Head injury form motor vehicle accidents is an enormous problem in our community.
In all areas of medicine prevention is the best treatment and the main cause of head injury in our community is still road crashes. The road accident mortality figures have shown a continual decline over the past 10-20 years and the total numbers of injuries from motor vehicle accidents has also been declining recently. We saw a significant reduction in admissions of patients with severe head injury to our neurosurgical unit at the Royal Adelaide Hospital in the early nineties from approximately 120 patients a year down to only 45 in 1992. The numbers have crept back up but still run at about 60 a year, or half the number 10 years ago.
Some of the possible reasons for this reduction include the introduction of legal blood alcohol limits for drivers in all states of Australia between 1964 and 1974: the introduction of compulsory helmets for motorcyclists in 1974, the introduction of seatbelts in1972-1974 and the compulsory wearing of helmets for pedal cyclists in 1990. The more recent introduction of air bags into our vehicles may also be having an effect. The policing methods have also changed recently with the use of random breath testing and red light and speed cameras. In 1984 51% of fatalities were over the legal blood alcohol limit and this fell to 28.9% in 1991.
Many of these changes have been campaigned for by the neurosurgical community and we continue to promote road safety as the best way to reduce the effects of severe head injury.
As far as treatment of head injury is concerned, surgery has improved to the point where new techniques are unlikely to make any significant impact on the outcome from head injury. The trends for research recently have been centring on the cellular response to injury. Contrary to earlier beliefs, it now seems that not all of the damage is done at the time of the impact and by instituting suitable treatment at an early stage it may be possible to reduce the total amount of permanent damage to the brain. This work is still in its infancy but show great promise for the use of protective drugs early after head injury to minimise permanent brain injury.
PO Box 698, North Adelaide SA 5006, Australia
Telephone: +61 8 8371 0771
nrfginta@bigpond.com
