SEVERE HEAD-INJURY - SHOULD EXPECTED OUTCOME INFLUENCE RESUSCITATION AND 1ST DAY DECISIONS

被引：51

作者：

KAUFMANN, MA

BUCHMANN, B

SCHEIDEGGER, D

GRATZL, O

RADU, EW

机构：

[1] Department of Anesthesia and Intensive Care, University of Basel/Kantonsspital

[2] Department of Neurosurgery, University of Basel/Kantonsspital

[3] Department of Neuroradiology, University of Basel/Kantonsspital

来源：

RESUSCITATION | 1992年 / 23卷 / 03期

关键词：

HEAD INJURY; RESUSCITATION; PROGNOSIS; OUTCOME;

D O I：

10.1016/0300-9572(92)90003-U

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

An early 'prognosis' based on initial findings can influence clinical decisions. To evaluate the quality of first-day outcome prediction based on either clinical or neuroradiological information, we prospectively examined 100 consecutive severely head-injured patients from the surgical intensive care unit. The prognoses were always made by the same experienced neurosurgeon and neuroradiologist according to a contracted Glasgow Outcome Scale (GOS). Every patient's outcome was predicted according to a three-class GOS within 24 h after injury. Correct 'first-day' prognoses were made in 59 and 56% of the cases by the neuroradiologist and neurosurgeon, respectively. In those instances where the prognoses made by the clinician and the radiologist coincided, the prognoses were correct for 73% of the patients. Based on accepted criteria, the neuroradiologist tended to overpredict favorable outcomes and missed many of the unfavorable outcomes (dead or vegetative) whereas the clinician overestimated unfavorable outcomes. Our study showed that outcome prognosis of patients with severe head injury has limited accuracy when made within 24 h after the injury, although an improvement in accuracy occurred when there was agreement between clinical and radiological predictions. Even with sophisticated clinical and radiological technologies, it is not possible to predict outcome on the first day after the accident with sufficient accuracy to guide early management.

引用

页码：199 / 206

页数：8

共 21 条

[1]

Jennett, Teasdale, Braakman, Minderhoud, Heiden, Kurze, Prognosis of patients with severe head injury, Neurosurgery, 4, pp. 283-289, (1979)

[2]

Jennett, Teasdale, Braakman, Minderhoud, Knill-Jones, Predicting outcome in individual patients after severe head injury, Lancet, 1, pp. 1031-1034, (1976)

[3]

van Dongen, Braakman, Gelpke, The prognostic value of computerized tomography in comatose head-injured patients, J. Neurosurg., 59, pp. 951-957, (1983)

[4]

Braakman, Gelpke, Habbema, Maas, Minderhoud, Systematic selection of prognostic features in patients with severe head injury, Neurosurgery, 6, pp. 362-370, (1980)

[5]

Teasdale, Head injuries are badly managed in accident and emergency departments and neurosurgeons are partly to blame, Arch. Emerg. Med., 3, pp. 123-134, (1984)

[6]

Barlow, Teasdale, Prediction of outcome and the management of severe head injuries: the attitudes of neurosurgeons, Neurosurgery, 19, pp. 989-991, (1986)

[7]

Buchmann, Kaufmann, Scheidegger, Gratzl, Schwere Schadelhirntraumata: Nordwestschweiz 1984–1989, Schweiz. Med. Wschr., 121, pp. 214-220, (1991)

[8]

Jennet, Teasdale, Management of Head Injuries, pp. 301-316, (1981)

[9]

Baker, O'Neill, Haddon, Long, The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care, J. Trauma, 14, pp. 187-193, (1974)

[10]

Narayan, Greenberg, Miller, Enas, Choi, Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning and intracranial pressure, J. Neurosurg., 54, pp. 751-762, (1981)

← 1 2 3 →