THE WESTMEAD HEAD-INJURY PROJECT OUTCOME IN SEVERE HEAD-INJURY - A COMPARATIVE-ANALYSIS OF PREHOSPITAL, CLINICAL AND CT VARIABLES

A prospective study of 315 consecutive patients with a severe head inj ury was undertaken to study factors contributing to mortality and morb idity, both in the pre-hospital and hospital phases. Entry criteria we re a Glasgow Coma Scale (GCS) score of 8 or less after non-surgical re suscitation within 6 h of the injury, or a deterioration to that level within 48 h. Patients with gunshot wounds or who were dead on arrival were excluded. End points of the study were either death or at 6 mont hs after the injury. Predictors of mortality were increasing age, the presence of hypotension, a low GCS, abnormal motor responses and pupil lary non-reactivity. In the 167 patients in whom intracranial pressure (ICP) was measured, raised ICP and failure to respond to treatment fo r raised ICP also predicted mortality. Three CT predictors of mortalit y were the presence of cerebral oedema, intraventricular blood and the degree of midline shift. When analysed using logistic regression, the most accurate model (accuracy 84.4%) included increasing age, abnorma l motor responses and the three CT indicators. Analysis of the data fo r 'good' (Glasgow Outcome Score (GOS) 1 and 2) vs 'poor' (GOS 3 and 4) survival at 6 months was also performed using logistic regression. Th e model which provided the most accurate prediction of poor outcome in cluded age, hypotension and three different CT characteristics, subara chnoid blood, intracerebral haematoma or intracerebral contusion (accu racy 72.5%).