Citation

Boto GR, Gómez PA, de la Cruz J, Lobato RD. J. Neurol. Neurosurg. Psychiatry 2006; 77(9): 1054-1059.

Affiliation

HOSPITAL, Spain.

Copyright

(Copyright © 2006, BMJ Publishing Group)

DOI

10.1136/jnnp.2005.087056

PMID

16740580

PMCID

PMC2077742

Abstract

BACKGROUND: Severe head injury (SHI) is one of the most important health, social, and economical problems in industrialized countries. Unfortunately, none of the neuroprotection trials for traumatic brain injury have showed efficacy. One of the reasons for this failure could be the inclusion of patients with high probability of early-death. We conducted a population-based, retrospective study in order to develop a prognostic model for identification of these patients. METHODS: Between January 1987 and August 1999, we included a total of 895 patients (15 years or older) with non-missile SHI, in whom a computerized tomography scan was carried out within the first 6 hours of injury. The association between early-death (first 48 hours posttrauma) 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: nonevacuated mass (odds ratio [OR], 65; 95% confidence interval [CI], 11-379), diffuse injury IV (OR, 25; 95% CI, 5-112), diffuse injury III (OR, 8; 95% CI, 3-22), flaccidity (OR, 7; 95% CI, 3-15), bilaterally nonreactive mydriasis (OR, 6; 95% CI, 3-12), evacuated mass (OR, 4; 95% CI, 1-11), 65 years or older (OR, 4; 95% CI, 1-9), decerebration (OR, 3; 95% CI, 2-7), and shock (OR, 3; 95% CI, 2-6). The prognostic model identified correctly 93% of the patients. CONCLUSIONS: Our prognostic model, based on simple clinical and radiological data readily available during the first 6 hours after injury, is useful for identification of early-death after SHI.
Language: en