Study of 531 consecutive cases of severe head trauma in Florianópolis, 1994-2000

Background and objective

Trauma is the major cause of mortality in the population aged below 40 years. Brazil has a high incidence of traffic accidents. Our main objective was to study the epidemiology and the mortality secondary to severe head trauma in a medium-sized southern Brazilian city (Florianopolis, ca 600,000 inhabitants). We compared the impact of safety traffic campaigns on epidemiological variations and mortality during the period 1994-2000.

Settings

A regional reference hospital for head trauma.

Method

Data from 531 consecutive patients admitted to the ICU (period 1994-2000) with severe head trauma (Glasgow Coma Score ≤ 8) were obtained. The following variables were collected and analyzed: demographics, cause of trauma, Marshall's topographic classification for head trauma and in-hospital mortality. We compared total mortality and mortality during the periods 1994-1995 and 1999-2000.

Results

Patients were predominantly males (85%), aged 12 to 40 years (74%). In-hospital mortality was 35%; in 1994-1995 it was 44%, and in 1999-2000 it was 32%. There was a fall in the percentage of victims of car accidents from 33 to 21%, and an increase in the percentage of victims of motorcycle accidents from 13.4 to 21% and of pedestrian injuries from 31 to 33.4%. We observed an increase in injury type V (mass lesion evacuated) from 29 to 35%.

Conclusion

Seat belts and new traffic legislation have resulted in a change in the epidemiology of trauma. Car crashes were the most important cause of trauma during the period 1994-1995, but in 1999-2000 it was pedestrian injury and motorcycle accidents. A fall in mortality occurred that was of multifactorial cause, involving better prehospital and critical care assistance, more frequent monitoring and control of intracranial pressure, and better tomographic control, and clinical and surgical treatment. We highlighted the importance of traffic safety campaigns.