Severity and outcome of intracranial lesions in pedestrians injured by motor vehicles.

To evaluate the type and severity of intracranial lesions and the prognosis after closed head trauma in pedestrians injured by motor vehicles, we reviewed the cases of 225 consecutive patients who suffered major head injuries in collisions with motor vehicles. Patients in this series were comatose, had intracranial hematomas requiring surgical removal, or both. The initial Glasgow Coma Scale (GCS) score was 9-15 in 24% of patients, 6-8 in 32%, and 3-5 in 43%. Intracranial hypertension occurred in 40%. Diagnostic studies showed subdural hematomas in 45% of patients, epidural hematomas in 8%, intracerebral hematomas in 10%, and cerebral contusions in 9%. Clinically significant mass lesions were evacuated, and intracranial pressure was monitored and treated aggressively if elevated. After 6 months, 51% of the patients had died, 13% were vegetative or severely disabled, and 35% had a good outcome or moderate disability. These major head injuries in pedestrians struck by motor vehicles were usually severe, included a high incidence of intracranial hematomas and increased intracranial pressure, and frequently had poor outcomes.