AGGRESSIVE MANAGEMENT OF SEVERE CLOSED HEAD TRAUMA: TIME FOR REAPPRAISAL

The records of 187 patients (age 6 months to 82 years) who sustained severe closed head injuries and were admitted to a neurosurgical unit between 1983 and 1987 were retrospectively reviewed. The aim was to develop a scale for selecting patients whose death could be predicted with certainty at an early stage and who should therefore not receive prolonged intensive care. The scale was prospectively tested on 52 comparable patients admitted during 1988 and was found to be accurate with no falsely pessimistic predictions. The score is based mainly on clinical observations within 12 h of presentation.

[1]  J. Selhorst,et al.  Further experience in the management of severe head injury. , 1981, Journal of neurosurgery.

[2]  R. Narayan,et al.  Early insults to the injured brain. , 1978, JAMA.

[3]  R. Narayan,et al.  Enhanced specificity of prognosis in severe head injury. , 1988, Journal of neurosurgery.

[4]  B. Jennett,et al.  ASSESSMENT OF OUTCOME AFTER SEVERE BRAIN DAMAGE A Practical Scale , 1975, The Lancet.

[5]  J. Miller,et al.  Reversible brain-stem dysfunction following acute traumatic subdural hematoma: a clinical and electrophysiological study. , 1981, Journal of neurosurgery.

[6]  N. Dearden,et al.  Effect of high-dose dexamethasone on outcome from severe head injury. , 1986, Journal of neurosurgery.

[7]  McDowall Dg,et al.  Intensive management of severe head injuries , 1983 .

[8]  J. Habbema,et al.  Systematic selection of prognostic features in patients with severe head injury. , 1980, Neurosurgery.

[9]  M. Rosner,et al.  Significance of intracranial hypertension in severe head injury. , 1977, Journal of neurosurgery.

[10]  M. Klauber,et al.  Outcome from head injury related to patient's age. A longitudinal prospective study of adult and pediatric head injury. , 1988, Journal of Neurosurgery.

[11]  R. Gibson,et al.  Intensive management of severe head injuries. A scheme of intensive management of severe head injuries. , 1983, Anaesthesia.

[12]  R. Knill-Jones,et al.  The prediction of outcome of patients admitted following head injury in coma with bilateral fixed pupils. , 1979, Acta neurochirurgica. Supplementum.

[13]  N. Dearden,et al.  Assessment of Leeds device for monitoring intracranial pressure. , 1984, Journal of neurosurgery.

[14]  B Jennett,et al.  PREDICTING OUTCOME IN INDIVIDUAL PATIENTS AFTER SEVERE HEAD INJURY , 1976, The Lancet.

[15]  G G Enas,et al.  Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure. , 1981, Journal of neurosurgery.