title: Psychological consequences of blunt head trauma and relation to other indices of severity of injury.
abstract: 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.
authors.affiliation: Department of Neurology, Geisinger Clinic, Danville, Pennsylvania 17822.
authors.forename: I B
authors.initials: IB
authors.lastname: Gensemer
authors.forename: J L
authors.initials: JL
authors.lastname: Smith
authors.forename: J C
authors.initials: JC
authors.lastname: Walker
authors.forename: F
authors.initials: F
authors.lastname: McMurry
authors.forename: M
authors.initials: M
authors.lastname: Indeck
authors.forename: S
authors.initials: S
authors.lastname: Brotman
mesh_terms: 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*