Abstract
Objective
To identify the predictors determined early after admission and associated with unfavorable outcome or early (within 48 h) death after severe head injury.
Design
Prospective cohort study.
Setting
A neurosurgical intensive care unit in a university hospital.
Patients
198 consecutive comatose patients hospitalized from 1989 to 1992.
Results
Logistic regression showed that a combination of age, best motor response score from the Glasgow Coma Scale, and hypoxia provided a good prediction model of unfavorable outcome (sensitivity=0.93). The length of participation of survivors was 6 to 61 months (median 27.1). The Cox model demonstrated age, motor score less than 3, mydriasis, and hypoxia as poor prognosis factors.
Conclusions
Clinicians can determine the odds of a good outcome from the combination of three easily measurable factors using a simple diagram constructed from logistic regression. Survival analysis showed that motor score adjusted values greater than 3 had the same prognosis.
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Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF (1987) Outcome after severe head injury. J Neurosurg 67:648–656
Dikmen S, Temkin N, McLean A, Wyler A, Machamer J (1987) Memory and head injury. J Neurosurg Psychiatry 50:1613–1618
Greenberg RP, Newlon PG, Hyatt MS, Narayan RK, Becker DP (1981) Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study. J Neurosurg 55:227–236
Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R (1976) Predicting outcome in individual patients after severe head injury. Lancet I:1031–1034
Jennett B, Teasdale G, Braakman R, Minderkhoud J, Heiden J, Kurze T (1979) Prognosis of patients with severe head injury. Neurosurgery 4:283–289
Levin HS, Gary HE, Eisenberg HM, Ruff RM, Barth JT, Kreutzer J, High WM, Portman S, Foulkes MA, Jane JA, Marmarou A, Marshall LF (1990) Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank. J Neurosurg 73:699–709
Levin HS, Grafman J (1987) Neurobehavioral recovery from head injury. In: Eisenberg HM (ed.) Oxford University Press, New York
Levin HS, Williams D, Crofford MJ, High WM Jr, Eisenberg HM, Amparo EG, Guinto FC Jr, Kalisky Z, Handel SF, Godman AM (1988) Relationship of depth of brain lesions to consciousness and outcome after closed head injury. J Neurosurg 69:861–866
Luerssen TG, Klauber MR, Marshall LF (1988) Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg 68:409–416
McLean A Jr, Dirkmen SS, Temkin NR (1993) Psychosocial recovery after head injury. Arch Phys Med Rehabil 74:1041–1046
Oddy M, Humphrey M, Uttley D (1978) Subjective impairment and social recovery after closed head injury. J Neurol Neurosurg Psychiatry 41:611–616
Van Zomeren AH, Van Den Burg W (1985) Residual complaints of patients two years after severe head injury. J Neurol Neurosurg Psychiatry 48:21–28
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet I:480–484
Braakman R, Gelpke GJ, Habbema JD, Mass AI, Minderhoud JM (1980) Systematic selection of prognostic features in patients with severe head injury. Neurosurgery 6:362–370
Choi SC, Muizelaar JP, Barnes TY, Marmarou A, Brooks DM, Young HF (1991) Prediction tree for severely head injured patients. J Neurosurg 75:251–255
Choi SC, Ward JD, Becker DP (1983) Chart for outcome prediction in severe head injury. J Neurosurg 59:294–297
Gennarilli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, Marshall LF, Miller JD, Pitts LH (1982) Influence of the type of intracranial lesion on outcome from severe head injury: a multicenter study using a new classification system. J Neurosurg 56:26–32
Marshall LF, Gautille T, Klauber MR, Eisenberg HM, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1991) The outcome of severe closed head injury. J Neurosurg [Suppl] 75:28–36
Narayan RK, Greenberg RP, Miller JD, Enas GG, Choi SC, Kishore PR, Selhorst JB, Lutz HA, Becker DP (1981) Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning and intracranial pressure. J Neurosurg 54:751–762
Volmer DG, Torner JC, Jane JA, Sadovnic B, Charlebois D, Eisenberg H, Foulkes MA, Marmarou A, Marshall LF (1991) Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 75 [Suppl]:37–49
Waxman K, Sundine MJ, Young RF (1991) Is early prediction of outcome in severe head injury possible? Arch Surg 126:1237–1242
Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet II:81–84
Choi SC (ed) (1986) Statistical methods of discrimination and classification. Advances in theory and applications. Pergamon Press, Oxford
Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35
Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240: 1285–1292
Miller JD, Butterworth JF, Gudeman SK, Faulkner JE, Choi SC, Selhorst JB, Harbison JW, Lutz HA, Young HF, Becker DP (1981) Further experience in the management of severe head injury. J Neurosurg 54:289–299
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Combes, P., Fauvage, B., Colonna, M. et al. Severe head injuries: An outcome prediction and survival analysis. Intensive Care Med 22, 1391–1395 (1996). https://doi.org/10.1007/BF01709556
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DOI: https://doi.org/10.1007/BF01709556