Severe head injury and the risk of early death

Abstract

Background: Severe head injury (SHI) is one of the most important health, social and economic problems in industrialised countries. Unfortunately, none of the neuroprotection trials for traumatic brain injury have shown efficacy. One of the reasons for this failure could be the inclusion of patients with high probability of early death. A population-based, retrospective study was conducted to develop a prognostic model for identification of these patients. Methods: Between January 1987 and August 1999, a total of 895 patients (>15 years of age) with nonmissile SHI were studied, in whom a computed tomography scan was carried out within the first 6 h of injury. The association between early death (first 48 h after injury) and independent prognostic factors was determined by logistic regression analysis. A scoring system was also constructed. Results: The early-death rate was 20%. Independent predictors of early mortality after SHI were nonevacuated mass (odds ratio (OR) 65, 95% confidence interval (CI) 11 to 379), diffuse injury IV (OR 25, 95% CI 5 to 112), diffuse injury III (OR 8, 95% CI 3 to 22), flaccidity (OR 7, 95% CI 3 to 15), non-reactive bilaterally mydriasis (OR 6, 95% CI 3 to 12), evacuated mass (OR 4, 95% CI 1 to 11), age >65 years (OR 4, 95% CI 1 to 9), decerebration (OR 3, 95% CI 2 to 7) and shock (OR 3, 95% CI 2 to 6). The prognostic model correctly identified 93% of the patients.Conclusions: This prognostic model is based on simple clinical and radiological data readily available during the first 6 h after injury and is useful for identification of early death after SHI.

Validation of a prognostic score for early mortality in severe head injury cases

“…In a previous study, 2 we calculated a prediction score for early death using split-sample validation. In this publication, we constructed a prognostic model according to the most recent recommendations 33 by deriving a large sample of patients with severe TBI, which reflected the inherent heterogeneity in current practice.…”

“…40 The systematic reviews of prognostic models for TBIs that have been published in the past 20 years have generated criticism regarding their clinical or methodological validities; 15,33 only a few studies have been subjected to extensive internal and external validations. 2,10,16,36,37,39,42 Few studies have analyzed the characteristics of patients who succumbed to early death after a TBI. 2,[6][7][8] The first aim of this study was to derive a prognostic model for early death (within 48 hours) to be used within the first 6 hours after a severe TBI and to externally validate this model.…”

“…2,10,16,36,37,39,42 Few studies have analyzed the characteristics of patients who succumbed to early death after a TBI. 2,[6][7][8] The first aim of this study was to derive a prognostic model for early death (within 48 hours) to be used within the first 6 hours after a severe TBI and to externally validate this model. The second aim was to develop a clinical prediction rule based on the previous model to identify those patients who would be most likely to die early.…”

Endogenous plasminogen activators mediate progressive intracerebral hemorrhage after traumatic brain injury in mice

“…1,2 Delayed intracerebral hemorrhage (ICH) is a strong predictor of morbidity and mortality. [3][4][5] Serial computed tomography scans reveal expansion of ICH in ;50% of patients post-TBI, [6][7][8] but intervention based on the current presumptive pathophysiology is often futile.…”

Plasma Interleukin-8 as a Potential Predictor of Mortality in Adult Patients with Severe Traumatic Brain Injury

“…Therefore, we determined IL-8 levels in central venous blood plasma and cerebrospinal fluid (CSF) of patients with isolated TBI at admittance to Intensive Care Unit and analyzed their potential relevance as prognostic indicators of mortality. The age of patients as well as clinical scoring systems Acute Physiologic and Chronic Health Evaluation (APACHE II) and Glasgow Coma Scale (GCS) known to be reliable predictive parameters in TBI patients (Ghajar 2000;Boto et al 2006) were also analyzed in respect to the mortality.…”