Risk factors predicting surgically significant intracranial hematomas in patients with head injuries.

This population-based study was designed to determine the risk of patients with head injuries to develop surgically significant intracranial hematomas (SSIHs). A total of 28,500 cases of head injury were reviewed in Taipei City and Hualien County from 1988 to 1992. The Glasgow Coma Scale (GCS) was used to determine the severity of head injury. The presence of skull fracture and intracranial hematoma was determined by x-ray and computed tomographic (CT) scan, respectively. Those patients suffering from both loss of consciousness and skull fracture had a significantly greater risk of developing SSIHs than those having none or only one of these conditions. The relationship between skull fracture and severity of head injury revealed that the presence of a skull fracture in mildly head-injured patients could be used as an indicator to investigate the development of SSIHs before the occurrence of irreversible damage. The distribution of hematomas by location showed that a higher rate of SSIH resulting in parenchymal damage occurred when consciousness was lost. It also showed that epidural hematomas occurred more frequently with skull fractures. Skull fracture and impaired consciousness are important indices in determining the risk of developing SSIH.