Early Predictors of Mortality and Morbidity After Severe Closed Head Injury

Abstract

Mortality and morbidity of 158 patients with severe head injury were studied in relation to age, and early (24-h) clinical and computed tomography data. For comparison of outcome data in survivors, a group of 32 patients with traumatic injuries to parts of the body other than the head was used as controls. Within the head-injured group, the mortality rate was 51%. Logistic regression analyses combined 13 out of 16 predictors into a model with an accuracy of 93%, a sensitivity of 90%, and a specificity of 95%. These include age, Glasgow Coma Scale (GCS) score, pupillary reactivity, blood pressure, intracranial pressure, blood glucose, platelet count, body temperature, cerebral lactate, and subdural, intracranial, subarachnoid, and ventricular hemorrhage. At 6 months postinjury, head-injury survivors and trauma controls were evaluated with the Glasgow Outcome Scale (GOS), a neuropsychological test battery and the Sickness Impact Profile (SIP). Head-injury survivors had a higher proportion of disabilities and neuropsychological dysfunctions than trauma controls. They also report more quality of life-related functional limitations on the SIP scales for mobility, intellectual behavior, communication, home management, eating, and work. Linear regression analysis resulted in age being the only important predictor of outcome on the GOS, the GCS score being the best predictor of neuropsychological functioning, and pupillary reactivity being the most predictive for self-reported quality of life as measured by SIP. Those factors important for predicting mortality (clinical variables such as ICP or blood glucose level, and CT observations) failed to show any significant relationship with morbidity.

Prevalence of persistent vegetative state in patients with severe traumatic brain injury and its trend during the past four decades: A meta-analysis

“…After 2324 duplications removed, 1930 additional articles were excluded on the basis of their titles or abstracts, resulting in the full text of 341 articles being examined. Finally, 20 articles reporting 21 cohort studies were included in the present analysis (Andriessen et al, 2011;Fearnside, Cook, McDougall, & McNeil, 1993;Foulkes, Eisenberg, Jane, Marmarou, & Marshall, 1991;Gomez et al, 2000;Heiden, Small, Caton, Weiss, & Kurze, 1983;Jourdan et al, 2013;Judson, Cant, & Shaw, 1990;Lannoo et al, 2000;Mamelak, Pitts, & Damron, 1996;; L. S. Myburgh et al, 2008;Nordstrom, Messeter, Sundbarg, & Wahlander, 1989;Pang et al, 2007;Petroni et al, 2010;Rusnak, Janciak, Majdan, Wilbacher, & Mauritz, 2007;Selladurai, Jayakumar, Tan, & Low, 1992;Stranjalis et al, 2008;Turazzi, Bricolo, & Pasut, 1984;Turazzi, Bricolo, Pasut, & Formenton, 1987). A flow diagram of the selection process is presented in Fig.…”

Early Indicators of Prognosis in Traumatic Brain Injury and their Association with Outcome

“…Presence of traumatic subarachnoid haemorrhage, obliteration of the basal cistern or third ventricle, and non-evacuated haematoma were associated with poorer outcome at 6 months [6,8,21,25,26]. There was strong evidence of no relationship between intraventricular haemorrhage and outcome [7,20,27]. Vital signs.…”

Coagulation disorder in moderate to severe traumatic brain injuries

“…1 Many studies have suggested possible adverse effects of disseminated intravascular coagulation and other coagulopathies on outcome of the patients. [2][3][4][5][6][7] Post-traumatic coagulopathy, in particular, appears to be linked to secondary cerebral injury. 5,8 Although the extent of this process is yet to be elucidated fully, coagulation abnormalities are evident soon after trauma.…”