Severe head injury and the risk of early death

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 77; no. 9; pp. 1054 - 1059
• Main Authors: Boto, G R, Gómez, P A, De La Cruz, J, Lobato, R D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-09-2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Clinical trials; Coma; Confidence intervals; Craniocerebral Trauma - diagnostic imaging; Craniocerebral Trauma - mortality; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Expected values; Female; GCS; Glasgow Coma Scale; Head injuries; Humans; Hypoxia; Injuries of the nervous system and the skull. Diseases due to physical agents; Logistics; Male; Medical sciences; Middle Aged; Models, Theoretical; Mortality; Neurology; Prognosis; receiver–operator characteristic; Regression Analysis; Retrospective Studies; ROC; ROC Curve; severe head injury; Severity of Illness Index; SHI; Tomography; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Variables; Nervous system diseases; Head trauma; Craniocerebral; Risk factor
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2005.087056

Background: Severe head injury (SHI) is one of the most important health, social and economic problems in industrialised countries. Unfortunately, none of the neuroprotection trials for traumatic brain injury have shown efficacy. One of the reasons for this failure could be the inclusion of patients with high probability of early death. A population-based, retrospective study was conducted to develop a prognostic model for identification of these patients. Methods: Between January 1987 and August 1999, a total of 895 patients (⩾15 years of age) with non-missile SHI were studied, in whom a computed tomography scan was carried out within the first 6 h of injury. The association between early death (first 48 h after injury) and independent prognostic factors was determined by logistic regression analysis. A scoring system was also constructed. Results: The early-death rate was 20%. Independent predictors of early mortality after SHI were non-evacuated mass (odds ratio (OR) 65, 95% confidence interval (CI) 11 to 379), diffuse injury IV (OR 25, 95% CI 5 to 112), diffuse injury III (OR 8, 95% CI 3 to 22), flaccidity (OR 7, 95% CI 3 to 15), non-reactive bilaterally mydriasis (OR 6, 95% CI 3 to 12), evacuated mass (OR 4, 95% CI 1 to 11), age ⩾65 years (OR 4, 95% CI 1 to 9), decerebration (OR 3, 95% CI 2 to 7) and shock (OR 3, 95% CI 2 to 6). The prognostic model correctly identified 93% of the patients. Conclusions: This prognostic model is based on simple clinical and radiological data readily available during the first 6 h after injury and is useful for identification of early death after SHI.