head trauma

Last reviewed 01/2018

Head injury remains a major cause of death, especially in the young. Many die in the initial impact. Of those who survive and remain in coma for 6 hours, 40% die within 6 months.

  • head injury is defined as any trauma to the head other than superficial injuries to the face.
    • head injury is the commonest cause of death and disability in people aged 1-40 years in the UK
      • each year, 1.4 million people attend emergency departments in England and Wales with a recent head injury
      • between 33% and 50% of these are children aged under 15 years
      • annually, about 200,000 people are admitted to hospital with head injury
      • of these, one-fifth have features suggesting skull fracture or have evidence of brain damage
      • most patients recover without specific or specialist intervention, but others experience long-term disability or even die from the effects of complications that could potentially be minimised or avoided with early detection and appropriate treatment

  • incidence of death from head injury is low, with as few as 0.2% of all patients attending emergency departments with a head injury dying as a result of this injury
    • ninety five per cent of people who have sustained a head injury present with a normal or minimally impaired conscious level (Glasgow Coma Scale [GCS] greater than 12) but the majority of fatal outcomes are in the moderate (GCS 9-12) or severe (GCS 8 or less) head injury groups, which account for only 5% of attenders
      • therefore, emergency departments see a large number of patients with minor or mild head injuries and need to identify the very small number who will go on to have serious acute intracranial complications
      • estimated that 25-30% of children aged under 2 years who are hospitalised with head injury have an abusive head injury

In some patients (for example, patients with dementia, underlying chronic neurological disorders or learning disabilities) the pre-injury baseline GCS may be less than 15

Recovery depends upon the nature of the injury

  • residual effects are both physical, e.g. hemiparesis, dysphasia; and mental, e.g. impaired intellect, memory, and behavioural problems.

The extent of recovery is often correlated with the duration of post-traumatic amnesia. As a guide, post- traumatic amnesia of more than 28 days is rarely associated with a return to work. Post-traumatic amnesia of more than one week is likely to impair higher intellectual activity. That of less than one day should allow a return to previous activity after several months. The prognosis is better for younger patients, worse for older ones.

Most of the improvement is within the first 6 months. Physiotherapy and occupational therapy have important roles, both in overcoming physical disability and in stimulating motivation.