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Problems for accident and emergency departments.

Two prospective studies carried out in 1976 indicate that more than 6,000 head injured patients were treated in the Accident & Emergency Department of the Glasgow Western Infirmary--ofthese rather more than 1,000 were admitted to wards and the rest were discharged home. The findings of these studies, as well as of previously reported series of head injuries in this hospital (Galbraith et al., 1976, 1977), highlight some of the problems faced by the staff of an Accident Department when treating patients with head injuries. Three-quarters of head injured patients were males under the age of 39 years. More than half arrived at hospital after 6.00 p.m, and at the weekend. Assault and 'fall under the influence' of alcohol were, in this Glasgow hospital, the most common causes of head injuries. This points to misuse of leisure hours especially by young men whose head injuries have often resulted from violence, and who then impose a heavy burden on hospitals at times when staffing is difficult. The difficulties which arise in the reception, diagnosis and subsequent management of these patients are described in this paper.