Article
The predictive value of early clinical findings in coma after head injury. A multicenter study on multiple injuries
Prospektive Bedeutung früher klinischer Befunde bei Koma nach Schädel-Hirn-Trauma. Ergebnisse einer Multizenterstudie bei traumatischen Mehrfachverletzungen
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Published: | April 23, 2004 |
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Outline
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Objective
The reliability of different neurological findings measured 24 hours after head injury, was analysed.
Methods
In a multicenter study on 650 patients neurological findings 24 hours after head injury were correlated with clinical and radiological data from the place of accident, the time of hospital admittance, the course on the intensive care unit (ICU) and to outcome as defined by the Glasgow Outcome Score (GOS) 6 months postinjury.
Results
Low blood oxygen saturation at the place of accident was significantly correlated with the presence of decerebrate rigidity, anisocoria and bilaterally fixed pupils. Systolic blood pressure at the place of accident as well as mean ICP and CPP on ICU also correlated significantly with neurological findings and concomitant haemorrhages of thorax and abdomen. These data predict the duration of coma and are also correlated with the compression of the basal cisterns on the initial computertomography scan (CT) and a poor outcome and a high mortality.
Conclusions
Parameters like decerebrate rigidity or pupillary dysfunctions are of the highest predictive value. The initial systolic blood pressure is of equally high predictive value, as recordings below 80 mmHg indicate concomitant lesions with a high mortality.