Outcome Of Head Injury Research Articles

Variability in mild head injury outcome as a function of admission Glasgow coma scale score

Variability in mild head injury outcome as a function of admission Glasgow coma scale score

The abbreviated injury scale as a predictor of outcome of severe head injury

This study examined the correlation between the worst abbreviated injury scale 1990 (AIS) intracranial severity score and outcome following severe head injury. The initial CT scans of 109 severely head injury patients were examined by a neuroradiologist and classified according to the worst applicable intracranial severity code from the AIS. This score was then correlated with the glasgow outcome scale (GOS) at 6 months. For comparison, the GOS was also correlated with the diffuse injury scale (DIS) described by L.F. Marshall et al. [5], the worst post-resuscitation Glasgow coma score (GCS) in the first 24 h, and the head injury outcome prediction tree described by Choi et al. [1]. Our results show Spearman rank correlation coefficients of 0.58 (p < 0.001), 0.47 (p < 0.001), 0.45 (p < 0.001), and 0.31 (p < 0.01) for the correlation between the AIS, prediction tree, DIS, and GCS respectively and the GOS. Independent outcome (i.e. GOS good or moderate) was strongly predicted by an AIS of 3 or less (positive predictive value 95%, specificity 98%, sensitivity 40%, likelihood ratio 25:1). Death or vegetative survival was less strongly predicted in patients with an AIS of 5 (positive predictive value 71%, specificity 75%, sensitivity 67%, likelihood ratio 2.7:1). The AIS, based on initial CT scan, provides useful prognostic information in patients with severe head injury.

Prediction of outcome in severe head injury based on recognition of sleep related activity in the polygraphic electroencephalogram.

This study shows that the continuing presence of activity similar to normal sleep in the EEG in conjunction with the EEG polygraph (EEGP) can be used to determine the severity of brain damage after head injury. Recordings were taken within seven days of head injury from 154 unselected patients after resuscitation and emergency surgery. Sixteen patients with ongoing seizures were excluded. In the remaining 138 patients the presence of activity in the EEG, EEGP, or both, which can also be recognised in normal alertness and sleep, was noted. Particular attention was paid to the presence or absence of arousal related phasic activity involving EEG, motor, and autonomic changes. The traces were allocated to one of five groups: group 1, wakeful traces with normal alpha in at least one hemisphere; group 2, sleep-like traces with K complexes responsive to stimulation; group 3, traces with phasic activity related to abnormal spontaneous arousal including EEG changes; group 4, traces with abnormal spontaneous arousal activity without EEG changes; group 5, traces with no spontaneous arousal activity. The mean follow up was 21.5 months. Groups 2 and 3 were significantly associated with a good outcome and group 5 with death or a vegetative state. Comparison between the EEG/EEGP findings and the Glasgow coma scale at the time of the recording showed the EEG/EEGP to be the better predictor of outcome, particularly for individual patients.

Factors Related to the Presence of Head Injury in Bicycle-Related Pediatric Trauma Patients

Using data from the National Pediatric Trauma Registry, this study examined the characteristics of bicycle-related head injury, factors related to the presence of head injury, and different outcomes of head injury up to the time of discharge. Of the 2,333 patients ages 0 to 14 years who were admitted to trauma centers because of bicycle-related injury during 1989 through 1992, more than one-half (54%) sustained head injury, predominantly concussions and skull fractures. With adjustment for age, sex, and motor vehicle involvement, children who had pre-existing mental disorders, who did not wear a helmet at the time of injury, or who were injured on roads had a significantly increased likelihood of sustaining head injuries. Patients with a head injury were four times as likely as patients with no head injury to be treated in intensive care units, and were almost twice as likely to develop complications. Head injury was associated with an increased risk of inhospital fatality and high prevalence rates of communication and behavior impairments at discharge. Although it is urgent to increase helmet use substantially by child bicyclists, special attention should be paid to high-risk groups, such as children with mental disorders and children who are likely to ride in traffic.

EEG reactivity in the prognosis of severe head injury

We compared reactivity of EEG to external stimuli--an easily and quickly available measure--with the central conduction time (CCT) of the somatosensory evoked potentials, currently the most-used electrophysiologic method to predict outcome in severe head injury (SHI), and with the initial Glasgow Coma Scale (GCS) score. In 50 patients, comatose subsequent to SHI, we measured EEG reactivity and CCT within 48 to 72 hours and compared them with the outcome after 1.5 years. Using discriminant analysis, EEG reactivity correctly classified 92%, CCT classified 82%, and both measures together classified 98% of the patients into globally good or bad outcome groups. GCS allowed a correct classification in only 72% and, combined with either of the two electrophysiologic measures, did not further increase predictability. EEG reactivity is an excellent long-term global outcome predictor in SHI, superior to CCT and GCS. When the two electrophysiologic measures are combined, a prognostic accuracy is achieved that is better than that of any other reported method.

