This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (23)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Martin A. Schreiber, MD; Noriaki Aoki, MD; Bradford G. Scott, MD; J. Robert Beck, MD

Arch Surg. 2002;137:285-290.

Context  Head injury is the leading cause of traumatic death in the United States.

Hypothesis  A set of clinical parameters available soon after injury can be used to accurately predict outcome in patients with severe blunt head trauma.

Design  Validation cohort study.

Setting  Urban level I trauma center.

Patients and Methods  Data from patients with severe blunt head injury, as defined by inability to follow commands, were prospectively entered into a neurosurgical database and analyzed. The impact on survival of 23 potentially predictive parameters was studied using univariate analysis. Logistic regression models were used to control for confounding factors and to assess interactions between variables, whose significance was determined by univariate analysis. Goodness of fit was calculated with the Hosmer-Lemeshow c statistic. The predictability of the logistic model was evaluated by measuring the area under the receiver operating characteristic curve (AUC).

Results  Logistic regression analysis revealed that 5 risk factors were independently associated with death. These variables included systemic hypotension in the emergency department, midline shift on computed tomographic scan, intracranial hypertension, and absence of pupillary light reflex. A low Glasgow Coma Scale score and advanced age were found to be highly correlated risk factors that, when combined, were independently associated with mortality. The model showed acceptable goodness of fit, and the AUC was 80.5%.

Conclusions  Systemic hypotension and intracranial hypertension are the only independent risk factors for mortality that can be readily treated during the initial management of patients with severe head injuries. When used together, Glasgow Coma Scale score and age are significant predictors of mortality.

From the Departments of Surgery (Drs Schreiber and Scott) and Medicine (Drs Aoki and Beck), Baylor College of Medicine, and Ben Taub General Hospital (Drs Schreiber and Scott), Houston, Tex. Dr Schreiber is now with Oregon Health & Science University, Portland.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2002;137(3):365-366.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence
von Elm et al.
Br J Anaesth 2009;103:371-386.
ABSTRACT | FULL TEXT  

Functional and Cognitive Recovery of Patients With Traumatic Brain Injury: Prediction Tree Model Versus General Model
Oh and Seo
Crit Care Nurse 2009;29:12-22.
FULL TEXT  

Identifying traumatic brain injury in patients with isolated head trauma: are arterial lactate and base deficit as helpful as in polytrauma?
Zehtabchi et al.
Emerg. Med. J. 2007;24:333-335.
ABSTRACT | FULL TEXT  

Severe head injury and the risk of early death
Boto et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:1054-1059.
ABSTRACT | FULL TEXT