Prognosis in head injury.

The prognosis of head injury when viewed from the perspective of the Glasgow Coma Scale confirms the utility of this measure. In particular, decrease in mortality is associated with an increase in GCS. In addition, the motor score portion of the GCS was of predictive value when taken alone. The outcome of patients in coma (GCS less than 8) was closely related to three preventable or treatable factors, namely, hypoxia, shock, and increased intracranial pressure. These three factors, when considered in combination, powerfully predicted mortality. Of considerable interest was the finding that moderate head injury (GCS 9-12) was associated with a small but perhaps preventable mortality. The morbidity was intermediate between that of severe and minor and was surprisingly high. Minor head injury, while not associated with significant mortality, also resulted in considerable morbidity. Neuropsychological evaluation of the patients and an experimental study suggests that an organic component may be involved even in this group. To deal with head injury, distinctions must be made between grades of severity. The Glasgow Coma Scale is suited for this task. Nonetheless, the recognition of this basic continuity should elicit the further recognition that different health providers may be involved in the case of, say, severe, as opposed to mild, injury, and that different outcome measures are suitable for one group but not another.