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The Westmead Head Injury Project outcome in severe head injury. A comparative analysis of pre-hospital, clinical and CT variables.
- Source :
-
British journal of neurosurgery [Br J Neurosurg] 1993; Vol. 7 (3), pp. 267-79. - Publication Year :
- 1993
-
Abstract
- A prospective study of 315 consecutive patients with a severe head injury was undertaken to study factors contributing to mortality and morbidity, both in the pre-hospital and hospital phases. Entry criteria were a Glasgow Coma Scale (GCS) score of 8 or less after non-surgical resuscitation within 6 h of the injury, or a deterioration to that level within 48 h. Patients with gunshot wounds or who were dead on arrival were excluded. End points of the study were either death or at 6 months after the injury. Predictors of mortality were increasing age, the presence of hypotension, a low GCS, abnormal motor responses and pupillary non-reactivity. In the 167 patients in whom intracranial pressure (ICP) was measured, raised ICP and failure to respond to treatment for raised ICP also predicted mortality. Three CT predictors of mortality were the presence of cerebral oedema, intraventricular blood and the degree of midline shift. When analysed using logistic regression, the most accurate model (accuracy 84.4%) included increasing age, abnormal motor responses and the three CT indicators. Analysis of the data for 'good' (Glasgow Outcome Score (GOS) 1 and 2) vs 'poor' (GOS 3 and 4) survival at 6 months was also performed using logistic regression. The model which provided the most accurate prediction of poor outcome included age, hypotension and three different CT characteristics, subarachnoid blood, intracerebral haematoma or intracerebral contusion (accuracy 72.5%).
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Australia epidemiology
Brain Damage, Chronic diagnosis
Brain Damage, Chronic surgery
Brain Injuries diagnosis
Brain Injuries surgery
Cerebral Hemorrhage diagnosis
Cerebral Hemorrhage mortality
Cerebral Hemorrhage surgery
Child
Child, Preschool
Critical Care methods
Female
Glasgow Coma Scale
Hematoma, Epidural, Cranial diagnosis
Hematoma, Epidural, Cranial mortality
Hematoma, Epidural, Cranial surgery
Hematoma, Subdural diagnosis
Hematoma, Subdural mortality
Hematoma, Subdural surgery
Humans
Infant
Intracranial Pressure physiology
Logistic Models
Male
Middle Aged
Neurologic Examination
Prognosis
Prospective Studies
Regression Analysis
Treatment Outcome
Brain Damage, Chronic mortality
Brain Injuries mortality
First Aid
Resuscitation
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 0268-8697
- Volume :
- 7
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- British journal of neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 8338647
- Full Text :
- https://doi.org/10.3109/02688699309023809