Defining the limits of survivorship after very severe head injury.
Annual Meeting of the Congres of Neurological Surgeons. Chicago, Illinois (USA), 1994/10/01.
Reliable prediction of outcome after head injury is a daunting task.
Although previous reports have highlighted the difficulties of determining outcome in the cohort of severe head injury Glasgow Coma Scale (GCS) score ¾ 8), we wondered within the very severely injured population (GCS score 3-5) if a simple combination of clinical parameters may be predictive of poor outcome.
All patients admitted to a Level 1 trauma center with a GCS score of 3 to 5 from 1986 to 1991 inclusive (380 patients) were retrospectively reviewed and outcome a minimum of 6 months after injury was determined by chart review or telephone.
Follow-up was accomplished in all but five patients (1.3%). Functional survival (nonvegetative) was correlated to admission GCS score, pupillary abnormalities, and age.
As anticipated, overall functional survival was poor (12.5%), and even worse among those evidencing pupillary abnormalities (6.6%). Interestingly, there was an absence of survivors in the advanced age decades, with the oldest functional survivor of any GCS increasing in a stepwise fashion with increasing coma score.
This translated into the oldest survivor of a GCS score of 3 being in their chronologic 30s, a score of 4 in their 40s, and a score of 5 in their 50s.
Among patients older than these age decades, that is beyond this simple age/GCS cut-off (32.8% of cohort), there were no functional survivors (95% confidence interval 0,2.4). (...)
Mots-clés Pascal : Traumatisme, Crânioencéphalique, Gravité, Epidémiologie, Evaluation, Critère, Pronostic, Homme, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Système ostéoarticulaire pathologie, Crâne pathologie
Mots-clés Pascal anglais : Trauma, Craniocerebral, Gravity, Epidemiology, Evaluation, Criterion, Prognosis, Human, Nervous system diseases, Central nervous system disease, Cerebral disorder, Diseases of the osteoarticular system, Skull disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0147979
Code Inist : 002B16B. Création : 21/05/1997.