Afri. J. Neuro. Sci. Vol. 16 No. 1 Jan
1997
MANAGEMENT OF PATIENTS WITH SEVERE HEAD INJURIES.
P.L. SEMPLE, N. FISHER-JEFFES
Department of Neurosurgery, Groote Schuur Hospital, University
of Cape Town, Cape Town, South Africa.
Code Number:NS97001
SUMMARY
Introduction
At Groote Schuur Hospital head injured
patients are managed by the Neurosurgical Department. A
retrospective study was undertaken to determine whether the
intensive management of head injuries with a low Glasgow Coma Scale
(GCS) on admission is justified. One hundred and five patients
admitted during 1990 with a GCS of 8/15 or less were grouped on the
basis of their GCS following resuscitation. Thirty four patients
were admitted with a GCS of 3/15 and fifty two patients were
admitted with GCS of 6/15-8/15. The outcome of these patients was
then analyzed; the findings suggesting that those patients who have
been adequately resuscitated, and have had an intracranical
haematoma evacuated, but still present with a GCS 5/15 or less at 6
hours post injury have such a poor prognosis that high tech
intensive care may not be justified.
RESUME
Au Groote Schuur Hospital, les traumatises
craniens sont pris en charge par le Department de Neurochirurgie.
Une crude retrospective a ete entreprise pour savoir si les soins
intensifs etaient justifies pour les patients qui, a leur
admission, presentaient un faible niveau de "Glasgow Coma Scale"
(GCS); 105 patients hospitalises en 1990 avec un GCS egal ou
inferiur a 8/15, etaient groupes en se basant sur leur GCS apres
reanimation; 34 avaient un GCS de 3/15, 7 de 4/15, 12 de 5/15, et
52 de 6/15 a 8/15. Le devenir de ces patients a ete analyse. Il
en resulte que les patients qui, malgre une reanimation
correcte et une evacuation de leur haematome intra-cranien,
avaient, encore six heures apres le traumatisme, un GCS egal ou
inferieur a 5/15, le pronostic etait tellement mauvais que la
pratique des soins intensifs de haute technicite ne semblait pas
justifiee.
Copyright 1995 Pan African Association of Neurological Sciences