Neurobehavioral outcome 1 year after severe head injury

Experience of the Traumatic Coma Data Bank

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✓ The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.

Article Information

Address for Drs. Ruff and Marshall: San Diego Head Injury Center, University of California San Diego, San Diego, California.

Address for Drs. Barth, Kreutzer, and Foulkes: National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.

Address for Dr. Jane: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.

Address for Dr. Marmarou: Department of Neurosurgery, Medical College of Virginia, Richmond, Virginia.

Address reprint requests to: Harvey S. Levin, Ph.D., Division of Neurosurgery, D-73, The University of Texas Medical Branch, Galveston, Texas 77550.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Box plot depicting the relationship of Glasgow Outcome Scale (GOS) score at 1 year after injury to the lowest postresuscitation Glasgow Coma Scale (GCS) score. The width of each box plot depicts the interquartile range of GCS scores for the patients whose recovery at 1 year was characterized by the corresponding GOS score. For example, the upper bound (75th percentile) of the box for good recovery is a GCS score of 7 whereas the lower bound of the box (25th percentile) is 6. The extreme scores are represented by the line extensions (for example, GCS scores of 15 and 3 for the Good Recovery group).

  • View in gallery

    Square root of consistent long-term retrieval (CLTR) score at 1 year postinjury plotted against the lowest postresuscitation Glasgow Coma Scale (GCS) score for patients whose pupils remained normally reactive after resuscitation (left) and for those patients who had one or both pupils nonreactive following resuscitation (right).

  • View in gallery

    Square root of consistent long-term retrieval (CLTR) score at 1 year postinjury plotted against the highest intracranial pressure (ICP) recorded during the first 72 hours after injury. The negligible relationship depicted here is similar to the plots relating ICP to other neurobehavioral measures.

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