Comparison of outcome in two series of patients with severe head injuries

Gj, Gelpke; Braakman, R.; Jd, Habbema; Hilden, Joanne M.

doi:10.3171/jns.1983.59.5.0745

Cited by 45 publications

(16 citation statements)

References 18 publications

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“…While the maintenance of cardiorespiratory stability is beneficial to patients who sustain a head injury [18,19], the role of intensive care with ICP measurement and control in head-injured patients remains a subject of discussion [19,20,21,22,23,24]. Our data do not support or refute the suggestion that basic intensive care is desirable in severe head injury, since basic ICU care was available during both study epochs.…”

Section: Discussioncontrasting

confidence: 52%

Specialist neurocritical care and outcome from head injury

et al. 2002

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Specialist neurocritical care with protocol-driven therapy is associated with a significant improvement in outcome for all patients with severe head injury. Such management may also benefit patients requiring no surgical therapy, some of whom may need complex therapeutic interventions. We found it impossible to predict need for such interventions from clinical features at presentation. These data suggest that specialist critical care with ICP/CPP guided therapy may benefit patients with severe head injury.

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Section: Discussioncontrasting

confidence: 52%

Specialist neurocritical care and outcome from head injury

et al. 2002

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“…Therefore, scores cannot be averaged, statistical comparisons are limited, and comparisons among studies are difficult. To date, all CER studies in TBI have used either mortality or rate of unfavorable outcome as an end-point (Colahan et al, 1989;Gelpke et al, 1983;Lingsma et al, 2011). However, mortality as a measure provides no information about the quality of life of the survivors, and the use of dichotomous end-points such as favorable or unfavorable recovery may overestimate the effectiveness of treatments that produce results clustering near the cut-off point between these two groups.…”

Section: Journal Ofmentioning

confidence: 96%

Relating Quality of Life to Glasgow Outcome Scale Health States

Kosty

Macyszyn²,

Lai³

et al. 2012

Journal of Neurotrauma

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There has recently been a call for the adoption of comparative effectiveness research (CER) and related research approaches for studying traumatic brain injury (TBI). These methods allow researchers to compare the effectiveness of different therapies in producing patient-oriented outcomes of interest. Heretofore, the only measures by which to compare such therapies have been mortality and rate of poor outcome. Better comparisons can be made if parametric, preference-based quality-of-life (QOL) values are available for intermediate outcomes, such as those described by the Glasgow Outcome Scale Extended (GOSE). Our objective was therefore to determine QOL for the health states described by the GOSE. We interviewed community members at least 18 years of age using the standard gamble method to assess QOL for descriptions of GOSE scores of 2-7 derived from the structured interview. Linear regression analysis was also performed to assess the effect of age, gender, and years of education on QOL. One hundred and one participants between the ages of 18 and 83 were interviewed (mean age 40 ± 19 years), including 55 men and 46 women. Functional impairment and QOL showed a strong inverse relationship, as assessed by both linear regression and the Spearman rank order coefficient. No consistent effect or age, gender, or years of education was seen. As expected, QOL decreased with functional outcome as described by the GOSE. The results of this study will provide the groundwork for future groups seeking to apply CER methods to clinical studies of TBI.

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“…Gelpke and colleagues [35] found higher survival rates in centres with a more 'conservative' management regimen compared with more 'aggressive' treatment. Patel and colleagues [36] compared functional outcome between patients managed according to a contemporary ICP-guided protocol and historical controls from their own centre.…”

Section: Do We Know How To Manage Raised Icp?mentioning

confidence: 97%

Does ICP monitoring make a difference in neurocritical care?

Cremer

2008

European Journal of Anaesthesiology

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Raised intracranial pressure and low cerebral perfusion pressure are associated with ischaemia and poor outcome after brain injury. Therefore, many management protocols target these variables. However, there are no randomized controlled trials that have demonstrated the effectiveness of intracranial pressure-guided care in severely head-injured patients. Observational studies of such therapy have yielded inconsistent results, ranging from decreased mortality to no effect or increased morbidity or mortality. A recent cohort study supports the notion that the possible benefits of intracranial pressure monitoring after traumatic brain injury are small - if present - and would exceed a number needed for the treatment of 16. Furthermore, intracranial pressure monitoring and aggressive management of intracranial pressure and cerebral perfusion pressure have been associated with increased lengths of stay in the neurocritical care unit, conceivable costs and possibly an increased rate of complications. Against this background, there is sufficient clinical equipoise to warrant an adequately powered randomized controlled trial to compare intracranial pressure-guided care with supportive critical care without intracranial pressure monitoring in patients with severe traumatic brain injury. However, the realization of such a trial is likely to be problematic for a number of reasons, not least of which the firmly held biases of many clinicians.

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Comparison of outcome in two series of patients with severe head injuries

Cited by 45 publications

References 18 publications

Specialist neurocritical care and outcome from head injury

Specialist neurocritical care and outcome from head injury

Relating Quality of Life to Glasgow Outcome Scale Health States

Does ICP monitoring make a difference in neurocritical care?

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