Neuropsychological outcome and quantitative neuroimaging in mild head injury,

Four cases of well-documented mild traumatic brain injury (Glasgow Coma scores ≥ 13) in whom preinjury neuroimaging studies were available (three with computerized tomography and one with magnetic resonance [MR] imaging) were examined in terms of postinjury MR imaging and neuropsychological outcome. All scans were subjected to quantitative analysis by measuring ventricular volumes and calculating a ventricle-to-brain ratio. Since ventricular measurements provide an index of parenchymal integrity, any systematic increase in postinjury ventricle size would be an indication of tissue loss. In addition to using the preinjury scan for a within-subject design in comparing postinjury changes, similar MR measures were obtained on a group of medical controls. Despite neuropsychological findings that suggested significant sequelae, quantitative postinjury MR studies did not show differences between preinjury neuroimaging or medical control subjects.

Intracerebral temperature monitoring in severely head injured patients.

In a series of 6 severely head injured patients, intraventricular as well as rectal, bladder and jugular vein temperature is recorded. The relationship between these temperatures in different conditions is evaluated. Intracerebral temperature is 0.5 +/- 0.2 degrees C (mean +/- SD) higher than bladder temperature except in conditions such as brain death. It is concluded that rectal temperature is not representative and therefore not a good alternative to the measurement of brain temperature. More data on human intracerebral temperature are mandatory as well as prospective studies correlating intracerebral temperature with final outcome in head injury.

One year psychosocial outcome in head injury.

Psychosocial outcome at one year post-injury was examined prospectively in 466 hospitalized head-injured subjects, 124 trauma controls, and 88 friend controls. The results indicate that head injury is associated with persistent psychosocial limitations. However, the presence and extent of limitations are related to the demographics of the population injured, to other system injuries sustained in the same accident, and particularly to the severity of the head injury. More severe head injuries are associated with limitations implying greater dependence on others including poorer Glasgow Outcome Scale (GOS) ratings, dependent living, unemployment, low income, and reliance on family and social subsidy systems. Head injury severity is more closely related to more objective indices of psychosocial outcome (e.g., employment) than to self-perceived psychosocial limitations, such as measured by the Sickness Impact Profile (SIP).

Neuropsychological outcome and quantitative neuroimaging in mild head injury

Four cases of well-documented mild traumatic brain injury (Glasgow Coma scores > or = 13) in whom preinjury neuroimaging studies were available (three with computerized tomography and one with magnetic resonance [MR] imaging) were examined in terms of postinjury MR imaging and neuropsychological outcome. All scans were subjected to quantitative analysis by measuring ventricular volumes and calculating a ventricle-to-brain ratio. Since ventricular measurements provide an index of parenchymal integrity, any systematic increase in postinjury ventricle size would be an indication of tissue loss. In addition to using the preinjury scan for a within-subject design in comparing postinjury changes, similar MR measures were obtained on a group of medical controls. Despite neuropsychological findings that suggested significant sequelae, quantitative postinjury MR studies did not show differences between preinjury neuroimaging or medical control subjects.

The long-term outcome of head injury: implications for service planning.

As most of those experiencing traumatic brain injury tend to be young, disabled survivors will be gradually accruing in each locality as each year passes. How many need continuing care a decade after injury? How many need day care, or need help with finding work, or continuing support for carers? 190 patients who had been admitted to two UK regional neurosurgical units on average some 7 years earlier were followed up. With an average age of 29 years these patients stayed in hospital for an average 33 days. At follow-up 23% were classified as having moderate disability or worse on the Glasgow Outcome Scale, including 7.4% who had died subsequent to discharge. Survivors were given a neuropsychological assessment and a socioeconomic interview. Of the survivors, 17% had failed to make a good recovery, but 36% were failing to occupy their time in a meaningful way. Age over 30 at time of injury, not occupied before injury, and above-average length of stay were some of the predictors for failing to occupy time. Quality of life was severely curtailed for those who could not occupy their time, as was the case for their carers. Appropriate counselling, vocational evaluation and family support in the early years following injury may help to improve quality of life for both the head-injured person and their carers.

