Relative incidence of intracranial mass lesions and severe torso injury after accidental injury: implications for triage and management.

In a previous study of head injury patients we found that old age, low Glasgow Coma Scale (GCS) score, pupillary inequality, and falls were significant predictors of intracranial mass lesions (IMLs). Injury to motor vehicle occupants was less likely to result in IML. The present study defines predictors of severe torso injury (STI) in 646 patients admitted to a trauma unit and compares these with predictors of IML obtained in the previous study. Tachycardia and low blood pressure were associated with an increased incidence of STI (p = 0.003, p = 0.0000). The incidence of STI in falls differed from that of IML (13.2% vs. 47.7%, p less than 0.001). There was a greater incidence of STI than IML in MVAs (33.6% vs. 14.8%, p less than 0.001). Patients 70 years of age or older had a higher incidence of IMLs than STIs (p less than 0.001). Patients less than 30 years old had a significantly greater incidence of STIs than IMLs (p less than 0.001). These data suggest that in MVA victims who are less than 30 years old, are hypotensive, and tachycardic, the diagnosis and emergent treatment of severe torso injury should take precedence over measures designed to detect and treat intracranial mass lesions. The converse is true for older patients injured in falls.