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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
- 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
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
Last reviewed 01/2018