ASSESSMENT OF MORTALITY ASSOCIATED WITH MILD HEAD-INJURY IN THE PEDIATRIC AGE GROUP

Reducing mortality among accident and trauma patients requires careful attention to monitoring those regarded as being at low risk. We hospi talized almost 1600 head-injured patients in the period between 1979 a nd 1992 at the Neurosurgery Department of Gazi University Medical Scho ol, Ankara, Turkey. These patients were selected from among the numero us patients admitted to our emergency unit and treated with the same p rotocol in the same department. Among the hospitalized children, there were three patients defined as having a mild head injury on the basis of Glasgow Coma Scale scores of 15 who later had unfavorable outcomes . Clinical signs that might identify potentially endangered patients w ith mild injury were gathered; these included the presence of post-tra umatic amnesia, somnolence, irritability, anisocoria, local evidence o f trauma to the head, associated injuries, history of altered consciou sness, and skull fracture. The study was designed to identify features by which patients who are in real danger can be distinguished among t he many with trivial trauma that we face every day. We did not find an y identifying clinical features and concluded that computed tomographi c scanning is the only reliable answer. This will reduce avoidable mor tality and morbidity by identifying the patients who are at higher ris k than is at first evident.