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Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department

¹ Dipartimento dell’Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda Unitè Sanitaria Locale di Forlì, Forlì, Italy
² Divisione di Neurochirurgia per la Traumatologia, Ospedale M. Bufalini, Azienda Unitè Sanitaria Locale di Cesena, Cesena, Italy
³ Alma Mater Studiorum, Universitè di Bologna, Bologna, Italy
⁴ Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Correspondence to:
Andrea Fabbri, MD, Dipartimento dell’Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda USL Forlì, Via Forlanini 34, I - 47100 Forlì, Italy; andrea.fabbri{at}formulatre.it

Patients and methods: We reviewed, prospectively, 12 675 subjects attending the ED of a General Hospital between 1999 and 2005 for head injury. A total of 309 cases (2.4%) with an admission Glasgow Coma Scale (GCS) 9–13 were identified as having moderate head injury. The main outcome measure was an unfavourable outcome at 6 months after injury. The predictive value of a model based on main entry variables was evaluated by logistic regression analysis.

Findings: 64.7% of subjects had a computed tomographic scan that was positive for intracranial injury, 16.5% needed a neurosurgical intervention, 14.6% had an unfavourable outcome at 6 months (death, permanent vegetative state, permanent severe disability). Six variables (basal skull fracture, subarachnoid haemorrhage, coagulopathy, subdural haematoma, modified Marshall category and GCS) predicted an unfavourable outcome at 6 months. This combination of variables predicts the 6-month outcome with high sensitivity (95.6%) and specificity (86.0%).

Interpretation: A group of selected variables proves highly accurate in the prediction of unfavourable outcome at 6 months, when applied to subjects admitted to an ED of a General Hospital with moderate head injury.