Comment on the paper “Talk and Die’ patients presenting to a major trauma centre over a 10 year period: A critical review’

Abstract

The 1975 paper ‘patients with head injury who talk and die’ depended on the insight of Bryan Jennett who coined the phrase and saw the significance of this group of patients and the excellent neuropathological studies of a large series of fatal head injuries conducted by Hume Adams and David Graham – a type of study almost impossible to replicate. That paper highlighted the distinction between primary head injury, in this group minor, and secondary head injury which was fatal. The important implication of that paper was that the primary head injury itself was potentially survivable. An analysis of ‘talk and die’ patients might therefore be an important audit of a trauma system. Goldschlager et al. in a retrospective review over 10 years, identified 15 patients who died after being admitted with mild head injury to a major trauma centre. This is an incidence of 1.5% per year or >6% of all mild head injuries. The selection of patients is based on coronial reporting but the analysis is based on CT scans rather than neuropathology. The patients were mostly elderly and the majority died as the result of acute subdural haematomas or contusions with swelling.