Patients with moderate head injury: a prospective multicenter study of 315 patients.
OBJECTIVE
To analyze the risk factors of worst outcome associated with moderate head injury.


METHODS
Data on patients with moderate head injury were collected prospectively in 11 Italian neurosurgical units over a period of 18 months. Patients older than 18 years with blunt head injury and at least one Glasgow Coma Scale (GCS) score between 9 and 13 were enrolled. The outcome was determined at 6 months using the Glasgow Outcome Scale.


RESULTS
We analyzed 315 patients. Initial computed tomographic scans showed a diffuse injury type I or II in 63%, a mass lesion in 35%, and traumatic subarachnoid hemorrhage in 42% of the patients. The risk of progression toward a mass lesion was 23% when the admission computed tomographic scan showed diffuse injury type I or II. An emergency craniotomy was performed in 22% of the patients, delayed surgery was performed in 14%, and both were performed in 25%. A favorable outcome was obtained in 74% of the patients. When the GCS score was 9 or 10, the predictor of worst outcome was a motor GCS score of 4 or lower (odds ratio [OR], 8.08; 95% confidence interval [CI], 1.22-67.35; P = 0.008), but when the GCS score was 11 to 13, the factors associated with worst outcome were neuroworsening (OR, 3.43; 95% CI, 1.45-8.17; P = 0.002), seizures (OR, 7.94; 95% CI, 1.18-64.48; P = 0.02), and medical complications (OR, 4.24; 95% CI, 1.74-10.33; P = 0.0006).


CONCLUSIONS
There is a high percentage of surgery and worsening on computed tomographic scans in patients with moderate head injury. Neuroworsening, seizures, and medical complications as outcome predictors were more strongly associated with a GCS score of 11 to 13, whereas a low motor GCS score was more outcome-related in patients with GCS scores of 9 and 10.
Compagnone
Christian
C
Intensive Care Unit, Bufalini Hospital, Cesena, Italy.
d'Avella
Domenico
D
Servadei
Franco
F
Angileri
Filippo F
FF
Brambilla
Gianluigi
G
Conti
Carlo
C
Cristofori
Luciano
L
Delfini
Roberto
R
Denaro
Luca
L
Ducati
Alessandro
A
Gaini
Sergio M
SM
Stefini
Roberto
R
Tomei
Giustino
G
Tagliaferri
Fernanda
F
Trincia
Giuseppe
G
Tomasello
Francesco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005544:Forecasting; D023261:Glasgow Outcome Scale; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult