Neurotrauma: Management of Acute Head Injuries

Christopher J. Lettieri, MD, MAJ, MC, USA

Disclosures

Medscape Critical Care. 2006;7(2) 

In This Article

Epidemiology

Regardless of improved preventive measures, neurologic trauma, specifically head injuries, remains a common and often devastating occurrence. Each year, 1 million Americans (200-400 per 100,000) seek medical attention for acute head injuries, 27% of which are moderate or severe.[1,2,3,4,5] Head trauma results in approximately 70,000 deaths, 80,000 long-term disabilities, and 60,000 new seizure disorders each year.[1,2,3,4,5] These injuries most often occur in individuals who are 15-24 years old and are twice as common in men.[2,3] Causality is bimodal with vehicular accidents being most common in those under 25 years and falls in those over 75 years.[1,2,5] Nearly half involve intoxication with drugs or alcohol.[5,6]

Head injuries represent 2% to 3% of all-cause deaths and 26% to 68% of trauma-related deaths.[1,2,3,4,5,7] Mortality following severe head injuries may be as high as 30% to 50% and is predicted by the initial Glasgow Coma Scale (GCS), older age, hypotension, the development of secondary injuries/insults, and the depth and duration of coma.[4,5,7,8,9] Among survivors, neurologic impairment is unfortunately common and the socioeconomic consequences related to prolonged hospitalizations, need for rehabilitation, and permanent disabilities are tremendous.[8,10]

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