Analysis of management in thirty-three closed head injury patients who 'talked and deteriorated'

G. L. Rockswold, P. R. Leonard, M. G. Nagib

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Of 215 patients with severe head injuries, 33 (15%) closed head injury patients who talked before their conditions deteriorated to a Glasgow coma scale score of 8 or less were identified. Of this select group, 15 died (45%), but none of the remaining were left in a vegetative state and 14 patients had a 'favorable' outcome (42%). Twenty-five patients (76%) underwent surgical decompression. In these 25 patients, 14 subdural hematomas, 4 epidural hematomas, and 7 intracerebral contusions and hematomas were the initial surgical lesions. Twenty of the 25 patients were operated on within 4 hours (16 within 2 hours) of their neurological deterioration. Eleven of the 25 surgically treated died, for a mortality rate of 44%. All 15 deaths were studied further. Autopsies with examination of the brain were performed in 13 patients. Five patients died with severe brain injuries not complicated by iatrogenic factors, and 4 patients died of severe associated injuries. Iatrogenic factors significantly complicated the deaths of 6 patients (40%). It is concluded that most patients who 'talk and deteriorate' have sustained very serious life-threatening injuries. Intracranial hematomas are the most frequent cause of this situation, and rapid dignosis and decompression is the most important factor in salvaging these patients.

Original languageEnglish (US)
Pages (from-to)51-55
Number of pages5
Issue number1
StatePublished - Jan 1 1987

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