Head injuries: Early mortality and airway management

As penetrating injuries are uncommon in Europe, their increase may consecutively shift injury pattern, preoperative care needed (depicted in the level of consciousness and consecutive intubation) and preoperative mortality by far. Single hospital analysis of Chris Hani Baragwanath hospital (CHB) Emergency Department Data from Johannesburg, South Africa. During 9/2000-5/2005 5602 Patients were amenable and potential endpoints intubation and demise in the ED were analysed. With penetrating injuries increasing thoracoabdominal injuries incidence will rise, as head injuries will do so moderately. Penetrating head injuries will push up intubation frequency from 31.4% (blunt head trauma) to 52.5% (gunshot head). Emergency Department mortality of blunt head injuries is 8.3%, whereas that of gunshot heads is 25.6%. Average demise time of blunt head patients is 2.3 and 2.8 hours despite maximum care; whereas half of the penetrating head patients deaths already occurred within one hour (p=0.02; log rank test). With penetrating injuries increasing a moderate rise in penetrating head injuries is to be exspected. This may consecutively lead to more intubations (from 30% to 50%), mortality in head injuries may triple, and deaths may occur much earlier then before despite aggressive resuscitation efforts. These deaths are to be expected at scene, during evacuation or in the Emergency Department. © Georg Thieme Verlag KG Stuttgart - New York.