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LETTERS: Paul Frost and Matt P Wise Time of hospital presentation may be important BMJ 2008; 336: 522 [Full text]

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Skull Trauma

Bárbara A. García Hernández MD, Jesús Vila Díaz MD, Juana Hernández Fernández MSc   (12 March 2008)

Skull Trauma 12 March 2008
Bárbara A. García Hernández MD, Radiolgy Department Paediatric University Hospital. Cienfuegos 55100. Cuba, Jesús Vila Díaz MD, Juana Hernández Fernández MSc Send response to journal: Re: Skull Trauma	In the latest years, there have been great changes in medicine in regards to the diverse therapeutic changes for each disease. Trauma of the encephalon and of the cranium is perhaps, one of the entities in which the cited words are applied because of the greatest possibilities it has had for changes. This entity has great possibilities for a multidisciplinary participation of a specialized staff , being the radiologist a new specialist who has started to have an active participation in both the initial diagnosis of the lesions as well as in the follow up of the patient’s conditions. It is known that skull trauma can occur at any age of life with a higher frequency in males specifically adults aged in the group 20-60 years old. This entity is considered the basis of the most frequent and severely ill neurological disorders. Trauma in children is considered the commonest cause of hospital admission in developed countries , 75 % of these traumas are due to skull-encephalon trauma (new epidemics of the millennium).It is more frequent in boys than in girls with a higher morbidity between 5-14 years of age. This reality contrasts with the results of the Cienfuegos Paediatric Hospital in Cuba due to the fact that the entity under study (cephalic trauma) did not classify amongst the first nine causes of hospital admission in the year 2007, year in which only 37 children were admitted because of moderate or severe conditions. The remaining cases (163) were not considered under the category for admission, aspect this which coincides with the medical literature consulted up to the present. Our results represented the 40,4% of all the neurological pathologies assisted in our hospital. 12 out of the 37 admitted patients suffered from a lineal fracture, 3 of them with brain commotion and 1 of the patients presented a depressed fracture that required neurosurgical assistance and therefore surgical treatment. The remaining 21 patients were admitted for close observation. The system of organization for the surveillance of the traumatized patients’ (Skull trauma) in our Cuban Hospital follows the indications of a CT-Scan when we have a Glasgow scale less than 12 or when there is progressive neurological impairment with focal signs, depressed fracture ample skull fractures with possibilities to perform Neuroimage studies in the first 24 hours, if the condition of the patient allows it. Apart from the severity of the trauma, physicians should develop a thoughtful assessment of the patient taking into account the dangerous consequences of an inadequate management can cause in a developing brain. References: 1. Frost P, Wise MO. Time of hospital presentation may be important. BMJ 2008; 336: 522. 2. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008; 336:425-9. 3. Mosquera Soto TA. Trauma Encéfalocraneano [monografía en Internet] Competing interests: None declared