Whats New in Emergencies Trauma and Shock? Autopsy in Fatal Head Injuries.

Autopsy is considered as a gold standard to understand the pathological changes responsible for fatal outcome in head injury;[12] however, no one will wish to have increase in the numbers. In the present study, the authors describe the autopsy findings in fatal head injury victims and correlate with the clinical picture and imaging report.[2] The study[2] supports the existing evidence that the most of victims were young males in their productive age group and sustained a fatal head injury in road traffic accidents and only few of them reached the hospital in golden hour (in the present study, only 8% met the same).[34567] It is interesting to note that all these patients were alive at the time of presentation to the hospital but sustained fatal injuries in varying severity and combinations.[2]

It is also worrisome to note that almost 50% of the victims sustained head injury alone (most of them sustained severe head injury, 77.2%), which suggested a diffuse injury to the brain (i.e., Subarachnoid hemorrhage (SAH) and acute subdural hematoma (SDH), etc.,) and almost 50% succumbed to the injuries within 24 h of the admission to the hospital.[2] Another concern is that 50% of the victims had injuries to the chest, abdomen, and long bones[2] which are known to worsen the outcome in these patients.[3568]

The central nervous system injuries were responsible for up to 40%–50% fatalities in one series,[1] and in another series, 31.51% victims sustained isolated which resulted in fatal outcome.[8] The authors highlight very well that the best strategy will be reducing the number of injuries by implementing preventive strategies or providing better prehospital care and early definitive management to improve the outcome on injured victims. The limitation of this study is that we do not know that how patients were dead at the time they reached the hospital and how many were died at scene or before reaching the hospital.