Central Nervous System Trauma

Abstract

Abstract Head injuries account for half of all trauma deaths and for more cases of permanent disability than any other type of trauma (Kraus, 1993). Head injury statistics vary markedly depending upon how the head injury is defined and whether the data come from hospitals, medical examiners’ reports, or police reports; data on admissions for head injury are not collected uniformly in the United States. Many hospitalized patients who have other severe injuries in addition to their head injury do not have the diagnosis of head injury recorded in the hospital record, so those injuries are lost from the database (Moss and Wade, 1996). In a series of 49,143 patients from 95 trauma centers, the overall mortality of patients with head injury was 18.2%, three times higher than in patients with no head injury (Gennarelli et al., 1989). U.S. mortality data from 1979 to 1986 recorded 315,328 deaths associated with head injury, representing 2% of all deaths, 26% of injury deaths, and an annual death rate of 16.9 per 100,000 residents (Sosin et al., 1989). The head injury death rate varies among different population settings up to a high of about 32 per 100,000 residents, and urban populations have the higher rates. The most common causes of these head injuries are traffic accidents (~50%), gunshot wounds (20%–40%), falls (10%), and assaults (5%–10%). Head injury is a major cause of mortality and morbidity at all ages. The death rate for head injury in children is about 10 per 100,000, five times the mortality rate for leukemia, the next leading cause of death (Kraus et al., 1986). The annual head injury rate for children in San Diego was found to be 185 per 100,000. The most common causes of childhood head injury were falls (35%), recreational activities (29%), and traffic accidents (24%). The mechanism of children’s head injuries varies with the age of the child. In some series, falls account for as many as 75% of head injuries in those under the age of 3 years (Jamison and Kaye, 1974; Hanhn et al., 1988; Luerssen et al., 1988). Many studies find that children have a lower mortality rate and better outcome than adults after severe head injury, although this trend does not hold for the very young child who sustains abusive head injury (Berger et al., 1985; Alberico et al., 1987).