JOURNAL OF THE NATIONAL ACADEMY FOR CHILD DEVELOPMENT
1985 Volume 5, No. 3
Trauma
Robert J. Doman, M.D.
Head trauma or injury is the leading
cause of death of persons between the ages of one and forty-four.
The leading causes of head injuries include vehicle accidents,
industrial accidents, assaults, sports injuries, falls, gun
shot wounds, etc. Head injuries may be divided into closed
injuries in which the brain is not exposed and open injuries
such as gun shot wounds in which the brain is exposed.
Over 50% of head injuries are due to
automobile accidents. This country has a sad record of over
50,000 deaths each year from that cause alone. Ten years ago
at the onset of the oil shortage when the national speed limit
was reduced to 55 MPH the death rate temporarily fell below
the 50,000 level; but since that time, as the result of so
many people ignoring the 55 MPH limit and ignoring the use
of seat belts, deaths have again risen. Many states still
do not have a law requiring motorcyclists to wear protective
helmets. Motorcyclists are very vulnerable to head injury.
In vehicular accidents two-thirds of
the deaths occur at the scene of the accident. The remaining
one-third of the deaths occur later at the hospital.
Approximately 25% of severe head injury
patients are admitted to the hospital in a state of coma.
Of severe head injuries admitted to the hospital, 25% have
injuries to the brain which occurred at the time of the accident,
which will cause the patient's death. Another 25% of the head
injury patients admitted have mild enough injuries (usually
concussion which will be discussed later) that they will improve
rapidly. The remaining 50% will improve slowly or deteriorate.
Of that 50% of patients, one out of three will be complicated
by a hematoma (bloodclot). Depending upon the location of
the clot, its severity, and its treatment, as many as half
of the patients with blood clots may deteriorate and die.
The most common forms of brain clots
are called: a) Epidural "Epi-" upon, "dura-"
the outer thick covering of the brain. Such a clot lies between
the skull bone and the dural cover of the brain. b) Subdural
"sub-" below the dura. The clot lies under the outer
brain covering. Another form of bleeding is called subarachnoid
"Sub-" below, "arach-noid" the inner thin
covering of the brain. Such bleeding goes into the spinal
fluid, which follows in and around the brain acting as a cushion
for the brain in an effort to diminish the effects of head
injury.
Approximately 80% to 90% of brain blood
clots are associated with fractures of the skull bones. The
three main forms of skull fractures are called: a) Linera
a line-like fracture which is sometimes mild enough not to
require treatment; b) Comminuted a fracture with several bone
fragments; c) Depressed in which a bone fragment or many fragments
are pushed down into the skull. These are more serious and,
if not properly treated, could lead to seizures. A comminuted,
depressed fracture always requires neurosurgical intervention.
Of the two-thirds of the severely head
injured patients who do not have blood clots most of them
will recover slowly.
Mild head injuries generally include
the following: a) Abrasions of the scalp where application
of ice will generally be all that is needed after cleansing
the area properly; b) Bleeding under the skin a burn where
again an ice pack will help minimize the bleeding; c) Lacerations
of the scalp, although often bloody, usually are not serious
but should be cleansed properly and sutured when necessary.
Every patient suffering even a mild
head injury should be carefully observed for a minimum of
twenty-four hours to watch for possible signs of increased
pressure within the skull including drowsiness, vomiting that
is projectile (forceful shooting out), headaches, visual disturbances,
etc. With the onset of such signs, the patient should be hospitalized
immediately and tests done to determine if there is increased
pressure within the skull.
NACD firmly believes in proper hospital
testing for head injury patients not only to reduce mortality
but also to prepare the patient better for NACD's program
for neurological rehabilitation.
Reprinted from the Journal
of the National
Academy for Child Development
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