The epidemiology of head injuries in an urban/rural population, together with an evaluation of a more selective admission policy
Gorman, David Francis
The epidemiological characteristics of two groups of patients with head injuries attending the accident and emergency department at Chester Royal Infirmary are detailed. This hospital serves a mixed urban /rural population of approximately 260,000. The earlier study comprised all those who attended during the twelve months ending 30.6.77 and was retrospective. The later study included all attenders in the year ending 30.11.80 and was prospective. During each study period patient characteristics, including age last birthday, sex, time, day and month of attendance were recorded, in addition to cause of injury and predisposing factors or associations such as alcohol. Some elements of the history and examination were also noted. X -ray usage was documented as well as the proportion of patients with radiologically apparent skull fractures. Some treatment measures were quantified. For admitted patients, in addition to the above characteristics, reasons for admission and length of stay were examined. Macroscopic post -mortem findings were described for all patients who died, including those who died prior to arrival at hospital. Analysis of deaths included the calculation of Injury Severity Scores. Results were discussed in the light of an extensive review of the literature.A more selective admission policy was introduced during the prospective study. As a result of this change head injury admissions were reduced by half. Comparison of the results during the prospective study with those during the retrospective study, when a more orthodox admission policy was in use, revealed that the more selective policy was associated with no worse results than is current practice. Recognition and treatment of acute post- traumatic intracranial haematomas, whilst the patient was alive, was more likely during the prospective study. Likewise survival of patients with such lesions was more likely during the prospective study. These latter differences between the two study groups were, however, not statistically significant.