Early prediction of outcome in very severe closed head injury

Summary Background People with severe head injury and admission Glasgow Coma Scale (GCS) score ≤5 have a poor outcome and greatly strain limited resources. Aim To identify patients with the best chances of survival, using routine clinical measures. Methods People attending the trauma intensive care unit, who had isolated blunt head injury and GCS ≤ 5 and who had survived ≥4 h, were included in the study, resuscitated and clinically assessed. The GCS score was followed serially after admission. Bivariate analysis of various parameters with outcome was performed using the chi-square test. Serial GCS scores were compared with admission GCS by paired t -testing. Results Of the 102 patients who were studied prospectively, 78 (76.5%) died and 24 (23.5%) survived. Age, gender, pre-hospital delay and admission GCS scores were comparable between the two groups. Adequate spontaneous respiration, brisk pupillary light reactivity on admission and increase in GCS by at least 2 at 24 h after admission significantly affected the outcome ( p < 0.05). In the presence of all these factors, the survival rate increased from 6.1% to 57.1% ( p < 0.001). Conclusions People with GCS score ≤5 still have a reasonable chance of survival, so all patients should be aggressively managed initially. Better survival was observed among those with adequate spontaneous respiration, good pupillary reaction and improvement in GCS of at least 2 at 24 h. These clinical parameters can help to predict survival and thus make best use of limited resources.