Head injury (moderate to severe)

Annals of Emergency Medicine, 2006

Study objective: Emergency physicians are concerned about minor head injury patients who present with a Glasgow Coma Scale (GCS) score of 15 yet require neurosurgical intervention. Our objectives are to determine the accuracy of the Canadian CT Head Rule (CCHR) in this important subset, the prevalence of patients requiring urgent intervention, and their clinical course and possible warning signs.

The Journal of Trauma: Injury, Infection, and Critical Care, 2004

Background: Preresuscitation Glasgow Coma Scale (P-GCS) score is frequently obtained in injured patients and incorporated into mortality prediction. Data on functional outcome in head injury is sparse. A large group of patients with head injuries was analyzed to assess relationships between P-GCS score, mortality, and functional outcome as measured by the Functional Independence Measure (FIM). Methods: Records for patients with International Classification of Diseases, Ninth Revision diagnosis codes indicating head injury in a statewide trauma registry between 1994 and 2002 were selected. P-GCS score, mortality, and FIM score at hospital discharge were integrated and analyzed. Results: Of 138,750 patients, 22,924 patients were used for the mortality study and 7,150 patients for the FIM study. A good correlation exists between P-GCS score and FIM, as determined by rank correlation coefficients, whereas mortality falls steeply between a P-GCS score of 3 and a P-GCS score of 7 followed by a shallow fall. Although P-GCS score is related to mortality in head-injured patients, its relationship is nonlinear, which casts doubt on its use as a continuous measure or an equivalent set of categorical measures incorporated into outcome prediction models. The average FIM scores indicate substantial likelihood of good outcomes in survivors with low P-GCS scores, further complicating the use of the P-GCS score in the prediction of poor outcome at the time of initial patient evaluation. Conclusion: Although the P-GCS score is related to functional outcome as measured by the FIM score and mortality in head injury, current mortality prediction models may need to be modified to account for the nonlinear relationship between P-GCS score and mortality. The P-GCS score is not a good clinical tool for outcome prediction in individual head-injured patients, given the variability in mortality rates and functional outcomes at all scores.

Injury, 2009

Traumatic brain injury is the most common cause of death and of acquired disability among children and young adults in developed countries; even when adequate treatment is provided, there is usually neuronal loss. 10 The pathophysiology of this condition highlights the importance not only of the primary lesions, but also of secondary processes that may lead to cerebral hypoxia and ischaemia. 44 Secondary brain damage is the leading cause of death in hospital after traumatic brain injury. 26,44 Moreover, the outcome of childhood head trauma varies from centre to centre depending on the availability of modern neurosurgical and neuroradiological facilities and qualified expertise. 38 In Tunisia, nearly 13,000 victims of motor vehicle accident are recorded annually and about 1500 of these die, according to the National Guard statistical data. 1 Paediatric morbidity and mortality due to head trauma are increasing because of the high rate of road traffic accidents. Survivors are susceptible to irreversible neurological damage that represents an important socioeconomic problem. 13,31 In the Sfax area (South Tunisia), everyone with severe traumatic head injury is admitted to our medicosurgical intensive care unit (ICU), where specific monitoring tools (jugular venous saturation, intracranial pressure monitoring and transcranial Doppler sonography) are, however, not available. The aim of the present study was to evaluate outcome of severe head injury among children referred to this unit, and to define simple predictive factors which could be used in routine practice in general ICUs as indicators of prognosis. Materials and methods This study was approved by an internal review board. Patients In this retrospective study, we included all consecutive patients with severe traumatic brain injury and Glasgow Coma Scale (GCS)

Archives of Surgery, 2004

Hypothesis: To identify significant risk factors associated with mortality in patients with a Glasgow Coma Scale score of 3.

Acta Neurochirurgica, 1997

Guidelines for the management of severe head injury in adults as evolved by the European Brain Injury Consortium are presented and discussed. The importance of preventing and treating secondary insults is emphasized and the principles on which treatment is based are reviewed. Guidelines presented are of a pragmatic nature, based on consensus and expert opinion, covering the treatment from accident site to intensive care unit. Specific aspects pertaining to the conduct of clinical trials in head injury are highlighted. The adopted approach is further discussed in relation to other approaches to the development of guidelines, such as evidence based analysis.

Journal of Korean Neurosurgical Society, 2009

The purpose of this study was to analyze risk factors that are associated with intracranial lesion, and to propose criteria for classification of mild head injury (MHI), and appropriate treatment guidelines. The study was based on 898 patients who were admitted to our hospital with Glasgow Coma Scale (GCS) score of 13 to 15 between 2003 and 2007. The patients' initial computerized tomography (CT) findings were reviewed and clinical findings that were associated with intracranial lesions were analyzed. GCS score, loss of consciousness (LOC), age and skull fracture were identified as independent risk factors for intracranial lesions. Based on the data analysed in this study, MHI patients were divided into four subgroups : very low risk MHI patients are those with a GCS score of 15 and without a history of LOC or headache; low risk MHI patients have a GCS score of 15 and with LOC and/or headache; medium risk MHI patients are those with a GCS score of 15 and with a skull fracture, n...

