Early prediction of outcome in severe head injury patients with evacuated mass lesions.

Abstract

To clarify the early prediction of outcome in severe head injury patients with evacuated mass lesions, 32 patients with a Glasgow Coma Scale (GCS) score of 8 or less were classified as having a good outcome (11 cases) or a poor outcome (21 cases). The following parameters affecting the prognosis were analyzed, i,e., the patient's age and sex, type of injury, the presence of hypotension and/or hypoxia, time from injury to arrival at the emergency room and/ or operating room, the admission GCS, pupillary abnormalities, CT findings, and continuous monitoring of intracranial pressure (ICP), cerebral perfusion pressure (CPP) and jugular venous oxygen saturation (SjO2) for 1-5 days after the injury. The patient's age, the admission GCS score, ICP on day 1 after the injury, and CPP on day 0 after injury were powerful factors that affected the prognosis. Other parameters showed little difference between the two groups. However, the presence of hypotension and/or hypoxia showed a tendency for poorer outcomes, and episodes of jugular venous desaturation (SjO2<50%) were common during the initial 3 days in the poor outcome group. These results suggest that the first prognostic evaluation can be performed after 3 days by considering primary and secondary brain damage. (JJAAM 1998; 9: 95-101)