Can glasgow score at discharge represent final outcome in severe head injury?

Abstract

Background:Patients with head injury continue to improve over time and a minimum follow-up of six months is considered necessary to evaluate outcome. However, this may be difficult to assess due to lack of follow-up. It is also well known that operated patients who return for cranioplasty usually have the best outcome.Aims and Objectives:To assess the outcome following severe head injury using cranioplasty as a surrogate marker for good outcome.Materials and Methods:This was a retrospective study carried out from January 2009 to December 2010. All patients with severe head injury who underwent decompressive craniectomy (DC) in the study period were included. Patients who came back for cranioplasty in the same period were also included. Case records, imaging and follow up visit data from all patients were reviewed. Glasgow Coma Score (GCS) on admission and Glasgow Outcome Score (GOS) at discharge were assessed.Observations and Results:Of the 273 patients, 84.25% (n=230) were males and 15.75% (n= 43) were females. The mean age was 34.3 years (range 2-81 years, SD 16.817). The mean GCS on admission was 5.615 (range 3-8, SD 1.438). The in-hospital mortality was 54% (n=149). Good outcome (GOS of 4 or 5) at discharge was attained in 22% (n=60) patients. Sixty five patients returned for cranioplasty (with a GOS of 4 or 5) during the study period. There was no statistical difference in the number of patients discharged with good outcome and those coming back for cranioplasty in the study period (P>0.5). Patients who came back for cranioplasty were younger in age (mean age 28.815 years SD 13.396) with better admission GCS prior to DC (mean GCS 6.32 SD1.39).Conclusions:In operated severe head injury patients significant number of patients (24% in our study) have excellent outcome. However, insignificant number of patients had further improvement to GOS 4 or 5 (good outcome) from the time of initial discharge. This suggests that due to lack of intensive rehabilitative facilities, GOS at discharge may be representative of final outcome in the vast majority of cases of severe head injury in developing countries like India

Head Injury-A Neglected Public Health Problem: A Four-Month Prospective Study at Jimma University Specialized Hospital, Ethiopia

“…Another reason for the low percentage of this group is their frequent habit of early self-discharge before proper records are taken. The overall mortality rate of 21.2% and the mortality rate of 57.9% in severe head injuries are similar to other studies conducted in Nigeria, Kenya, Benin and India (18, 19, 21, 23, 25). Initial GCS and pupilary reaction have been identified as valid outcome predictors in this study like in many other studies (17, 18).…”

“…This shows that further treatment after discharge is needed. Outcome improvement of severe head injury patients is not only about enhancing acute care but providing rehabilitation facilities (19). …”

Decompressive craniectomy in traumatic brain injury: A single-center, multivariate analysis of 1,236 patients at a tertiary care hospital in India

“…Hence, the factors predicting outcome in the present study were analyzed for their short-term GOS at discharge rather than analyzing the follow-up GOS that was only available in a limited subgroup. The assumption used here was that there is usually no statistical difference between GOS at discharge and at a follow-up at 6 months as shown in a study by Agrawal et al [23] In a retrospective cohort of 55 patients with severe head injury, Pompucci et al, [24] showed that age >65 years and a poor GCS (3)(4)(5) at presentation were adversely associated with the functional outcome in TBI patients undergoing a DC. Similarly, Hukkelhoven et al, [6] performed a meta-analysis of 5,600 patients with severe TBI, and found that the association between the patient's age and outcome is a continuous one that is inversely related.…”

Management and outcome of moderate head trauma: our experience

“…We found that total number of cases treated surgically was 17 cases (28.3%) and 43 cases (71.6%) were treated conservatively. According to outcome 36 cases (60%) were alive and 24 cases (40%) died, all cases managed in ICU, figures (1,2).…”

“…So the lower GCS, the more chance for surgical treatment and the worst outcome. Perel et al (2008) and Agrawal et al (2012) considered that GCS after full resuscitation was one of the most important predictor factor of outcome after TBI. Baum J. et.al.…”