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Donald P. Becker, J. Douglas Miller, John D. Ward, Richard P. Greenberg, Harold F. Young and Romas Sakalas

shift was higher (53%) than in those in whom midline shift was 0 to 9 mm (25%; χ 2 = 9.57; p < 0.01). There was, however, less difference in the numbers of patients who made a satisfactory recovery from injury (χ 2 = 4.27; p < 0.05). Thus, although pronounced brain shift implied a significantly worse neurological picture and a higher mortality rate, the number of severely disabled and vegetative patients was not increased and the number of recoveries was still substantial. TABLE 3 Midline brain shift, neurological signs on admission and the outcome from

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J. Douglas Miller, Donald P. Becker, John D. Ward, Humbert G. Sullivan, William E. Adams and Michael J. Rosner

, septicemia, and renal failure. TABLE 6 Mortality rates and cause of death Diagnosis Total Deaths Cause of Death Increased ICP Medical Causes acute epidural hematoma 12 1 (8%) 1 0 acute subdural hematoma 26 11 (42%) 4 7 acute intracerebral mass lesion 24 13 (54%) 9 4 all intracranial mass lesions 62 25 (40%) 14 11 diffuse brain injury 98 23 (23%) 8 15 all head injuries 160 48 (30%) 22 26 Fig. 3. Death from uncontrollable

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) that our criteria for entry into our study differ from those used in the Glasgow/Holland/Los Angeles study. However, their group have made such comparisons with other studies where the criteria for inclusion were not strictly comparable, in order to show that mortality rates were similar in all series. However, as in their own internal comparisons, they have deemed those other series comparable on the basis of similar percentages of patients showing certain features, such as absent pupillary function. We made the comparison on the same basis. We believe that the

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are associated. We did so with some reservations, realizing (and pointing out at length in our paper) that our criteria for entry into our study differ from those used in the Glasgow/Holland/Los Angeles study. However, their group have made such comparisons with other studies where the criteria for inclusion were not strictly comparable, in order to show that mortality rates were similar in all series. However, as in their own internal comparisons, they have deemed those other series comparable on the basis of similar percentages of patients showing certain features

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criteria for entry into our study differ from those used in the Glasgow/Holland/Los Angeles study. However, their group have made such comparisons with other studies where the criteria for inclusion were not strictly comparable, in order to show that mortality rates were similar in all series. However, as in their own internal comparisons, they have deemed those other series comparable on the basis of similar percentages of patients showing certain features, such as absent pupillary function. We made the comparison on the same basis. We believe that the overall severity

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J. Douglas Miller, John F. Butterworth, Steven K. Gudeman, J. Edward Faulkner, Sung C. Choi, John B. Selhorst, John W. Harbison, Harry A. Lutz, Harold F. Young and Donald P. Becker

of our IDB-compatible group of patients are very similar to those actually recorded by the IDB participants. The mortality rate in our IDB-compatible series (40%) is, however, significantly lower than the 49% mortality rate recorded by the members of the IDB. 12 This is the case regardless whether comparisons are made between the Richmond IDB-compatible series and the entire IDB series or the subsets of data from its three constituent reporting centers (p < 0.001). The issue of comparability cannot be completely settled, however. The mean age of the IDB patients

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Improved confidence of outcome prediction in severe head injury

A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure

Raj K. Narayan, Richard P. Greenberg, J. Douglas Miller, Gregory G. Enas, Sung C. Choi, Pulla R. S. Kishore, John B. Selhorst, Harry A. Lutz III and Donald P. Becker

outcomes in patients with extracerebral and intracerebral lesions when these occurred exclusively (53% and 54%, respectively); however, the simultaneous presence of both lesions was associated with a poorer outcome (only 33% G/MD), and a high mortality rate (63%). We applied several combinations of CT categories to predicting outcome, and achieved best results when patients with high-density lesions were compared to the rest of the patients (64% correct predictions) ( Table 8 ). Computerized tomography data, when used as a categorical variable with five groups ( Table

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John M. Seelig, Richard P. Greenberg, Donald P. Becker, J. Douglas Miller and Sung C. Choi

. Approximately one-third of patients with acute SDH and decerebration survived in our series and in the series of McLaurin and Tutor, 29 Gutterman and Shenkin, 18 and Richards and Hoff, 34 but only 10% survived in Jamieson and Yelland's series 20 ( Table 4 ). In these patients, the presence of an additional adverse clinical sign, bilaterally unreactive pupils, increased the mortality rate to 76% to 85%, depending on the series. In our series and that reported by Bricolo and Turazzi 7 there was an 80% mortality rate, whereas Jamieson and Yelland 20 recorded a 95

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Intracranial pressure: to monitor or not to monitor?

A review of our experience with severe head injury

Raj K. Narayan, Pulla R. S. Kishore, Donald P. Becker, John D. Ward, Gregory G. Enas, Richard P. Greenberg, A. Domingues Da Silva, Maurice H. Lipper, Sung C. Choi, C. Glen Mayhall, Harry A. Lutz III and Harold F. Young

, 24, 28, 32, 38, 39 Such proof is, however, difficult to establish. 27, 28 Nevertheless, there have been reports that support such an inference. Bowers and Marshall, 2 in a study of 200 patients with severe head injury, noted that among 86 patients with a GCS score of 3 to 5, there was only a 39% mortality in patients who underwent monitoring with an effort to control ICP, as compared to a 62% mortality rate in those not monitored (p < 0.05). However, their decision to monitor or not to monitor ICP was somewhat arbitrary and not strictly randomized. Another study

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John D. Ward, Donald P. Becker, J. Douglas Miller, Sung C. Choi, Anthony Marmarou, Cheryl Wood, Pauline G. Newlon and Richard Keenan

T he recorded mortality rate associated with severe head injury, in which the patient has been rendered comatose for at least 6 hours, unable to open his eyes, speak recognizable words, or obey commands, is between 40% and 50%. 17 While some of this mortality is inevitable, an undetermined proportion of head injury fatality is avoidable. We and others have devoted much time and effort to delineating factors that mediate a poor outcome in an attempt to lower mortality caused by head injury to the absolute minimum. 2, 12, 17, 18 The importance of intracranial