Factors predicting outcome in patients with severe head injury: Multivariate analysis^{[*] [**]}

Abstract

Background

Outcome prediction after severe head injury is of great clinical importance especially for countries like India for better targeting of limited healthcare resources. This study was undertaken to evaluate various factors as predictors of outcome in severe head injury.

Patients and Methods

This study is based on prospective analysis of 110 patients admitted over a period of one and half year with severe head injury. Patients with associated severe chest, abdominal or orthopedic trauma were excluded. Clinical outcome was evaluated at the time of discharge and after six months, according to Glasgow outcome score.

Results

Road traffic accident was commonest (83.64%) mode of severe head injury. Only 5.71% of patients were following traffic rules. Increasing age of patients, hypoxia, low GCS and abnormal pupillary reflex were found to be significant predictors of adverse clinical outcome. Early operative intervention, when indicated as per CT findings, was significantly associated with favorable outcome. Greater degree of midline shift and effacement of Basal cisterns were associated with adverse outcome.

Conclusion

Predicting outcome is an assimilative and integrative process of various pre-injury, injury and post-injury variables. Strict enforcement of traffic rules can help us to save precious life. Hypoxia should be avoided on absolute basis. CT scan should be done on urgent basis to look for operable mass lesions.

Keywords

Severe head injury - Glasgow coma score - Glasgow outcome score

^* Work attributed to: Department of Neurosurgery, Christian Medical College & Hospital, Ludhiana, Punjab.

^** This manuscript was not presented at any meeting.

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