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Patients with a Head Injury Who “Talk and Die” in the 1990s

Dunn, Laurence T. PhD, FRCS(NS); Fitzpatrick, Michael O. MD, FRCS(NS); Beard, Diana RGN, MBA; Henry, Jennifer M. BSc

The Journal of Trauma: Injury, Infection, and Critical Care: March 2003 - Volume 54 - Issue 3 - p 497-502
doi: 10.1097/01.TA.0000030627.71453.CD

Background  Patients who “talk and die” after head injury may represent a group who suffer delayed and therefore potentially preventable complications after injury. We have compared the clinical and pathologic features of patients who talk and die with those who “talk and live” after head injury.

Methods  Data collected prospectively by the Scottish Trauma Audit Group were used to identify patients with a head injury and classify them according to verbal response at admission to hospital. All “talking” patients in the catchment area of a regional neurosurgical center were selected and those who died were compared with those who survived.

Results  Seven hundred eighty-nine talking patients were identified. Seven hundred twenty-seven patients survived and 62 died. Patients who talked and died were older, had more severe extracranial injuries, had lower consciousness levels, and reached theater more quickly than those who talked and lived. Thirty-one of the patients that died had extra-axial hematomas.

Conclusion  Even with increased availability of computed tomographic scanning, some patients still talk and die after head injury.

From the Department of Neurosurgery, University of Glasgow, Institute of Neurological Sciences, Southern General Hospital (L.T.D., M.O.F.), Glasgow, and the Scottish Trauma Audit Group, Royal Infirmary of Edinburgh (D.B., J.M.H.), Edinburgh, United Kingdom.

Submitted for publication January 30, 2002.

Accepted for publication May 28, 2002.

Presented, in part, at the 134th Annual Meeting of the Society of British Neurological Surgeons, April 21–23, 2000, Leeds, United Kingdom, and published in abstract format: Fitzpatrick MO, Beard D, Henry JM, Dunn LT. Head injured patients who talk and die in the 1990’s. Br J Neurosurg. 2000;14:508.

Address for reprints: Laurence T. Dunn, PhD, FRCS(NS), Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, United Kingdom; email:

© 2003 Lippincott Williams & Wilkins, Inc.