Acta Anaesthesiologica Scandinavica, 2007

S INCE the middle of the 1990s, most neurotrauma centres have followed the guidelines or recommendations put forward by the US Traumatic Coma databank (1), the European brain trauma consortium (2) or some local protocols such as the Addenbrooke algorithm (3), for the treatment of severe brain trauma. Even though these guidelines differ in details, they include essentially the same therapeutic components, such as osmotherapy, barbiturate therapy, preservation of cerebral perfusion pressure (CPP) with vasopressors and moderate hyperventilation. To date, there have been no randomised studies proving the effectiveness of any of the guidelines available today or their various components regarding outcome following a severe head injury; no specific therapy or guideline has been shown to be more effective than another and no single therapy has been identified to allow improvement in outcome. We lack scientific support for the use of osmotherapy (4, 5), high-dose barbiturate therapy (6), active cooling (7), vasopressors, or continuous CSF drainage. We also lack scientifically based guiding of the optimal CPP, degree of sedation, type of nutrition and how to handle fluid therapy and blood volume. Except for the studies showing that marked hyperventilation should be avoided (8), we also lack scientific guiding on how to handle ventilatory resuscitation, such as PEEP and inhalation regime. We lack studies defining the optimal haemoglobin concentration in head-injured patients, but a restrictive blood transfusion policy is often recommended, and low haemoglobin levels have reached a high degree of acceptance. No clinical neuroprotective drug trial has so far shown any beneficial effect on outcome after severe head injury (9).

Journal of the American College of Surgeons, 2004

We assessed the prognostic value and limitations of Glasgow Coma Scale (GCS) and head Abbreviated Injury Score (AIS) and correlated head AIS with GCS. We studied 7,764 patients with head injuries. Bivariate analysis was performed to examine the relationship of GCS, head AIS, age, gender, and mechanism of injury with mortality. Stepwise logistic regression analysis was used to identify the independent risk factors associated with mortality. The overall mortality in the group of head injury patients with no other major extracranial injuries and no hypotension on admission was 9.3%. Logistic regression analysis identified head AIS, GCS, age, and mechanism of injury as significant independent risk factors of death. The prognostic value of GCS and head AIS was significantly affected by the mechanism of injury and the age of the patient. Patients with similar GCS or head AIS but different mechanisms of injury or ages had significantly different outcomes. The adjusted odds ratio of death in penetrating trauma was 5.2 (3.9, 7.0), p < 0.0001, and in the age group > or = 55 years the adjusted odds ratio was 3.4 (2.6, 4.6), p < 0.0001. There was no correlation between head AIS and GCS (correlation coefficient -0.31). Mechanism of injury and age have a major effect in the predictive value of GCS and head AIS. There is no good correlation between GCS and head AIS.

Anaesthesia & Intensive Care Medicine, 2005

Journal of Neurosurgical Anesthesiology, 1999

Objectives-To assess the eVectiveness of interventions routinely used in the intensive care management of severe head injury, specifically, the eVectiveness of hyperventilation, mannitol, CSF drainage, barbiturates, and corticosteroids. Methods-Systematic review of all unconfounded randomised trials, published or unpublished, that were available by August 1996. Results-None of the interventions has been reliably shown to reduce death or disability after severe head injury. One trial of hyperventilation was identified of 77 participants. The relative risk for death was 0.73 (95% confidence interval (95% CI) 0.36-1.49), and for death or disability it was 1.14 (95% CI 0.82-1.58). One trial of mannitol was identified of 41 participants. The relative risk for death was 1.75 (95% CI 0.48-6.38), no data were available for disability. No randomised trials of CSF drainage were identified. Two randomised trials of barbiturate therapy were identified, including 126 participants. The pooled relative risk for death was 1.12 (95% CI 0.81-1.54). Disability data were available for one trial. The relative risk for death or disability was 0.96 (95% CI 0.62-1.49). Thirteen randomised trials of corticosteroids were identified, comprising 2073 participants. The pooled relative risk for death was 0.95 (0.84 to 1.07) and for death or disability it was 1.01 (95% CI 0.91 to 1.11). On the basis of the currently available randomised evidence, for every intervention studied it is impossible to refute either a moderate increase or a moderate decrease in the risk of death or disability. Conclusion-Existing trials have been too small to support or refute the existence of a real benefit from using hyperventilation, mannitol, CSF drainage, barbiturates, or corticosteroids. Further large scale randomised trials of these interventions are required. (J Neurol Neurosurg Psychiatry 1998;65:729-733) Keywords: head injuries; systematic review; metaanalysis; randomised controlled trials World wide, several million people, mostly children and young adults, are treated each