Early predictors of mortality and morbidity after severe closed head injury

Mortality and morbidity of 158 patients with severe head injury were studie d in relation to age, and early (24-h) clinical and computed tomography dat a. For comparison of outcome data in survivors, a group of 32 patients with traumatic injuries to parts of the body other than the head was used as co ntrols. Within the head-injured group, the mortality rate was 51%. Logistic regression analyses combined 13 out of 16 predictors into a model with an accuracy of 93%, a sensitivity of 90%, and a specificity of 95%. These incl ude age, Glasgow Coma Scale (GCS) score, pupillary reactivity, blood pressu re, intracranial pressure, blood glucose, platelet count, body temperature, cerebral lactate, and subdural, intracranial, subarachnoid, and ventricula r hemorrhage. At 6 months postinjury, head-injury survivors and trauma cont rols were evaluated with the Glasgow Outcome Scale (GOS), a neuropsychologi cal test battery and the Sickness Impact Profile (SIP). Head-injury survivo rs had a higher proportion of disabilities and neuropsychological dysfuncti ons than trauma controls. They also report more quality of life-related fun ctional limitations on the SIP scales for mobility, intellectual behavior, communication, home management, eating, and work. Linear regression analysi s resulted in age being the only important predictor of outcome on the GOS, the GCS score being the best predictor of neuropsychological functioning, and pupillary reactivity being the most predictive for self-reported qualit y of life as measured by SIP. Those factors important for predicting mortal ity (clinical variables such as ICP or blood glucose level, and CT observat ions) failed to show any significant relationship with morbidity.