Influence of the type of intracranial lesion on outcome from severe head injury

Abstract

✓ Recent studies attempting to define the outcome from severe head injury have implied, directly or indirectly, that the severity of injury (as determined by the Glasgow Coma Scale (GSC)) is the sole determinant of outcome. Little attention has been focused on the type of lesion that causes the low GCS score, and there exists an unstated hypothesis that the lesion type is not an important determinant of outcome. No attempt has been made to determine whether patients who have the same GCS score caused by different lesions have the same or different outcomes. Since this is impossible to test without a large number of cases, data were obtained from seven head-injury centers on patients who fulfilled the Glasgow criteria for severe head injury (GCS ≤ 8 for at least 6 hours). Patients were categorized according to a simple classification system comprising seven lesion types, each of which was further subdivided into two GCS score ranges (3 to 5 and 6 to 8). Of 1107 patients, the overall mortality was 41%, but ranged from 9% to 74% among the different lesion categories. Conversely, 26% had good recovery (at 3 months), but among the different lesion groups the range was 6% to 68%. Acute subdural hematoma with GCS scores of 3 to 5 was uniformly the worst problem (74% mortality and 8% good recovery), whereas diffuse injury coma of 6 to 24 hours with GCS scores of 6 to 8 had 9% mortality and 68% incidence of good recovery. Results of this study demonstrate marked heterogeneity within this severe head-injury group and point out that patients with the same GCS score have markedly different outcomes, depending on the causative lesion. The type of lesion is thus as important a factor in determining outcome as is the GCS score, and both must be considered when describing severely head-injured patients.

Clinical study of acute subdural haematoma – a level I trauma care centre experience

“…Our study also found these three factors together have significant impact to the extent of 90% mortality. 18 Heissler et al found thickness of hematoma, midline shift are having significant impact on outcome. They found hematoma thickness of >10mm, with midline shift >5mm are having 30% increased mortality than those without.…”

Decompressive craniotomy: prognostic factors and complications in 89 patients

“…Prognostic factors -Age, anisocoria, polytrauma, tomographic findings and ICH have been reported as factors independent from prognosis 12,[25][26][27][28][29][30] . In this study none of these factors was statistically correlated to prognosis (p>0.05).…”

A resposta metabólica ao trauma cranioencefálico é autolimitada? Análise das proteínas de fase aguda e glicemia

“…É importante ressaltar que se tratava de um grupo homogêneo do ponto metabólico, com pacientes apresentando hematomas subdurais, extradurais, assim como lesões focais e inchaço cerebral isolado. O fato de um dos pacientes ter falecido, em razão de falência de múltiplos orgãos, dias após a última análise, em nada altera a assertiva de que todos os pacientes, mesmo aqueles com hematoma subdural, de pior prognóstico 9 , estavam dentro da categoria de boa evolução, no que se refere à lesão causal.…”

“…No que se refere ao metabolismo protéico-energético, Young et al 8 demonstraram que as proteínas de fase aguda tendem à normalização passadas duas semanas após o TCE. A influência do tipo da lesão intracraniana é comumente associada ao prognóstico do TCE , de forma que se estabeleceu para pacientes com escore de Glasgow entre 3 a 5 , uma taxa de mortalidade de 30% a 74% e, dependendo da lesão, boa recuperação entre 6% a 52% 9 .…”