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 (> or = 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 > or = 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.
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 (> or = 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 > or = 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.
Authors: T Yamaki; N Murakami; Y Iwamoto; Y Nakagawa; S Ueda; Y Irizawa; S Komura; T Matsuura Journal: Acta Neurochir (Wien) Date: 1992 Impact factor: 2.216
Authors: L S Murray; G M Teasdale; G D Murray; B Jennett; J D Miller; J D Pickard; M D Shaw; J Achilles; S Bailey; P Jones Journal: Lancet Date: 1993-06-12 Impact factor: 79.321
Authors: L F Marshall; A I Maas; S B Marshall; A Bricolo; M Fearnside; F Iannotti; M R Klauber; J Lagarrigue; R Lobato; L Persson; J D Pickard; J Piek; F Servadei; G N Wellis; G F Morris; E D Means; B Musch Journal: J Neurosurg Date: 1998-10 Impact factor: 5.115
Authors: Grace Martin; Dhavan Shah; Nora Elson; Ryan Boudreau; Dennis Hanseman; Timothy A Pritts; Amy T Makley; Brandon Foreman; Michael D Goodman Journal: Neurocrit Care Date: 2018-06 Impact factor: 3.210
Authors: Grace E Martin; Amanda M Pugh; Ryan Moran; Rose Veile; Lou Ann Friend; Timothy A Pritts; Amy T Makley; Charles C Caldwell; Michael D Goodman Journal: J Trauma Acute Care Surg Date: 2019-04 Impact factor: 3.313
Authors: Adrian M Svingos; Steven A Robicsek; Ronald L Hayes; Kevin K Wang; Claudia S Robertson; Gretchen M Brophy; Linda Papa; Andrea Gabrielli; H Julia Hannay; Russell M Bauer; Shelley C Heaton Journal: Neurocrit Care Date: 2022-03-01 Impact factor: 3.532
Authors: Sandro B Rizoli; Blessing N R Jaja; Alex P Di Battista; Shawn G Rhind; Antonio Capone Neto; Leodante da Costa; Kenji Inaba; Luis Teodoro da Luz; Bartolomeu Nascimento; Adic Perez; Andrew J Baker; Airton Leonardo de Oliveira Manoel Journal: Crit Care Date: 2017-02-23 Impact factor: 9.097