الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
Head injuries are one of the most common forms of emergency admissions from accidents as well as from assaults. All degrees and types of injuries to the head may occur either to the scalp, skull, brain or to any other structures of the head.
Head injury cane be considered as a major cause of morbidity and mortality. All age groups are exposed to head injuries. Currently, there is no effective treatment to reverse the effects of the primary brain injury sustained, and treatment is aimed at minimizing the secondary brain injury that can occur due to the effects of ischaemia, hypoxia and raised intracranial pressure.(1)
prospective study that was carried out on 100 consecutive patient admitted in Alexandria university Emergency& Neurosurgery Departments.
A standard sheet was constructed to record the data for each patient to achieve the purpose of the study[appendix (1)] .
A formal consent was obtained from every case involved in the current study or from one of his legal guardian.
The aim of the work was to study the management of head injury according to the international guidelines and to study the laws related to the legal rights of the patients and their relatives in order to protect medical staff from any legal responsibilities which may arise during their dealing with the patients and relatives.
from the present study, it was noticed that:
• Male were affected more than female;
• Manual workers accounted for the majority of head injured patients 57% with the median age of 22 years old
• Smoking was the most common habit among patients 46%.
• Most of head injured patients had mild head injury 62%.
• Alleged assault was the most common cause of head injury.
• Facilities other than ambulance were the main mode of transportation 81% of head injured patients with time lapse till arrival to ER ranging from one to six hours.
• Epilepsy was the most common preexisting medical conditions among patients followed by diabetes mellitus.
• Cervical CT was done for 29 patients most of them had severe head injury and only one patient had cervical MRI because it was paid and most of patients admitted to AMUH can’t pay.
• Most of patients presented with single lesion in the CT 62.5%, Skull fracture was the commonest CT brain finding 76.3% and fissure fracture was the commonest type 65.6% followed by extramural hematoma 25%.
• Headache and drowsiness were the commonest symptoms which necessitate hospital admission with a median duration of 30 minutes.
• from all patients need for hospital admission 96 , It was only 55 patients were admitted among them 4 patients were not in need for admission.
• Most of patients in this study were treated medically 71%.
• As regard ICU admission, there were 21 patients need for ICU admission. Of those patients 17 cases were admitted.
• Most of ICU admitted cases received conservative treatment with median duration of 14 days.
• Infection (chest &wound) and bed sores were the most common complication for ICU admitted cases.
• As regards the out come,13% of head injured patients were died ,7% had moderate disability, 3%had permanent disability and 73% had good recovery.
• Duration of hospital stay ranged from 0.13 to 90days with median duration 12 hours.
• Possible assailant in the present study were determined in 29 cases either by the patient himself, relatives or witnesses.
• As regards the suppliers of informed consent, it was taken most commonly from the relatives of the patients 52%.
• As regards the adequacy of investigations, It was not adequate in three cases where CT brain was not present and one case had first cervical fracture and only plain x ray lateral view was available and misinterpreted.
• As regards the law suite, it was raised in 47 cases included head injury which resulted from alleged assault 25 cases 53.2% and road traffic accidents (pedestrian &motorcyclist) 15 cases 31.9%.
• No significant relation was found between law suites and outcome.
• As regards the organ transplantation and decision making of don’t resuscitate orders neither the relatives of severely head injured patients nor the legal guardians accepted these recommendations.
• As regard the quality of life there were 3 dependant patients and only one of them was able to pear the expenses of rehabilitation programs.
• There were 9 cases which were referred from the surrounding hospitals, All received first aid before transportation, only one case did CT brain before transportation and one case had referral sheet with time lapse till arrival to AMUH ranged from 6to12 hours.