The outcome of severe closed head injury

Lawrence F. Marshall Division of Neurosurgery, University of California Medical Center, San Diego, California
Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia
Division of Neurosurgery, Indiana University Medical Center, Indianapolis, Indiana
Division of Neurosurgery, Medical College of Virginia, Richmond, Virginia
Biometry and Field Studies Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland

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Theresa Gautille Division of Neurosurgery, University of California Medical Center, San Diego, California
Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia
Division of Neurosurgery, Indiana University Medical Center, Indianapolis, Indiana
Division of Neurosurgery, Medical College of Virginia, Richmond, Virginia
Biometry and Field Studies Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland

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Melville R. Klauber Division of Neurosurgery, University of California Medical Center, San Diego, California

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Howard M. Eisenberg Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas

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John A. Jane Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, Virginia

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Thomas G. Luerssen Division of Neurosurgery, Indiana University Medical Center, Indianapolis, Indiana

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Anthony Marmarou Division of Neurosurgery, Medical College of Virginia, Richmond, Virginia

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Mary A. Foulkes Biometry and Field Studies Branch, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland

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✓ The outcome of severe head injury was prospectively studied in patients enrolled in the Traumatic Coma Data Bank (TCDB) during the 45-month period from January 1, 1984, through September 30, 1987. Data were collected on 1030 consecutive patients admitted with severe head injury (defined as a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation). Of these, 284 either were brain-dead on admission or had a gunshot wound to the brain. Patients in these two groups were excluded, leaving 746 patients available for this analysis.

The overall mortality rate for the 746 patients was 36%, determined at 6 months postinjury. As expected, the mortality rate progressively decreased from 76% in patients with a postresuscitation GCS score of 3 to approximately 18% for patients with a GCS score of 6, 7, or 8. Among the patients with nonsurgical lesions (overall mortality rate, 31%), the mortality rate was higher in those having an increased likelihood of elevated intracranial pressure as assessed by a new classification of head injury based on the computerized tomography findings. In the 276 patients undergoing craniotomy, the mortality rate was 39%. Half of the patients with acute subdural hematomas died — a substantial improvement over results in previous reports. Outcome differences between the four TCDB centers were small and were, in part, explicable by differences in patient age and the type and severity of injury.

This study describes head injury outcome in four selected head-injury centers. It indicates that a mortality rate of approximately 35% is to be expected in such patients admitted to experienced neurosurgical units.

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  • 1.

    Abbreviated Injury Scale. Arlington Heights, Ill: American Society of Automotive Medicine, 1985 Abbreviated Injury Scale. Arlington Heights, Ill: American Society of Automotive Medicine, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Becker DP, , Miller JD, & Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive treatment. J Neurosurg 47:491502, 1977 Becker DP, Miller JD, Ward JD, et al: The outcome from severe head injury with early diagnosis and intensive treatment. J Neurosurg 47:491–502, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Bowers SA, & Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237242, 1980 Bowers SA, Marshall LF: Outcome in 200 consecutive cases of severe head injury treated in San Diego County: a prospective analysis. Neurosurgery 6:237–242, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Cox DR: Analysis of Binary Data. London: Methuen & Co, 1970 Cox DR: Analysis of Binary Data. London: Methuen & Co, 1970

  • 5.

    Cox DR: Regression models and life-tables. J R Stat Soc B 34:187220, 1972 Cox DR: Regression models and life-tables. J R Stat Soc B 34:187–220, 1972

  • 6.

