Measuring the quality of early treatment of head injured patients

Early treatment of head injured patients can affect the prognosis; therefore it is useful to define some parameters related to the quality and time of the first aid. The occurrence of hypoxia, hypotension, seizures and presence of foreign bodies in the airways has been recorded in more than 300 head injured patients admitted to Intensive Care Unit during a 3 years period. Patients are classified using APACHE. Trauma Score, Glasgow Coma Score and other indices of trauma severity. After the first evaluation the patients have undergone an intensive treatment including mechanical ventilation, haemodynamic monitoring and intracranial pressure monitoring. Outcome was assessed six month after the trauma using the Glasgow Outcome Score: relationships between the parameters recorded at the admission and the clinical course were investigated, with particular emphasis on inhalation and the occurrence of pneumonia during the first week of intensive treatment. Factors of secondary brain damage (hypoxia, hypotension, seizures, inhalation and delayed treatment) are detected in a high percentage of trauma patients and the time elapsing between trauma and hospitalization is still too long, sometimes exceeding four hours; they are related to a mortality rate averaging the 40% and a rate of severely disabled patients of 7%.