J Korean Neurotraumatol Soc.  2008 Dec;4(2):62-65. 10.13004/jknts.2008.4.2.62.

Analysis of Causes of Deaths of the Patients Who Had a Head Injury with Multiple Traumas in Emergency Department

• Lee HW
• Chang IB
• Cho SM
• Rim DC
• Song JH
• Ahn SK

• KMID: 2156151
• DOI: http://doi.org/10.13004/jknts.2008.4.2.62

Abstract

OBJECTIVE
The mortality rate of patients with isolated head injuries is about 20-30%, whereas in multiple traumas with head injuries mortality rates can reach over 40%. The authors reviewed the multiple trauma patients with traumatic brain injury who died in emergency department and wanted to describe causes of deaths and to reconsider the role of neurosurgeons in association with trauma team.
METHODS
Between July 1999 and May 2007, 48 patients who had multiple traumas were dead in the emergency department of our hospital before admission. Of them, 42 patients were selected in this study. Twenty eight were male and 14 were female. The medical and radiological records were reviewed retrospectively.
RESULTS
The mode of accidents consisted of 18 pedestrian traffic accidents (TAs), 10 falls, 5 in car TAs, 4 motorcycle accidents, and 5 others. Initial mentality showed that alert or drowsy were 20 (47.6%), stupor 6 (14.3%), and semicoma or coma 16 (38.1%). Most frequent cause of deaths was hypovolemic shock and followed by hypoxia, severe brain swelling, and tension pneumothorax. The major causes of hypovolemia were pelvic bone fracture and abdominal bleeding. Among them, brain computed tomography (CT) and abdomen CT could be checked in 43% of patients and peripheral angiography in only 5 patients (12%).
CONCLUSION
The major cause of deaths of patients who had traumatic brain injury with multiple traumas in emergency department was not brain injury but hypovolemic shock. Early detection and adequate management of bleeding causes might decrease the mortality.

Keyword

Head injury; Multiple traumas; Arterial embolization

MeSH Terms

Abdomen
Accidents, Traffic
Angiography
Anoxia
Brain
Brain Edema
Brain Injuries
Cause of Death
Coma
Craniocerebral Trauma
Emergencies
Female
Head
Hemorrhage
Humans
Hypovolemia
Male
Motorcycles
Multiple Trauma
Pelvic Bones
Pneumothorax
Shock
Stupor

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