PREDICTING SURVIVAL FROM HEAD TRAUMA 24 HOURS AFTER INJURY - A PRACTICAL METHOD WITH THERAPEUTIC IMPLICATIONS

Objective: To develop a method to predict long-term outcome after head injury and determine if outcome can be accurately predicted 24 hours after injury. Design: A retrospective review was performed on a study cohort of 672 head-injured patients admitted in coma (Glascow Coma Sca le score less than or equal to 8) who remained comatose for at least 6 hours, survived more than 24 hours, and had 6-month outcome data avai lable, Stepwise logistic regression analysis was used to determine whi ch clinical variables predicted 6-month outcome, Statistically signifi cant clinical predictors were combined into a single examination varia ble (MPX score), which reflected a rank-ordering of examinations from worst to best, which was then further weighted by patient age, The rel ation between 6-month outcome and MPX score at admission and 24 hours was plotted and analyzed. Measurement and Main Results: Age, best moto r score, and pupillary reactivity at admission and 24 hours were signi ficant predictors of outcome; extraocular motility was predictive at 2 4 hours only, Age was the most important independent predictor, follow ed by best motor score, pupillary reactivity, and extraocular motility , Combining these predictors into MPX score resulted in a set of graph s that reliably predicted long-term outcome, The 24-hour MPX data were better predictors of 6-month outcome and were more specific in predic ting negative outcomes than admission data, Conclusions: The method is simple to use, relying on bedside neurologic examination and a single graph, but appears to predict long-term outcome accurately as early a s 24 hours after head injury, If validated on other large series of pa tients, this method could provide an objective and practical basis for terminating care in patients unlikely to survive a head injury.