Background: Number of neurosurgery patients is increasingly high. With respect to controversies about morbidity and mortality in these patients and lack of any information about these cases in our university this study was carried out in Kashan Naghavi hospital during 1999-2001.

Materials and Methods: This�descriptive study was performed on medical files of all neurosurgery ICU cases during the study period. Demographic information, morbidity & mortality rates and their causes were assessed. Descriptive statistics was used for analysis.

Results: Of 280 cases, 267 cases were enrolled the study. Rate of mortality in 1990 was 43. 1% that reduced during the years of study (P<0.02). With increase of duration of hospitalization, urinary tract infection rate increased.

Conclusion: Low GCS and high mortality are matter of concerns. We suggest further studies on the causes. Preventive interventions are also recommended.

Background: Head injury is a major cause of traumatic death and disability. However, there is no definite and unified strategy in the management of mild head injury victims.

Materials and Methods: All cases of head injury in a 24-month interval between April 2003 and March 2005 were included to the study, and those with Glasgow Coma Scale Score (GCSS) of 14 or 15, without associated trauma were analyzed.

Results: Of 4290�victims�3894 (90.8%) had mild head injury with GCSS of 14 or 15. The incidence of head injury in our region is 429 for each 100,000 people. Of 1629 (48%) of the patients with skull X-ray 200 (12.2%) had a fracture. From 400 (10.3%) head CT scans, 118 were abnormal. Of all the patients, 2676 had only head injury. The cost for only one night of hospitalization on the base of the expenses in 2003 was 326,654 Rls for each patient, while at the same time the charge for a brain CT scan was 150,000 Rls.

Conclusion: It is recommended that, at least in neurosurgical centers, all patients with head injury screened and candidate for admission, undergo a head CT scan study after their early evaluations and only those with abnormal findings on CT scan be admitted for further observation. With this strategy, we predict an at least 50% decrease in the costs compared with hospital admission and observation of all patients.

Background: Injury is one of the most important non-contagious epidemiological phenomena dominant in this century contributing to a high rate of mortality in the world. The present study converses the epidemiologic aspect of trauma in Kashan during a 30 months period.

Materials and Methods :�In a cross sectional study from March 2004 to September 2006 all victims of injuries admitted to hospitals of Kashan were classified in four groups consisting of domestic, traffic, occupational, and sport ones. External causes of the injuries were also recorded under the code of ICD 10. The data collected was then computerized by means of SPSS software and analyzed afterwards.

Results: A total of 18166 patients were studied during 30 months. The female to male ratio stood at 1:3.25. The average age of patients was 29.23±19.5 years, with 27.54±17.74 for men and 34.81±25.04 for women. The most common age range of the patients was 20-29 and 10-19 years with 26.5% and 23.6% respectively. Traffic injuries were the predominant type (50.5%), and in terms of external causes, the majority was involved in driving injuries and falls. Motor-cycle crashes (58.3%) were the main causes of accidents. A group of 231(1.3%) injured patients died in the hospital.

Discussion: Traffic accidents were the predominant cause of injuries followed by domestic causes along with occupational ones in the second stand. The injuries happened at a lower age range than those abroad which may lead to a loss of more fruitful length of life and imposition of expenses on the society. 

Background : Compound depressed skull fracture (CDF) is a complication of trauma to head. In spite of many decades of studies on the management of CDF there is yet disagreements regarding primary repair or discarding the bone fragments and late repair. This study has conducted to evaluate infection rate in primary repair of CDF.

Materials and Methods : This study included 60 patients with blunt trauma to head and CDF admitted to Naghavi hospital of Kashan University of Medical Sciences (KAUMS), from 1997 to 2005. Age, sex, the interval between admission and operation, severity of trauma, duration of hospital stay, and infections were recorded and analyzed with descriptive statistics.

Results : Male to female ratio was 7.6:1, and mean age 19±12.4 years. It was most common in the age range of 11-20 (19 patients, 31.7%). Motorcycle was the most common cause of the problem (45 patients, 75%). Tirty nine patients (65%) had dural laceration. The most common site of fracture was frontal bone (37 and 61.7%). Twenty eight cases (46.6%) had mild, 13 (21.7%) moderate, and 19 (31.7%) severe head injury. Fifty four patients (90%) underwent operation in less than 24 hours of their arrival to hospital and had primary bone replacement. In 6 months follow up there was no infection in either the wound or bone.

Conclusion : In the absence of heavy contamination, and by carrying debridment as soon as possible there will be excellent outcome with primary replacement of bone fragments in CDF patients, excluding the need for another operation and the apprehension about infection.

Background: Bilateral Intracranial hematoma is an uncommon sequela of closed head injury. Approach to this complicated problem is poorly defined. The present study tries to find out the incidence, and possible markers for the earlier detection of the problem.

Materials and Methods: In this descriptive study all head trauma patients undergoing surgical decompression from September 2006 to October 2008 in Kashan Beheshti Hospital, were included. Cases were studied for age, sex, cause of trauma, skull fracture, Glasgow Coma Scale Score, pre-operative CT findings, and the number of surgical procedures. Using SPSS software, the obtained data was analyzed through descriptive statistics, Chi Square and t-test.

Results: During a 24-month period, for 96 admitted patients with traumatic injuries, 121 surgical procedures were performed. Due to the hematomas, 73 (75.3%) and 23 (24.7%) cases had one and more than one surgical operation, respectively. In addition, the age range was between 6 months and 83 years in the former and 17 and 66 years in the latter with a mean of 40.7±24.1 and 33.7±15.9, respectively. Male/female ratio was 13.7/1 in unilateral cases and 22/ 1 in bilateral cases. In 31 (43%) out of 73 unilateral hematomas and 12 (52%) out of 23 bilateral cases various types of skull fractures were seen. While no significant difference was seen between the groups in terms of age, sex, cause of trauma, skull fracture, and GCSS , it was significant for subdural hematoma (P=0.004).

Conclusion: No specific marker could be found for early detection of bilateral intracranial hematoma. The high incidence of hematomas in our centre may be an incidental finding secondary to the high number of intracranial hematomas.

Background: Traumatic brain injury (TBI) is the leading cause of death in traumatic injuries. The aim of this prospective study was to estimate the incidence of hospitally-treated TBI and to describe the severity of brain injuries and related outcome among such patients.

Materials and Methods: Data was collected from all hospitalized cases of head traumas in Kashan hospitals during a 2-year period (2004-2005). The initial severity of TBI was measured by the Glasgow Coma Scale. Age, gender, initial neurological state, lesions on computed tomographic scan mechanisms of injury and the subsequent outcome were recorded.

Results: During a 24-month study, a number of�4290 patients were enrolled in the study. The mean age was 27.8 ±19.14 years and male to female ratio 3:1. The highest incidence of TBI was found in 20-29 years range (27.7%). The annual incidence of TBI was 429/100,000. Vehicle accidents (69.7%), falls (21.3%), and assaults (5%) were among the leading causes of TBI. Motorcycle accidents were the main cause of TBI among vehicle accidents (64.5%). Regarding the severity, 3962 cases (92.7%) were considered mild, 108 (2.5%) moderate, and 205 (4.8%) severe. Death occurred in only 148 (3.4%) cases.

Conclusion: Our data suggest that the incidence of TBI in Kashan was higher and the age range of casualties was lower than other studies. In this study vehicle accidents were responsible for the majority of TBI. These findings can be used to develop prevention-directed programs in Kashan.