Early prediction of outcome in head-injured patients

Abstract

The relationship between Glasgow Coma Scale (GSC) scores obtained during the 1st week after head injury and outcome at 1 year was analyzed in 170 patients. Seventy-two of 76 patients with initial GCS scores of 3 or 4 lived, and only one had a favorable outcome. Favorable and unfavorable outcomes were almost equally divided when the initial GCS scores were in the intermediate range of 5, 6, or 7. No patients with an initial GCS score in this intermediate range that subsequently worsened had a favorable outcome, while over 80% of those improving to a score higher than 7 had a favorable outcome. Only 12% of those persisting with a score of 5, 6, or 7 for 1 week had favorable outcome. Outcome predictions using the multiple logistic model were made for this intermediate group of patients based on GCS scores and data on midline shift derived from computerized tomography (CT). The patients with initial scores of 5, 6, or 7 with midline shifts of less than 4.1 mm on initial CT scanning had a significantly higher favorable outcome rate compared with patients with a larger shift. However, outcome prediction made by combining shift data and initial GCS scores are not significantly more accurate than predictions based solely on initial GCS scores. Combining 48-hour GCS scores and shift data significantly improves predictive accuracy based only on coma scores. The data obtained by combining GCS scores at 72 hours and 1 week and shift data is marginally significant for improving accuracy of outcome predictions. It is concluded that GCS scores and shift data are highly accurate indicators of outcome in head-injured patients.

Wechsler Memory Scale-Revised in closed head injury

“…Severity of injury, as assessed by the Glasgow Coma Scale, was not correlated with performance on any WMS-R index. Although the Glasgow Coma Scale is correlated highly with early outcome, e.g., mortality (Jennett et al, 1979), it is less consistently correlated with long-term outcome (Young et al, 1981). While generally a reliable measure of injury severity, it can be influenced by non-head-injury variables such as facial swelling, intoxication, and systemic injuries (Levin et al, 1982), which may result in inaccurate initial assessment.…”

Recuperação das vítimas de traumatismo cranio-encefálico no período de 1 ano após o trauma

“…O de BRICOLO et al 4 incluíram vítimas "especialmente graves" à medida que se restringiu a indivíduos que permaneceram em estado de coma por pelo menos 2 semanas e o de YOUNG et al 49 que, embora tenham avaliado vítimas graves, acrescenta em sua população elementos com lesões anatômicas específicas as quais recebem diferentes categorizações de gravidade no Manual da AIS-90 1 : ferimento penetrante por míssil -AIS = 5, hematoma intracraniano sem outras especificações -AIS = 4 e afundamento de crânio -AIS = 3. Embora, conforme referência dos próprios autores, a gravidade do dano cerebral fosse variada, tinham sido operados ou tratados em unidade de terapia intensiva.…”

“…No presente estudo, que foram incluídos indivíduos hospitalizados que apresentavam diferente gravidade de trauma craniano e que somente 8,4% das vítimas apresentaram TCE grave ou ECG1 < 8, o padrão de recuperação das vítimas foi muito semelhante a de YOUNG et al 49 , conforme pode-se observar nos resultados da ERG (vide Quadro 1). A similaridade de resultados é bastante grande principalmente quando comparado com os demais.…”

Avaliação da gravidade do traumatismo crânio-encefálico por índices anatômicos e fisiológicos

“…Esta correlação é também constatada em muitos estudos 19,22,47 . No entanto, constatou-se também elevados percentuais de pacientes com TCE grave que receberam alta.…”