**2. Classification of head injury**

 Hearing loss is a well known entity following head injury. The degree of hearing loss may vary depending on the severity of the head injury. The severity of Head injury is measured clinically using the Glasgow coma scale scoring system (G.C.S). The Glasgow Coma Scale was first published by Teasdale and Jennett in 1974. Several years later it was modified by Jennett and Teasdale and by Rimel et al (Rimel RW et al 1981, 1982) .This scoring system provides the best measure of severity of head injury. The score is the sum of the scale's three measures of eye opening, best motor and verbal responses. This ranges from a score of 3 for a patient with no motor, verbal response or eye opening to painful stimuli, to 15 for a patient who is oriented, follows commands, and has spontaneous eye opening. Patients, who do not follow commands, speak or open their eyes, with a score of 8 or less, are by definition in coma. Head injury is defined as mild when the GCS score is either 13 or 14–15, moderate by a score of 9–12 or 13, and severe by a score of 3–8. The GCS score on admission, and its prognostic usefulness, are easily confounded by other factors particularly substance misuse, but sequential monitoring after admission plays a crucial role in detecting early deterioration and in its management.

Culotta (Culotta VP et al, 1996) following a retrospective study found that patients with a GCS score of 13–15, represent a heterogeneous group with statistically significant different head tomography abnormalities. On the basis of findings they suggested separating patients with GCS score 13–14 into a different category from patients with a GCS score of 15, thus effectively redefining minor head injury. These findings were confirmed by a similar study by Gomez (Gomez PA,et al1996). Hsiang , on the basis of a cohort study of 1360 patients with GCS score of 13–15 suggested that this group of patients could also be divided into two subgroups, mild head injury and high risk mild head injury(Hsiang JNK et al,1997). Mild head injury is defined as GCS 15 without radiographic abnormalities, high risk mild head injury being defined as GCS 13–14, or a GCS 15 with acute radiographic abnormalities. More recently Swann and Teasdale recognizing the limitation of the GCS with regard to minor head injury have suggested another sub classification. Mild head injury is defined as GCS 13–14. Minor head injury is defined as GCS score of 15. The authors recognized in their monograph that this is a somewhat arbitrary definition. However in Clinical practice GCS is used in evaluation of Head injury (Swan IJ,Teasdale Gm 1999)


Glasgow coma scale and score (Table-1). Glasgow coma score: (E+M+V) = 3–15.

Table 1. Glasgow coma score

In India, in the year 2000, official statistics revealed that 80,118 persons died and 3, 42,200 were injured in road traffic accidents . However this is an underestimate, as not all accidents are reported to the police. A study done in Haryana (India) recorded all traffic-related

 Hearing loss is a well known entity following head injury. The degree of hearing loss may vary depending on the severity of the head injury. The severity of Head injury is measured clinically using the Glasgow coma scale scoring system (G.C.S). The Glasgow Coma Scale was first published by Teasdale and Jennett in 1974. Several years later it was modified by Jennett and Teasdale and by Rimel et al (Rimel RW et al 1981, 1982) .This scoring system provides the best measure of severity of head injury. The score is the sum of the scale's three measures of eye opening, best motor and verbal responses. This ranges from a score of 3 for a patient with no motor, verbal response or eye opening to painful stimuli, to 15 for a patient who is oriented, follows commands, and has spontaneous eye opening. Patients, who do not follow commands, speak or open their eyes, with a score of 8 or less, are by definition in coma. Head injury is defined as mild when the GCS score is either 13 or 14–15, moderate by a score of 9–12 or 13, and severe by a score of 3–8. The GCS score on admission, and its prognostic usefulness, are easily confounded by other factors particularly substance misuse, but sequential monitoring after admission plays a crucial role in detecting early

Culotta (Culotta VP et al, 1996) following a retrospective study found that patients with a GCS score of 13–15, represent a heterogeneous group with statistically significant different head tomography abnormalities. On the basis of findings they suggested separating patients with GCS score 13–14 into a different category from patients with a GCS score of 15, thus effectively redefining minor head injury. These findings were confirmed by a similar study by Gomez (Gomez PA,et al1996). Hsiang , on the basis of a cohort study of 1360 patients with GCS score of 13–15 suggested that this group of patients could also be divided into two subgroups, mild head injury and high risk mild head injury(Hsiang JNK et al,1997). Mild head injury is defined as GCS 15 without radiographic abnormalities, high risk mild head injury being defined as GCS 13–14, or a GCS 15 with acute radiographic abnormalities. More recently Swann and Teasdale recognizing the limitation of the GCS with regard to minor head injury have suggested another sub classification. Mild head injury is defined as GCS 13–14. Minor head injury is defined as GCS score of 15. The authors recognized in their monograph that this is a somewhat arbitrary definition. However in Clinical practice GCS is

**2. Classification of head injury** 

deterioration and in its management.

Table 1. Glasgow coma score

used in evaluation of Head injury (Swan IJ,Teasdale Gm 1999)

Glasgow coma scale and score (Table-1). Glasgow coma score: (E+M+V) = 3–15.

Spontaneous - 4 Obeys commands - 6 Oriented - 5

No motor response - 1

EYE OPENING BEST MOTOR RESPONSE VERBAL RESPONSE

In India, in the year 2000, official statistics revealed that 80,118 persons died and 3, 42,200 were injured in road traffic accidents . However this is an underestimate, as not all accidents are reported to the police. A study done in Haryana (India) recorded all traffic-related

Abnormalextension - 2 No verbal response -1

To speech - 3 Localizes to pain - 5 Confused, Disoriented-4 To pain - 2 Withdraws (Flexion) - 4 Inappropriate words - 3 None - 1 Abnormal flexion -3 Incomprehensible sounds -2 injuries and deaths through bi-weekly home visits to all households in 9 villages for a year. This study showed that the ratio between critical, serious and minor injuries was 1:29:69. (Varghese .M .Mohan.D 2003).
