Psychological consequences of blunt head trauma and relation to other indices of severity of injury.
To investigate the relationship between APACHE II, Injury Severity Score (ISS), Glasgow Coma Score (GCS), and behavioral outcome, a group of 39 patients who had been admitted on an emergency basis with a traumatic head injury were selected from the Neuropsychology Registry for study. Except for subtle personality and cognitive changes, all of the patients were making good neurological recoveries. The Halstead-Reitan Neuropsychological Test Battery, which has been shown to be accurate in identifying brain-damaged patients, was used as the measure of outcome. The age of the patients ranged from 16 to 49 years (mean, 25.6; SD, 9.3). The patients' educational levels ranged from elementary school to college (mean, 11.6 years of education; SD, 1.5). Halstead Impairment Indexes (HII) ranged from 0.0 to 1.0 (mean, 0.6; SD, 0.26). APACHE II scores were calculated using the worst values, obtained during the first 24 hours. These scores ranged from 5 to 35 (mean, 16; SD, 7). APACHE II was found to not significantly correlate with HII (r = 0.21, P greater than .05). ISS was calculated for each patient and ranged from 5 to 70 (mean, 27; SD, 13). ISS was found to significantly correlate with HII (r = 0.38, P less than .01). GCS ranged from 3 to 15 (mean, 9.3; SD, 3.4). Of all the correlations, GCS was the most strongly correlated with outcome as measured by the HII (r = -0.44, P less than .01). Our data emphasize that head-injured patients have subtle cognitive dysfunction even when apparently recovering well and demonstrate the need for formal psychological evaluation in all patients with injury significant enough to warrant hospitalization.
Gensemer
I B
IB
Department of Neurology, Geisinger Clinic, Danville, Pennsylvania 17822.
Smith
J L
JL
Walker
J C
JC
McMurry
F
F
Indeck
M
M
Brotman
S
S
D000293:Adolescent; D000328:Adult; D001925:Brain Damage, Chronic / Q000523:psychology; D006259:Craniocerebral Trauma / Q000145:classification / Q000150:complications / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008606:Mental Processes; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010551:Personality; D012720:Severity of Illness Index; D014949:Wounds, Nonpenetrating / Q000523:psychology*