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A prospective clinical and epidemiological study of head injuries in Northern Italy: The Comune of Ravenna

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Abstract

An analysis of all the head injuries occurring during one year within a well-defined geographical area was conducted in the region served by the Ravenna City Hospital in Northern Italy. This hospital does not have a neurosurgical service, so that patients suspected of having neurosurgical problems are transferred to the neurosurgical unit in Bologna, a distance of 65 Km (40 mi.). Of the 1468 head-injured patients seen in the emergency room, 644 (44%) were hospitalized, with an incidence of 372/105 pop/year) and were subjected to X-ray study of the skull (83%), EEG (64%), and CT scan (7,5%).

9 patients were transferred to the neurosurgical unit as emergencies on a clinical basis only, all were found to harbor cerebral lesions, and 7 were operated on. Of the patients hospitalized and subjected to CT scan in Ravenna, only one (0,17%) was found to have a lesion necessitating surgery. Mortality was 7.2% with 83% of these patients dying before admission.

Three-month follow-up examination revealed the persistence of some symptoms in 20% of the 379 patients examined, but 91% had already returned to their previous occupation.

Analysis of the risk factors present in the patients admitted to a non-specialized hospital seems to show that the presence of skull fracture, abnormal EEG, and alteration of the clinical condition constitute the indications for a CT scan, in order to detect the presence of intracranial lesions. In spite of the recommendation to reduce the number of hospital admissions after a minor head injury, no sure elements emerge from our series that can be used for this purpose, other than the already suggested but expensive policy of subjecting all patients seen in the emergency room to plain X-ray examination of the skull.

Sommario

Gli autori hanno studiato per un anno tutti i traumi cranici che sono avvenuti all'interno di un'area geografica ben delimitata afferente all'Ospedale di Ravenna, nel Nord-Italia.

L'Ospedale di Ravenna non possiede una Divisione di Neurochirurga per cui i casi con possibili problemi neurochirurgici vengono trasferiti nel Centro Specialistico regionale a Bologna, ad una distanza di 65 km (40 miglia). Dei 1.468 pazienti visti in Pronto Soccorso per trauma cranico, 644 (44%) sono stati ricoverati, con una incidenza di 172/105/anno, sono stati studiati con una radiografia del cranio (83%) con un E.E.G. (64%) e con una TAC (7,5%). Nove pazienti sono stati trasferiti d'urgenza in Neurochirurgia su sola indicazione clinica. Tutti presentavano lesioni cerebrali e 7 sono stati operati. Fra i pazienti ricoverati e sottoposti a TAC all'Ospedale di Ravenna, solo 1 (0.17%) ha presentato una lesione di pertinenza chirurgica. La mortalità è stata del 7,2% con un 83% di casi deceduti prima dell'ingresso in Ospedale. Un controllo clinico eseguito a tre mesi dal trauma in 379 pazienti ha mostrato la persistenza di qualche sintomo nel 20% ma il 91% dei casi era già tornato alla precedente attività lavorativa. Una analisi dei fattori di rischio presenti fra i pazienti ricoverati in un Ospedale non specializzato pare mostrare che la presenza di una frattura cranica, di un E.E.G. non normale e di condizioni cliniche alterate possa costituire indicazioni alla TAC in modo da poter rilevare la presenza di lesioni intracraniche. Nonostante la raccomandazione di ridurre il numero dei ricoveri dopo trauma cranico minore, nessun elemento sicuro pare emergere dalla nostra raccolta dati che possa essere usato per questo scopo al di là di quanto già suggerito, ma forse impraticabile a causa degli alti costi, cioé l'indicazione alla esecuzione della radiografia del cranio in tutti i pazienti che vengono visti in Pronto Soccorso dopo un trauma cranico minore.

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Authors and Affiliations

  1. Divisione Neurochirurgica, Ospedale Bellaria, Via Altura 3, 40139, Bologna

    Servadei F., Piazza G. & Gaist G.

  2. Divisione Neurologica Ospedale S.M. delle Croci, Ravenna

    Ciucci G., Bianchedi G. & Rebucci G.

  3. Istituto Superiore di Sanità, Roma

    Taggi F.

Authors
  1. Servadei F.
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  2. Ciucci G.
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  3. Piazza G.
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  4. Bianchedi G.
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  5. Rebucci G.
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  6. Gaist G.
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  7. Taggi F.
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Servadei, F., Ciucci, G., Piazza, G. et al. A prospective clinical and epidemiological study of head injuries in Northern Italy: The Comune of Ravenna. Ital J Neuro Sci 9, 449–457 (1988). https://doi.org/10.1007/BF02337162

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