Outcome analysis of patients with severe head injuries and prolonged intracranial hypertension
Resnick, D.K.; Marion, D.W.; Carlier, P.
Journal of Trauma 42(6): 1108-1111
1997
ISSN/ISBN: 0022-5282 PMID: 9210550 Document Number: 478421
Objective: To describe the functional outcome of a select group of patients with severe head injuries who would a priori be assumed to have a dismal outcome and to determine prognostic factors that can be used for effective family counseling and rational utilization of scarce resources. Methods: Thirty-seven patients with severe head injuries (admission Glasgow Coma Scale (GCS) score lt 8) with prolonged ( gt 96 hours) intracranial hypertension were studied. Parameters recorded included admission age, GCS, evidence of prehospital hypotension, initial computed tomography findings, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and therapeutic intensity level. Results: Thirty-eight percent of patients in this study achieved a Glasgow Outcome Scale score (GOS) of 4 (moderate disability) or better when assessed 1 year after injury. Patients who achieved these good outcomes were significantly younger (mean 23.6 +- 8.8 years) than patients who were severely disabled or worse (GOS 1-3) (34.3 +- 15.0 years) (p = 0.0098). The mean admission GCS in the good-outcome group tended to be higher than that of the poor-outcome group (5.8 +- 1.5 vs 4.8 +- 1.6, p = 0.065). When patients with good outcomes (GOS 4 or 5) were compared with those with poor outcomes (GOS 1-3), no significant differences in mean or peak ICP, percentage of time intervals with elevated ICP, lowest recorded CPP, or length of ICP monitoring were detected. Conclusion: Younger patients, particularly those with GCS gt 5, have the potential for excellent recovery despite prolonged ( gt 96 hours) intracranial hypertension. These patients will benefit from continued aggressive ICP and CPP management.