We present a prospective clinical analysis on the secondary systemic insults and prognosis after head injury. The patient population consisted of 104 cases who were admitte dto the Chung Ang Gil Hospital from July 1990 to June 1992 after head
injury,
and whose ages were ranged between 20 and 49 to exclude the influence of age derived systemic factors.
We reviewed clinical features and systemic insults including Glasgow Coma Scale score, size of pupil, pupillary reflex, blood pressure, arterial PH, PaO2, PaCO2, hematocrit and serum con centration of sodium.
The most common cause of injury was traffic accident (36%)
The interval from injury to admission was within one hour in 58.7%, and with in two hours in 78.9% and it was rather faster than expected. However, we found hypotension (systolic BP<90mmHg) in 7.7%, acidemia (PH<7.35) in 35.6%, arterial hypoxemia
(PaO2<60mmHg) in 15.4%, hypercarbia (PaCO2>45mmHg) in 16.3%, anemia (hematocrit<30%) in 1.0%, hyponatremia (Na<135 mEq/1) in 4.8%, and hypernatremia (Na>145mEq/1)in 17.3%.
The mortality was 32.7%. Of secondary systemic insults, the blood pressure, PH, PaO2, PaCO2 were statistically signincant prognostic values.
These results imply that the prehospital emergency care system (So called ABC principle ; A-Airway, B=Breathing, C=Circulation) at the scene of addident and during the transportation is very important in managing the head injury patient.
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