    Dixon WJ (ed): BMDP Statistical Software. Berkeley: University of California Press, 1985 Dixon WJ (ed): BMDP Statistical Software. Berkeley: University of California Press, 1985

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Foulkes MA, , Eisenberg HM, & Jane JA, et al: The Traumatic Coma Data Bank: design, methods, and baseline characteristics. J Neurosurg 75 (Suppl):S8S13, 1991 Foulkes MA, Eisenberg HM, Jane JA, et al: The Traumatic Coma Data Bank: design, methods, and baseline characteristics. J Neurosurg 75 (Suppl):S8–S13, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Hosmer DW, & Lemeshow S: Goodness of fit tests for the multiple logistic regression model. Commun Stat 10 (A):10431069, 1980 Hosmer DW, Lemeshow S: Goodness of fit tests for the multiple logistic regression model. Commun Stat 10 (A):1043–1069, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Jennett B, & Teasdale G: Management of Head Injuries. Philadelphia: FA Davis, 1981 Jennett B, Teasdale G: Management of Head Injuries. Philadelphia: FA Davis, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Jennett B, , Teasdale G, & Galbraith S, et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291298, 1977 Jennett B, Teasdale G, Galbraith S, et al: Severe head injuries in three countries. J Neurol Neurosurg Psychiatry 40:291–298, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Klauber MR, , Marshall LF, & Luerssen TG, et al: Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 24:3136, 1989 Klauber MR, Marshall LF, Luerssen TG, et al: Determinants of head injury mortality: importance of the low risk patient. Neurosurgery 24:31–36, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Marshall LF, , Becker DP, & Bowers SA, et al: The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results. J Neurosurg 59:276284, 1983 Marshall LF, Becker DP, Bowers SA, et al: The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results. J Neurosurg 59:276–284, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Marshall LF, , Marshall SB, & Klauber MR, et al: A new classification of head injury based on computerized tomography. J Neurosurg 75 (Suppl):S14S20, 1991 Marshall LF, Marshall SB, Klauber MR, et al: A new classification of head injury based on computerized tomography. J Neurosurg 75 (Suppl):S14–S20, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Marshall LF, , Smith RW, & Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring. J Neurosurg 50:2025, 1979 Marshall LF, Smith RW, Shapiro HM: The outcome with aggressive treatment in severe head injuries. Part I: The significance of intracranial pressure monitoring. J Neurosurg 50:20–25, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Marshall LF, , Toole BM, & Bowers SA: The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment. J Neurosurg 59:285288, 1983 Marshall LF, Toole BM, Bowers SA: The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment. J Neurosurg 59:285–288, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Seelig JM, , Marshall LF, & Toutant SM, et al: Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients. Neurosurgery 15:617620, 1984 Seelig JM, Marshall LF, Toutant SM, et al: Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients. Neurosurgery 15:617–620, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Selecki BR, , Ring IT, & Simpson DA, et al: Injuries to the head, spine and peripheral nerves. Report on a study. Initiated and sponsored by The Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee, in collaboration with the Division of Health Services Research, Health Commission of New South Wales, in: Epidemiology of Neurotrauma in New South Wales, South Australia and the Australian Capital Territory. New South Wales: Australian Neurological Foundation, 1977 Selecki BR, Ring IT, Simpson DA, et al: Injuries to the head, spine and peripheral nerves. Report on a study. Initiated and sponsored by The Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee, in collaboration with the Division of Health Services Research, Health Commission of New South Wales, in: Epidemiology of Neurotrauma in New South Wales, South Australia and the Australian Capital Territory. New South Wales: Australian Neurological Foundation, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Teasdale G, , Galbraith S, & Murray L, et al: Management of traumatic intracranial haematoma. Br Med J 285:16951697, 1982 Teasdale G, Galbraith S, Murray L, et al: Management of traumatic intracranial haematoma. Br Med J 285:1695–1697, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Teasdale G, & Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:8184, 1974 Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84, 1974

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Toutant SM, , Klauber MR, & Marshall LF, et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691694, 1984 Toutant SM, Klauber MR, Marshall LF, et al: Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 61:691–694, 1984

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    van Dongen KJ, , Braakman R, & Gelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951957, 1983 van Dongen KJ, Braakman R, Gelpke GJ: The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 59:951–957, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Vollmer DG, , Tomer JC, & Jane JA, et al: Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 75 (Suppl):S37S49, 1991 Vollmer DG, Tomer JC, Jane JA, et al: Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 75 (Suppl):S37–S49, 1991

    • PubMed
    • Search Google Scholar
    • Export Citation

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