title: Outcome after severe head injury: focal surgical lesions do not imply a better Glasgow Outcome Score than diffuse injuries at 3 months.
abstract: BACKGROUND
  Historically neurosurgeons have accepted head injured patients only in the presence of a mass lesion requiring surgical decompression. Underpinning this is an assumption that these patients have a better outcome than patients without a surgical lesion. This has meant that many patients without a surgical lesion have been managed locally in the referring hospital. However, there is now evidence that treatment of all head injured patients in a specialist centre leads to improved outcomes. Therefore, we have asked the question: does the presence of a surgical lesion imply better outcome from severe head injury?
  
  
  RESULTS
  We prospectively recorded the Glasgow Outcome score (GOS), at 3 months, of all the severely head injured patients treated at our institution over a two and a half year period. Of 116 patients admitted with an initial Glasgow Coma Score (GCS) of 8 or less, 58 had surgical lesions and 58 non-surgical head injuries. The two groups were well matched for presenting GCS and age. Overall our favourable outcome rate (GOS 4 and 5) at 3-months for the patients with a surgical lesion and for the non-surgical group were 47.3% and 46.6% respectively, with no significant difference between the two (P = 0.54).
  
  
  CONCLUSIONS
  The assumption in the past has always been that patients presenting in coma from traumatic diffuse brain injury will do worse than those that have a mass lesion amenable to surgical decompression. Our series would suggest that this is not the case and all severely head injured patients should expect similar outcome when cared for in a neuroscience centre.
authors.affiliation: Division of Neurosurgery, GMNC, Manchester Academic Health Sciences Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, UK. omar.pathmanaban@manchester.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Leach
authors.forename: Omar N
authors.initials: ON
authors.lastname: Pathmanaban
authors.forename: Hiren C
authors.initials: HC
authors.lastname: Patel
authors.forename: Julian
authors.initials: J
authors.lastname: Evans
authors.forename: Raphael
authors.initials: R
authors.lastname: Sacho
authors.forename: Richard
authors.initials: R
authors.lastname: Protheroe
authors.forename: Andrew T
authors.initials: AT
authors.lastname: King