Is early prediction of outcome in severe head injury possible?
K. Waxman, M. J. Sundine and R. F. Young
Department of Surgery, University of California, Irvine, Orange 92668.
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.
