title: Predictive Factors of Survival and 6-Month Favorable Outcome of Very Severe Head Trauma Patients; a Historical Cohort Study.
abstract: BACKGROUND
  Very severe head trauma cases, defined as Glasgow Coma Scale (GCS) scores of less than 6, have a higher mortality rate and poorer outcome. The purpose of this study was to recognize factors associated with survival and 6-month favorable outcome of very severe head trauma patients presenting to emergency department.
  
  
  METHODS
  In this historical cohort study, the authors retrospectively reviewed medical records of head trauma patients who were admitted to the emergency department with post-resuscitation GCS scores of less than 6. Both univariate and multivariate analyses were used to test the association between various parameters with survival and 6-month outcome.
  
  
  RESULTS
  103 cases with the mean age of 39 ± 16.5 years were studied (80% male). The overall survival rate was 41.7% and the rate of 6-month favorable outcome was 28.2%. In multivariate analysis, brisk pupil light reaction on admission and patent basal cistern on brain computed tomography (CT) scan were significant factors associated with both survival (OR 5.20, 95% CI 1.57-17.246, p = 0.007 and OR 3.65, 95% CI 1.22-10.91, p=0.02 respectively) and favorable outcome (OR 4.07, 95% CI 1.35-12.24, p=0.01 and OR 3.54, 95% CI 1.22-10.26, p 0.02), respectively.
  
  
  CONCLUSIONS
  Based on the results of present study, the survival rate of patients with very severe head trauma (GCS < 6) was 41.7%. The strong predictors of survival and 6-month favorable outcome of these patients were brisk pupillary reactivity and patent cistern on brain CT scan. It seems that very severe head trauma patients still have a reasonable chance to survive and aggressive management should be continued.
authors.affiliation: Neurosurgical unit, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Karin
authors.initials: K
authors.lastname: Vathanalaoha
authors.affiliation: Neurosurgical unit, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Thakul
authors.initials: T
authors.lastname: Oearsakul
authors.affiliation: Neurosurgical unit, Department of Surgery, Faculty of Medicine, Songklanagarind Hospital Prince of Songkla University, Hat Yai, Songkhla, Thailand.
authors.forename: Thara
authors.initials: T
authors.lastname: Tunthanathip
keywords: Glasgow coma scale; closed; head injuries; outcome assessment; prognosis; treatment outcome