POSTTRAUMATIC AMNESIA AS A PREDICTOR OF OUTCOME AFTER SEVERE CLOSED-HEAD INJURY - PROSPECTIVE ASSESSMENT

Objectives: To identify the demographic and clinical variables related to the duration of posttraumatic amnesia after severe closed head inj ury; to evaluate the usefulness of posttraumatic amnesia duration in p redicting outcome at the time of hospital discharge and at 6 months af ter injury. Setting: Four clinical centers located in primary care hos pitals. Patients: Three hundred fourteen severely injured subjects age d 16 years or older who did not have trauma as a result of a penetrati ng injury and came out of coma before hospital discharge. Intervention s: Approximately half of the subjects were administered phenytoin sodi um for some period after termination of coma; 17% were administered de xamethasone and 41% morphine sulfate. Main Outcome Measures: Galveston Orientation and Amnesia Test scores defined the duration of posttraum atic amnesia. The Glasgow Outcome Scale was used to grade outcome at t he time of hospital discharge and at 6 months. Results: Older age, low initial Glasgow Coma Scale score, nonreactive pupil(s), coma duration , and use of phenytoin were associated with a longer duration of postt raumatic amnesia. Poor pupillary response, time in coma, and duration of posttraumatic amnesia and use of phenytoin was predictive of the 6- month outcome. Conclusions:. The results support the prognostic useful ness of prospectively measuring duration of posttraumatic amnesia afte r termination of coma. Pending replication, our findings suggest that posttraumatic amnesia duration may be a useful surrogate outcome measu re for clinical trials involving interventions for acute head injury.