Variability in mild head injury outcome as a function of admission Glasgow coma scale score

Journal Article Variability in mild head injury outcome as a function of admission Glasgow coma scale score Get access V.P. Culotta, V.P. Culotta Search for other works by this author on: Oxford Academic PubMed Google Scholar M.E. Sementilli, M.E. Sementilli Search for other works by this author on: Oxford Academic PubMed Google Scholar K. Gerold, K. Gerold Search for other works by this author on: Oxford Academic PubMed Google Scholar J. Pafford J. Pafford Search for other works by this author on: Oxford Academic PubMed Google Scholar Archives of Clinical Neuropsychology, Volume 10, Issue 4, 1995, Pages 315–316, https://doi.org/10.1093/arclin/10.4.315 Published: 01 July 1995

Longterm outcome of head injuries: a 23 year follow-up study of children with head injuries

Longterm outcome of head injuries: a 23 year follow-up study of children with head injuries

Prognosis of rehabilitation outcome in head injury using the Disability Rating Scale

In this correlational study, we investigated the prediction of functional status on discharge from head injury rehabilitation in 64 adults with traumatic closed head injury. Subjects were rated on Rappaport's Disability Rating Scale during rehabilitation to obtain the Disability Rating Score on admission to rehabilitation, recovery rate during the first month of rehabilitation, and discharge Disability Rating Score. Potential prognostic variables included demographic and social characteristics, severity of injury indicators, head injury deficits present on admission to rehabilitation, and initial Disability Rating Score, and recovery rate. Multiple regression analyses were performed to determine if discharge Disability Rating Score could be predicted from subsets of the potential prognostic variables. Significant contributions were made to the regression equations by initial Disability Rating Score, recovery rate, post-traumatic amnesia and cognitive deficits. A single multiple regression containing the four significant predictors retained initial Disability Rating Score and recovery rate as significant. The findings were cross-validated on a new sample of 30 head injury patients. Initial Disability Rating Score on admission to rehabilitation emerged as a useful predictor of rehabilitation outcome.

Long term exposure to heat protects against brain damage induced by closed head injury in the rat

Closed head injury leads to delayed tissue-edema, necrosis and impaired neurological function. In the present study the effect of chronic exposure to heat on the outcome of head injury in rats was investigated. Rats were held at ambient temperature of 24°C (CON) or 34°C (heat acclimated, ACC) for one month, before induction of trauma. Injury was induced by a weight drop device, falling over the left cerebral hemisphere. Twenty-four or 48 h later the rats were sacrificed and their brains removed for evaluation of edema (specific gravity or water content). Blood-brain barrier integrity (Evans blue extravasation) was evaluated 4 h after injury. One, 24 and 48 h after injury the rats were evaluated by a set of criteria which yields their clinical status (Neurological Severity Score - NSS). Forty-eight hours after trauma specific gravity of the contused hemispheres was 1.0389 ± 0.0019 and 1.0364 ± 0.0007 (P < 0.01) and water content 81.44 ± 1.28 and 84.17 ± 1.03% (P < 0.001), for ACC and CON rats, respectively. Lower degree of edema was also evident at 24 h suggesting slower rate of edema formation in ACC rats. Evans blue uptake by the contused hemisphere was 315 ± 61 and 50 ± 23 ng/g tissue in the CON and ACC rats, respectively (P < 0.001). Clinical recovery of the ACC rats was significantly better (P < 0.001) than that of the matched controls as exhibited at 48 h by median NSS values of: 10.8 (range 6-16) and 5 (range 4-6) for CON and ACC, respectively. Based on the present results we suggest that heat acclimation offers protection to rats subjected to head trauma.

Late outcome of mild head injury: results from a controlled postal survey.

There is insufficient information about the long-term sequelae of mild head injury (postconcussional symptoms, PCS). Therefore, a questionnaire-based investigation was carried out in patients 1-5 years after mild head injury (MHI) and in non-concussed subjects in order to study the nature of long-term complaints after MHI. A three-factor model of residual subjective and psychological complaints that contained a dysthymic factor, a vegetative/bodily complaints factor, and a cognitive performance factor were identified in the patient population. Three rating scales were constructed from the relevant items or factors, and were used to compare the MHI patients with non-concussed controls. It was found that the profile of distresses and discomforts mentioned by a population of MHI patients 1-5 years after the trauma was similar to that of a non-concussed control population. These symptoms were indistinguishable from those encountered in ordinary everyday life. These symptoms were significantly more severe in the MHI patients. Stepwise regression analysis in the patient population indicated that a number of parameters were statistically of predictive importance: comorbidity, sex, and neurological complication at the time of the trauma. The results support the hypothesis that MHI may not ever be completely reversible.

