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A young boy falls on the ice while skating, lies still for a few seconds and then stands up with a headache, starts crying, vomits a few minutes later and says he wants to go home. Back home with his mother he becomes unresponsive and dies in a local hospital of an expanding epidural haematoma. If you have heard this story then you are familiar with the risks of head injury. In practice, most patients with head injury do not go to hospital and are managed at home or on the playing field because the risk of severe intracranial complications after minor head injury is so low (0.5%), but these occasionally can be life threatening and lead to long term psychosocial problems. Moderate–severe head injury is less common but more often causes considerable morbidity and mortality; it is the commonest cause of permanent disability and mortality in people under 45 years of age in developed countries and it is an even bigger problem in less developed countries. Also, because head injury is strongly associated with cervical spine injury, this risk should be assessed immediately, especially where facial or jaw injury is involved.
The management of head injury (also called traumatic brain injury) involves many disciplines—paramedics on the street, general practitioners, emergency department doctors, neurosurgeons, neurologists, intensivists and specialists in rehabilitation. Most countries now have evidence based guidelines for the acute management in the emergency department and also for intensive care unit (ICU) management of severely injured patients. And later, rehabilitation may be necessary to reduce the effects of the injury on daily life.
▶ The incidence of head injury is high: 1 million emergency department attendees for the UK in a year at the end of the last century.
▶ The highest incidence is in men aged 15–24 years.
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