Management of cerebral trauma

Abstract

1. 1. We have reviewed a series of 396 consecutive cases of craniocerebral injury admitted to the Peter Bent Brigham Hospital during the years 1913 to 1939 inclusive, of which 44.41 per cent were mildly injured, 37.88 per cent moderately injured, and 22.73 per cent severely injured. 2. 2. The gross mortality for the entire series was 11.87 per cent; for the mild cases, 1.2 per cent; for the moderately injured cases, 2.6 per cent; and for the severely injured cases, 51.9 per cent. The mortality for all cases has decreased from 26.98 per cent in 1913 to 1921 inclusive, to 7.92 per cent in 1931 to 1939 inclusive, but in the severely injured cases has remained constant. 3. 3. The incidence of operative intervention has been reduced from 52.38 per cent to 13.75 per cent from the former period (1913 to 1921) to the latter period (1931 to 1939). 4. 4. Mild dehydration therapy has been employed with steadily increasing frequency. From 1931 to 1939 inclusive 42 per cent of patients had some limitation of fluid intake and 31.67 per cent received large doses of magnesium sulfate orally or rectally. 5. 5. Diagnostic lumbar puncture has been utilized more and more frequently, up to 75 per cent of all cases from 1931 to 1939 inclusive; therapeutic lumbar puncture has been abandoned. 6. 6. A general plan of treatment as used by us at present is described.