Prognostic Factors in Patients with Severe Head Injury.

Lee, Seung Wook; Kim, Oh Lyong; Woo, Byung Gil; Kim, Seong Ho; Bae, Jang Ho; Choi, Byung Yon; Cho, Soo Ho

Original Article

Journal of Korean Neurosurgical Society 1999;28(9): 1288-1292.

Seung Wook Lee, Oh Lyong Kim, Byung Gil Woo, Seong Ho Kim, Jang Ho Bae, Byung Yon Choi, Soo Ho Cho

Department of Neurosurgery, Yeungnam University, College of Medicine, Taegu, Korea.

ABSTRACT

OBJECTIVE
To elucidate the problems that must be dealt with in the prognosis of patients with severe head injury and to find out the prognosis factors related to severe head injury.
METHODS
A clinical analysis was carried out retrospectively with 292cases of severe head- injured patients (Glasgow coma scale score 3-8) admitted to the our department for 10 years from January 1987 to December 1996.
RESULTS
Patients who were classified as having severe brain injury belonged to 13.1% of all craniocerebral trauma cases among which sixty-three cases had diffuse brain injury. The causes of head injuries were motor vehicle accident, falls from heights, bicycle and other causes in order of frequency. Pediatric patients showed better outcome(51.4%), compared with only 28.1% of all adult cases(p<0.0001). The patients with high initial GCS score(6-8, 47.9%) had significantly better outcome than the patients with low initial GCS socre(3-5, 16.9%) (p<0.0001). Fifty point three percents of patients with good motor response had good outcome, whereas only 15.8 percent in patients with poor motor response. The cases with diffuse head injury without basal cistern compression had significantly higher percentage of good outcome(74.0%) than those with basal cistern compression(16.9%, p<0.0001). The cases with normal pupillary reaction had significantly higher percentage of good outcome(50.3%) than those with bilateral oculomotor nerve palsy(18.4%, p<0.0001). The patients with skull fracture had good outcome(48.1%), compare to 20.3% of patients without skull fracture(p<0.0017).
CONCLUSION
The good prognostic factors in this study were young age, initial high Glasgow coma scale, good motor response, diffuse brain injury type I, II, bilaterally intact light reflex, with skull fracture. Individual prognostic factor is significant to indicate the patient's outcome and may be utilized for assessing the relative efficacy of the alternative treatment and prognosis.

Key Words: Severe head injury; Prognostic factor; Glasgow coma scale; Computerized tomography; Motor response