Data di Pubblicazione:
2009
Abstract:
OBJECTIVE: To analyze the risk factors of worst outcome associated with moderate
head injury.
METHODS: Data on patients with moderate head injury were collected prospectively
in 11 Italian neurosurgical units over a period of 18 months. Patients older than 18
years with blunt head injury and at least one Glasgow Coma Scale (GCS) score between
9 and 13 were enrolled. The outcome was determined at 6 months using the Glasgow
Outcome Scale.
RESULTS: We analyzed 315 patients. Initial computed tomographic scans showed a
diffuse injury type I or II in 63%, a mass lesion in 35%, and traumatic subarachnoid
hemorrhage in 42% of the patients. The risk of progression toward a mass lesion was 23%
when the admission computed tomographic scan showed diffuse injury type I or II. An
emergency craniotomy was performed in 22% of the patients, delayed surgery was performed
in 14%, and both were performed in 25%. A favorable outcome was obtained
in 74% of the patients. When the GCS score was 9 or 10, the predictor of worst outcome
was a motor GCS score of 4 or lower (odds ratio [OR], 8.08; 95% confidence interval
[CI], 1.22–67.35; P 0.008), but when the GCS score was 11 to 13, the factors associated
with worst outcome were neuroworsening (OR, 3.43; 95% CI, 1.45–8.17; P
0.002), seizures (OR, 7.94; 95% CI, 1.18–64.48; P 0.02), and medical complications
(OR, 4.24; 95% CI, 1.74–10.33; P 0.0006).
CONCLUSION: There is a high percentage of surgery and worsening on computed
tomographic scans in patients with moderate head injury. Neuroworsening, seizures, and
medical complications as outcome predictors were more strongly associated with a
GCS score of 11 to 13, whereas a low motor GCS score was more outcome- related in
patients with GCS scores of 9 and 10.
KEY WORDS: Computed tomographic scan, Moderate head injury, Neuroworsening, Outcome
head injury.
METHODS: Data on patients with moderate head injury were collected prospectively
in 11 Italian neurosurgical units over a period of 18 months. Patients older than 18
years with blunt head injury and at least one Glasgow Coma Scale (GCS) score between
9 and 13 were enrolled. The outcome was determined at 6 months using the Glasgow
Outcome Scale.
RESULTS: We analyzed 315 patients. Initial computed tomographic scans showed a
diffuse injury type I or II in 63%, a mass lesion in 35%, and traumatic subarachnoid
hemorrhage in 42% of the patients. The risk of progression toward a mass lesion was 23%
when the admission computed tomographic scan showed diffuse injury type I or II. An
emergency craniotomy was performed in 22% of the patients, delayed surgery was performed
in 14%, and both were performed in 25%. A favorable outcome was obtained
in 74% of the patients. When the GCS score was 9 or 10, the predictor of worst outcome
was a motor GCS score of 4 or lower (odds ratio [OR], 8.08; 95% confidence interval
[CI], 1.22–67.35; P 0.008), but when the GCS score was 11 to 13, the factors associated
with worst outcome were neuroworsening (OR, 3.43; 95% CI, 1.45–8.17; P
0.002), seizures (OR, 7.94; 95% CI, 1.18–64.48; P 0.02), and medical complications
(OR, 4.24; 95% CI, 1.74–10.33; P 0.0006).
CONCLUSION: There is a high percentage of surgery and worsening on computed
tomographic scans in patients with moderate head injury. Neuroworsening, seizures, and
medical complications as outcome predictors were more strongly associated with a
GCS score of 11 to 13, whereas a low motor GCS score was more outcome- related in
patients with GCS scores of 9 and 10.
KEY WORDS: Computed tomographic scan, Moderate head injury, Neuroworsening, Outcome
Tipologia CRIS:
Articolo su Rivista
Elenco autori:
Compagnone, C; Davella, D; Servadei, F; Angileri, Ff; Brambilla, G; Conti, C; Cristofori, L; Delfini, R; Denaro, L; Ducati, A; Gaini, Sm; Stefini, R; Tomei, Giustino; Tagliaferri, F; Trincia, G; Tomasello, F.
Link alla scheda completa:
Pubblicato in: