Three case studies are presented to illustrate the clinical usefulness of serial electrophysiologic and behavioral audiologic assessments in describing CNS function in severe head injury. There was an association among acute auditory brain stem and middle-latency evoked response findings, computed tomography of brain abnormality and neurologic status, and rate of recovery. Auditory evoked response findings 4 days after injury were also correlated with long-term outcome of diagnostic speech audiometry.

A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. Two hundred and ninety patients, who were found to have acute or subacute subdural haematomas, were considered. The mortality rate was 76%, with 19% making a satisfactory recovery. Several factors were found to produce significant improvement in outcome. The availability of neurosurgical facilities at the time of admission made a significant difference. Those patients who had decompressive operations also fared better. No patient survived without operation. Shock, defined as a systolic blood pressure lower than 90 mmHg for more than 60 min was associated with significantly increased mortality. The chance of developing a significant hypotensive episode was greater if two or more other parts of the body were injured. If three other areas were injured, the mortality was 100%. A case control study suggested that some 35 (16%) of all deaths could have resulted from preventable causes, notably delay in instituting definitive treatment and/or inadequate treatment of shock.

A pilot study of the effectiveness fo prehospital triage of trauma patients was carried out in western Sydney between February and July 1988. Triage guidelines were developed to identify seriously injured persons at the incident site who might warrant admission to a Level 3 Trauma Service Hospital (Trauma Centre), as part of the NSW Department of Health trauma services plan.1 The study results were based on 64% of ambulance trauma transports for which a triage decision was provided. Of trauma transports studied, 3.7% had injuried serious enough to warrant admission of Leel 3 Trauma Service Hospital. Ambulance officers correctly triaged 77% of these cases in the field. However, 62% of tauma transports triaged 'severe’or‘critical’did not have injuries serious enough to warrant admission to a Level 3 Trauma Service Hospital. Nevertheless, the triage guidelines compared favourably with similar instruments used elsewhere.2,3 Based on the performance of the triage guidelines it was concluded that the introduction of a regionalized trauma service in metropolitan NSW with local bypass is possible.

This study of 1161 neurotrauma patients in New South Wales hospitals was designed to examine the role of preventable causes of death and disability in cases of spinal injury, extradural, subdural and multiple intracranial haematomas in order to make recommendations for improvements in accident, emergency, ambulance and hospital services. Methods have been developed for standardizing diagnosis in different classes of hospital for the assessment of severity in terms of the patient's age, sex, physical signs, head and spine injuries and other injuries. Estimates have been made of the number of preventable deaths by a case control study of each category of neurotrauma under study.

A retrospective study of 126 patients with extradural haematomas was made to determine whether their outcome could be modified by alteration of their management. Poor outcome occurred in those over 65 years of age, in motor smash victims, in those with fixed pupils, in those with major associated injuries or those comatose on hospital admission. The detection of skull fracture or of a lucid interval was not prognostically useful. A graduation in mortality according to the type of hospital was present but did not reach statistical significance. Failure to correct shock and delay in instituting definitive treatment were the major preventable factors which could be modified to improve outcome.