rss
J Neurol Neurosurg Psychiatry 2008;79:567-573 doi:10.1136/jnnp.2007.120162
  • Research paper

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

  1. A Fabbri1,
  2. F Servadei2,
  3. G Marchesini3,
  4. S C Stein4,
  5. A Vandelli1
  1. 1
    Dipartimento dell’Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda Unitè Sanitaria Locale di Forlì, Forlì, Italy
  2. 2
    Divisione di Neurochirurgia per la Traumatologia, Ospedale M. Bufalini, Azienda Unitè Sanitaria Locale di Cesena, Cesena, Italy
  3. 3
    Alma Mater Studiorum, Universitè di Bologna, Bologna, Italy
  4. 4
    Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  1. 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
  • Received 10 March 2007
  • Revised 2 August 2007
  • Accepted 13 August 2007
  • Published Online First 31 August 2007

Abstract

Background: Subjects with moderate head injury are a particular challenge for the emergency physician. They represent a heterogeneous population of subjects with large variability in 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, 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.

Footnotes

  • Competing interests: None.

This Article

  1. Abstract
  2. Full text
  3. PDF
  4. All versions of this article:
    1. jnnp.2007.120162v1
    2. 79/5/567 most recent

Responses

  1. Submit a response
  2. No responses published

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

BMJ Careers - Latest neurology and neurosurgery jobs