Can general surgery improve the outcome of the head-injury victim in rural America? A review of the experience in American Samoa.

We analyzed the records of 50 head-injury patients managed by general surgeons from 1974 to 1981 in American Samoa. Patients were divided into three groups. Group 1 was awake and alert (n = 24). Group 2 was obtunded by talking (n = 7). Group 3 was comatose (n = 20). All patients were managed with diagnostic burr-hole procedures. Eighteen of the 20 unconscious patients had an intracranial hematoma. Five of the seven obtunded patients had an intracranial hematoma. Three of the nine deaths were directly attributable to a delay in diagnosis of an intracranial hematoma. We conclude that a burr-hole procedure in unconscious head-injury patients in rural hospitals is a safe and effective method of diagnosing and treating extradural and subdural hematomas. General surgery residents should receive training in operative head-injury management, to improve the care of the head-injury victim in rural America.