Head trauma.

Progress in research includes studies concerning the pathophysiology and outcome of pediatric head injury, the pathology of the hippocampus in fatal injury, and the use of multivariate statistics to predict outcome in survivors. Recent research has confirmed and extended findings regarding the differential effects of closed head injury, depending on the age of the individual. These studies indicate that the consequences of head injury are more severe in older adults and in children younger than 2 years. Neuroimaging findings include evidence for delayed brain injury as a major cause of mortality and disability. Functional brain imaging provides evidence for cerebral dysfunction that is not appreciated by structural brain imaging techniques and may have a stronger relationship to neurobehavioral sequelae. The neurobehavioral sequelae frequently implicate frontal dysfunction, even in the absence of structural findings on computed tomography or magnetic resonance imaging. Studies of mild head injury have expanded our knowledge concerning the pathogenesis of postconcussional symptoms, including a preinjury vulnerability based on recent life events. Persistent postconcussional symptoms after mild head injury are frequently associated with emotional disturbance of clinical proportions.

Blunt trauma in children: Causes and outcomes of head versus extracranial injury: I. Lescohier, and C. DiScala. Pediatrics, 91(4), 721–725

A subset of the National Pediatric Trauma Registry was analyzed to describe causes and outcomes of blunt trauma among children younger than age 15 years. This subset, of 8639 children with blunt trauma, was divided into three groups according to the injured body region: a group with extracranial injury only (ECI) accounted for one half of the population, and the remainder were equally distributed between a group with head injury only (HI) and one with both conditions (ECI + HI). The three groups were compared with respect to demographic characteristics, external cause of injury, injury severity, and outcomes. Falls were the leading cause of injury in the HI group, where children were younger, whereas traffic-related injuries predominated in children with ECI or ECI + HI. Pedestrian injuries accounted for a significant share of poor outcomes. The highest proportions of deaths and severe injuries were observed in the mixed group (ECI +HI), and the lowest, in the ECI group. In contrast, functional impairments at discharge were most frequently noted in the ECI group, where 60% of the children were discharged with at least one impairment. While only 6% of children with HI were discharged with impairment, those affected exhibited more deficits in cognition and behavior, which are expected to persist longer than dysfunction in activities of daily living.

Long term effects of closed head injuries in sport.

Closed head injury has been defined by several authors, but is not agreed upon. The incidence of closed head injury in sports is relatively small, but because the effects may be catastrophic it is an important topic. Forces may be applied to the head from different directions, which results in different types of lesions. The anatomical and physiological changes with head injury have been suggested to explain head injury outcomes. Effects on intelligence and memory have also been reported. Posture had been proposed as a model to examine the subtle effects of head injury. Vision, vestibular input, and somatosensory input are all involved in maintenance of posture. The interaction of these sensory modalities is also pertinent to posture maintenance. Somatosensory input appears to be improperly processed, while vision and vestibular input seem to compensate for lost somatosensation. Attention to regaining the somatosensory component, rather than waiting for compensation to occur, should be addressed in rehabilitation programmes.

Neurologic Trauma Concerns

Patients with underlying medical illnesses or conditions will comprise a progressively larger proportion of head-injury patients given the aging of the general population and improved survival in serious illnesses. Age and underlying illness can influence the presentation, management, and outcome of head injuries by increasing the frequency, severity, and complications from head injury. This article examines the conditions that are most often associated with head injury.

Disability following head injury.

Disability following head injury varies depending on injury mechanism, neuropathology, and other factors, including medical complications. Mild head injury (Glasgow Coma Scale score 13-15) has been shown to have considerable variability in outcome. Some persons experience rapid symptom resolution whereas others continue to evidence symptoms for an extended duration. A small, but clinically significant number of patients may be neuropsychologically and occupationally disabled at least up to 1 year postinjury. Methodological problems continue to plague mild head injury outcome studies. In contrast, moderate (Glasgow Coma Scale score 9-12) and severe head injury (Glasgow Coma Scale score 3-8) result in more consistent patterns of disability following injury. In general, patients who sustain moderate to severe head injury tend to experience persistent and extensive neuropsychological, psychiatric, and occupational impairment. The impact of rehabilitative interventions is variable and dependent on injury severity, intervention type, and outcome criteria.