Outcome of Severe Head Injury with and without Multiple Trauma

Abstract

The authors compared the clinical outcome in cases of isolated, severe, blunt head injury (IHI) and those involving multiple trauma that included head injury (HMI). There were 204 patients in the IHI group (mean age, 38.5 years) and 192 in the HMI group (mean age, 35.3 years). The overall mortality rate was 53.9% following IHI and 50.0% following HMI. The incidence of shock was significantly lower with IHI (6.9%) than with HMI (34.9%), although the mortality rate for patients in shock was over 70% in both groups. Among HMI patients with both chest and abdominal injuries, those in shock had a higher mortality rate. Among patients who did not go into shock, mortality was significantly lower in the HMI group (37.6%) than in the IHI group (50.5%). Glasgow Coma Scale and Outcome Scale scores did not differ significantly between IHI and HMI patients. Among patients with the same Trauma Scores, the mortality rate tended to be lower with HMI than with IHI. The results of this study suggest that head injury alone is more severe than head injury accompanied by other trauma, despite the similarity between the two groups of patients in Glasgow Coma Scale scores. In addition, the trauma scale should be applied to patients with multiple injuries, since it evaluates respiratory and cardiovascular function.