OUTCOME ANALYSIS OF PATIENTS WITH SEVERE HEAD-INJURIES AND PROLONGED INTRACRANIAL HYPERTENSION

Objective: To describe the functional outcome of a select group of pat ients with severe head injuries who would a priori be assumed to have a dismal outcome and to determine prognostic factors that can be used for effective family counseling and rational utilization of scarce res ources. Methods: Thirty-seven patients with severe head injuries (admi ssion Glasgow Coma Scale (GCS) score < 8) with prolonged (>96 hours) i ntracranial hypertension were studied, Parameters recorded included ad mission age, GCS, evidence of prehospital hypotension, initial compute d tomography findings, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and therapeutic intensity level. Results: Thirty-eigh t percent of patients in this study achieved a Glasgow Outcome Scale s core (GOS) of 4 (moderate disability) or better when assessed 1 year a fter injury. Patients who achieved these good outcomes were significan tly younger (mean 23.6 +/- 8.8 years) than patients who were severely disabled or worse (GOS 1-3) (34.3 +/- 15.0 years) (p = 0.0098), The me an admission GCS in the good-outcome group tended to be higher than th at of the poor-outcome group (5.8 +/- 1.5 vs 4.8 +/- 1.6,p = 0.065), W hen patients with good outcomes (GOS 4 or 5) were compared with those with poor outcomes (GOS 1-3), no significant differences in mean or pe ak ICP, percentage of time intervals with elevated ICP, lowest recorde d CPP, or length of ICP monitoring were detected. Conclusion: Younger patients, particularly those with GCS > 5, have the potential for exce llent recovery despite prolonged (>96 hours) intracranial hypertension , These patients will benefit from continued aggressive ICP and CPP ma nagement.