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

¹ Dipartimento Emergenza, Azienda USL Forlì, Italy
² Divisione di Neurochirurgia per la Traumatologia, Azienda USL Cesena, Italy
³ Alma Mater Studiorum, Università di Bologna, Italy
⁴ Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, United States

^* To whom correspondence should be addressed. E-mail: andrea.fabbri{at}formulatre.it.

Accepted 13 August 2007

	Abstract

Background: Subjects with moderate head injury are a special challenge for the emergency physician. They represent an heterogeneous population of subjects with large variability as to injury severity, clinical course and outcome. We aimed to determine the early predictors of outcome of subjects with moderate head injury admitted to an Emergency Department (ED) of a general hospital linked via telemedicine to the Regional Neurosurgical Centre.

Patients and methods: We reviewed the data prospectively collected in 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 GCS 9-13 were identified as 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 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 Glasgow coma scale) predicted an unfavourable outcome at 6 months. This combination of variables predicts six 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 Emergency Department of a General Hospital with moderate head injury.

Keywords: early predictors, emergency department, moderate head injury, unfavourable outcome