Immediate management of severe head injuries still poses a serious challenge. 50 patients with severe head injuries (Glasgow Coma Scale, 8 or less) were treated from February 1, 1989 to April 30, 1990. The effects of age, Glasgow Coma Score at admission, CT findings, pupillary reactivity to light and intracranial pressure on outcome, were evaluated. The results of the present series match those of other studies and in some aspects the results are even superior. We attribute the high incidence of good outcome to the direct referral of the severe head injury patients, thus excluding delays at peripheral hospitals. In addition, aggressive management in the intensive care units and a broader range of indications for operation were also correlated with favorable outcome.