Early prediction of outcome in head-injured patients

Publisher Website
Google Scholar
Abstract
The relationship between Glasgow Coma Scale (GCS) scores obtained during the 1st wk after head injury and outcome at 1 yr was analyzed in 170 patients. Of 76 patients, 72 with initial GCS scores of higher than 7 had favorable outcomes. Only 2 of the 21 patients with initial GCS scores of 3 or 4 lived, and only 1 had a favorable outcome. Favorable and unfavorable outcomes were almost equally divided when the initial GCS scores were in the intermediate range of 5, 6 or 7. No patients with an initial GCS score in this intermediate range that subsequently worsened had a favorable outcome, while over 80% of those improving to a score higher than 7 had a favorable outcome. Only 12% of those persisting with a score of 5, 6 or 7 for 1 wk had a favorable outcome. Outcome predictions using the multiple logistic model were made for this intermediate group of patients based on GCS scores and data on midline shift derived from computerized tomography (CT). The patients with initial scores of 5, 6 or 7 with midline shifts of less than 4.1 mm on initial CT scanning had a significantly higher favorable outcome rate compared with patients with a larger shift. Outcome predictions made by combining shift data and initial GCS scores are not significantly more accurate than predictions based solely on initial GCS scores. Combining 48 h GCS scores and shift data significantly improves predictive accuracy based only on coma scores. The data obtained by combining GCS scores at 72 h and 1 wk, and shift data is marginally significant for improving accuracy of outcome predictions. GCS scores and shift data are highly accurate indicators of outcome in head-injured patients.