Mortality of head injuries in immediate survivors of vehicular crashes

Gennarelli, Thomas A.; Champion, Howard R.; Copes, Wayne S.

Affiliations

¹Division of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania

²Trauma Service, Washington Hospital Center, Washington, D.C.

Abstract

An analysis of 174,160 patients in 165 trauma centers in the United States was undertaken to determine the mortality of head injuries (HI) in vehicular crashes. In this series, 59,713 patients incurred an injury to the brain or skull of which 39,738 (66.6%) were due to vehicular crashes. Of these vehicular causes, 73.2% were vehicle occupants (VO), 15.3% were pedestrians (PED) and 11.5% were motorcyclists (MC). The overall mortality for patients with vehicular HI was 13.3%, but was lower in VO (11.5%) than in MC (15.3%) or PED (20.7%). In all cases, mortality of HI was higher than if no head injury (NHI) occurred; overall mortality for vehicular NHI = 5.2%, VO =4.9%, MC = 4.2%, PED = 7.3%. Injury severity measured by AIS-85 had, as expected, a profound influence on mortality of both HI and NHI groups. For HI patients with no to moderate additional extracranial injury (AIS_ECI=0-2), a linear relationship was found for HI with severity AISHI = 2-5, approximated by MORTALITY(_ECI=0-2)= 13.6*AIS_{HI=2.5} - 28.7. For more severe ECI of AIS = 3-5, for AISHI = 2-5 mortality was approximated as expressed by MORTALITY_{ECI=3.5} = 13*AIS_{HI=2-5} - 19.2. By combining mortality with frequency, mortality indices are derived that can serve as targets for prevention strategies. These data support the proposition that head injuries are the most important single cause of vehicular fatality in patients who survive sufficiently long to reach medical care.

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Cited By (1)

Year	Entry
1993	Siegel JH, Mason-Gonzalez S, Dischinger PC, Read M, Cushing BM, Badellino MC, Goodarzi S, Smialek JE, Heatfield BM, Robinson RM, Parkinson K, Hill WJ, Jackson JW, Livingston DJ, Bents FD, Clark CC. Causes and costs of injuries in multiple trauma patients requiring extrication from motor vehicle crashes. J Trauma. December 1993;35(6):920-931.