Medical Service operating from the Royal London Hospital: the first year. Br J Surg. 1993 Feb;80(2):218–221. doi: 10.1002/bjs.1800800231. [DOI] [PubMed] [Google Scholar]
  7. Kohi Y. M., Mendelow A. D., Teasdale G. M., Allardice G. M. Extracranial insults and outcome in patients with acute head injury--relationship to the Glasgow Coma Scale. Injury. 1984 Jul;16(1):25–29. doi: 10.1016/0020-1383(84)90110-4. [DOI] [PubMed] [Google Scholar]
  8. MACIVER I. N., FREW I. J., MATHESON J. G. The role of respiratory insufficiency in the mortality of severe head injuries. Lancet. 1958 Feb 22;1(7017):390–393. doi: 10.1016/s0140-6736(58)90714-1. [DOI] [PubMed] [Google Scholar]
  9. Miller J. D., Becker D. P. Secondary insults to the injured brain. J R Coll Surg Edinb. 1982 Sep;27(5):292–298. [PubMed] [Google Scholar]
  10. Miller J. D. Head injury and brain ischaemia--implications for therapy. Br J Anaesth. 1985 Jan;57(1):120–130. doi: 10.1093/bja/57.1.120. [DOI] [PubMed] [Google Scholar]
  11. Miller J. D., Sweet R. C., Narayan R., Becker D. P. Early insults to the injured brain. JAMA. 1978 Aug 4;240(5):439–442. [PubMed] [Google Scholar]
  12. Nicholl J. P., Brazier J. E., Snooks H. A. Effects of London helicopter emergency medical service on survival after trauma. BMJ. 1995 Jul 22;311(6999):217–222. doi: 10.1136/bmj.311.6999.217. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Pietropaoli J. A., Rogers F. B., Shackford S. R., Wald S. L., Schmoker J. D., Zhuang J. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma. 1992 Sep;33(3):403–407. doi: 10.1097/00005373-199209000-00011. [DOI] [PubMed] [Google Scholar]
  14. Poon W. S., Li A. K. Comparison of management outcome of primary and secondary referred patients with traumatic extradural haematoma in a neurosurgical unit. Injury. 1991 Jul;22(4):323–325. doi: 10.1016/0020-1383(91)90016-8. [DOI] [PubMed] [Google Scholar]
  15. Price D. J., Murray A. The influence of hypoxia and hypotension on recovery from head injury. Injury. 1972 Apr;3(4):218–224. doi: 10.1016/0020-1383(72)90104-0. [DOI] [PubMed] [Google Scholar]
  16. Rose J., Valtonen S., Jennett B. Avoidable factors contributing to death after head injury. Br Med J. 1977 Sep 3;2(6087):615–618. doi: 10.1136/bmj.2.6087.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]
  18. Wright K. D., Knowles C. H., Coats T. J., Sutcliffe J. C. 'Efficient' timely evacuation of intracranial haematoma--the effect of transport direct to a specialist centre. Injury. 1996 Dec;27(10):719–721. doi: 10.1016/s0020-1383(96)00119-2. [DOI] [PubMed] [Google Scholar]
  19. Younge P. A., Coats T. J., Gurney D., Kirk C. J. Interpretation of the Ws statistic: application to an integrated trauma system. J Trauma. 1997 Sep;43(3):511–515. doi: 10.1097/00005373-199709000-00021. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Accident & Emergency Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES