Journal of Neurology, Neurosurgery, and Psychiatry 2006;77:1054-1059
PAPER
Severe head injury and the risk of early death
1 Department of Neurosurgery, Hospital 12 de Octubre, Madrid, Spain
2 Unit of Epidemiology, Hospital 12 de Octubre
Correspondence to:
G R Boto
Avda Doctor García Tapia, 159 Portal D Ático B, 28030 Madrid, Spain; grboto{at}yahoo.es
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.
Abbreviations: GCS, Glasgow Coma Scale; ROC, receiver–operator characteristic; SHI, severe head injury
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