Head injury overview

Head injury is a trauma to the head, that may or may not include injury to the brain(see also brain injury).

Common causes of head injury are traffic accidents, home and occupational accidents, falls, and assaults. Bicycle accidents are also a common cause of head injury-related death and disability, especially among children. ^[1]

The incidence (number of new cases) of head injury is 300 per 100,000 per year (0.3% of the population), with a mortality of 25 per 100,000 in North America and 9 per 100,000 in Britain. Head trauma is a common cause of childhood hospitalization.

Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover. Children who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer’s disease later in life.^[2]

The Glasgow Coma Scale is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. The Pediatric Glasgow Coma Scale is used in young children.

Unfortunately, once the brain has been damaged by trauma, there is no quick fix. However, there are some steps that can be taken to prevent secondary damage. If left untreated many patients with head injury will rapidly develop complications which may lead to death or permanent disability. Prompt medical treatment may prevent the worsening of symptoms and lead to a better outcome.

Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia.

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