Predictive Factors of Survival and 6-Month Favorable Outcome of Very Severe Head Trauma Patients; a Historical Cohort Study

• Main Authors: Karin Vathanalaoha, Thakul Oearsakul, Thara Tunthanathip
• Format: Article
• Language: English
• Published: Shahid Beheshti University of Medical Sciences 2016-12-01
• Series: Emergency
• Subjects: Glasgow coma scale; head injuries, closed; prognosis; treatment outcome; outcome assessment
• Online Access: http://journals.sbmu.ac.ir/emergency/article/view/11785

<p><strong>Introduction</strong>: 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. <strong>Methods:</strong> 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. <strong>Results:</strong> 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. <strong>Conclusion: </strong>Based on the results of present study, the survival rate of patients with very severe head trauma (GCS &lt; 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.</p>