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Prehospital Management of Head Injuries: International Perspectives

  • Julio H. Garcia
Conference paper
Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 57)

Abstract

The extent of disability and, therefore, the management of head injured patients before their arrival to the hospital should be influenced by a number of factors including:
  • the age of the victim (children with comparable severity of head injury have less disability and lower mortality than persons over the age of 40)

  • the type of injury (motor-vehicle accidents are the most frequent cause of head trauma in the U.S. and Canada)

  • the decision to transfer the patient to either the nearest hospital or to a designated neurotrauma center (at several communities in the U.S. and Canada, recent analysis has demonstrated that the extent of disability and the mortality among head injured victims can be significantly decreased by their admission to specialized trauma units)

  • elapsed time as another important factor (at least in one type of traumatic injury — acute subdural hemorrhage — it has been shown than an interval of less than 2 hours between the time of injury and the time of the craniotomy can significantly decrease both the mortality and the extent of neurological impairment among the survivors).

A number of acute injury effects on endothelial, neuronal or glial cells could potentially be influenced by compounds that may be administered before the victim arrives to the hospital. Evidence based on experimental and human observations will be reviewed concerning the potential ability to intervene in one or more of these areas: generation of free radicals, effect of opioid peptides, release of platelet-derived growth factors and their effects on astrocytic proliferation, alterations in thyroid hormones, hypoalbuminemia as a reflection of the effect of cytokines, and changes in vascular permeability and reactivity.

The application of methods with a statistically proven value to prognosticate the outcome of a head injury, such as developed by Choi et al. (J Neurosurg, 1988), may allow evaluation of the effects that free radical scavengers, as an example, may have on the patient–s recovery. More standardized and controlled animal experiments are needed before any of these drugs can be used in clinical trials.

Keywords

Head injury; prognostic factors hospital admission policy delay of treatment 

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Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Julio H. Garcia
    • 1
  1. 1.Department of Pathology, Division of NeuropathologyHenry Ford HospitalDetroitUSA

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