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Kenneth Waxman, MD; Michael J. Sundine, MD; Ronald F. Young, MD

Arch Surg. 1991;126(10):1237-1242.

Abstract
• To determine whether the outcome of patients with severe head injury could be predicted early after presentation to the hospital, the records of 306 trauma patients with head injury and Glasgow Coma Scale scores of 10 or less were reviewed. There was poor correlation between initial scores at patient arrival and eventual outcome, while scores 6 hours after presentation correlated better with eventual outcome. Many patients with scores as low as 3 had good neurologic recovery. Patient age, associated injuries, blood pressure, mechanism of injury, presence of spontaneous ventilation, and computed tomographic findings all affected survival. However, considering even these parameters, statistical analysis could not provide sensitive prediction of outcome, which we defined as identifying those patients who eventually had good recovery. We conclude that initial therapy should be aggressive for patients with severe head injury, regardless of initial neurologic status, because accurate prediction of outcome within 6 hours of presentation is impossible.

(Arch Surg. 1991;126:1237-1242)

Author Affiliations
From the Departments of Surgery (Drs Waxman and Sundine) and Neurosurgery (Dr Young), University of California, Irvine, Orange, Calif.

Footnotes
Accepted for publication August 8, 1991.

Presented at the 62nd Annual Scientific Session of the Pacific Coast Surgical Association, Pebble Beach, Calif, February 19, 1991.

Reprint requests to the Department of Surgery, University of California, Irvine, Medical Center, 101 City Dr S, Orange, CA 92668 (Dr Waxman).

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