Prognostic factors in traumatic brain injury and their association with outcome

Abstract

Introduction. Traumatic brain injuries (TBI) are a real social problem, with an upward trend worldwide. TBI is the leading cause of death and disability, especially among young men. Each year in Europe, and also in Poland, 243 per 100,000 individuals suffer from TBI. Assessing prognosis after traumatic brain injury is very important in order to help clinicians to make a decision about the implementation of specific methods of treatment, and to make communication with the patient and the patient's family easier. Objective. The objective of this review was to present prognostic factors, to assess outcomes within a short time after a moderate to severe traumatic brain injury, as well as to predict functional outcome. The most important independent variables were: age, Glasgow Coma Scale (GCS) motor score, pupil response, Marshall CT classification and traumatic subarachnoid haemorrhage. Other important prognostic factors included hypotension, hypoxia, glucose, coagulopathy, haemoglobin and category of CT characteristic, such as midline shift, mass lesion, basal cistern. Conclusions. Gender and intraventricular haemorrhage did not have predictive value. This subject needs much more research in the area of new prognostic factors which would be better associated with outcome after traumatic brain injury.

Initial Factors Affecting 6-month Outcome of Patients Undergoing Surgery for Acute Post-traumatic Subdural and Epidural Hematoma

“…The increasing age was associated with the worse outcome. 1,3 Other authors report that this relation was apparent not only after the age of 60 4 , but also especially above 40 5 . The age is the most powerful independent prognostic factor 6 and the increasing age is associated with worse 6-month outcomes, creating approximately linear function.…”

“…The Glasgow Coma Scale (GCS) is used not only to assess the patient's state of consciousness after a head injury, but it also has a strong prognostic value. 1 The age followed by the GCS motor score and the pupil response are most powerful independent prognostic factor. 6 In addition, GCS like age creates a linear function.…”

“…TBI causes dysautonomia manifested by episodes of fluctuations in blood pressure, heart rate, respiratory rate and others. 1 Hypotension and hypoxia following TBI are recognized as a significant secondary insult associated with a poor outcome. 16 Petroni et al found a very strong relationship between hypotension and outcome.…”

“…Sodium revealed a U-shaped relationship with outcome, but hyponatremia is more strongly related to a poorer outcome. 1,19,24 Hemoglobin, platelets showed an inverse linear relationship to the outcome (low values associated with a poorer outcome). Van Beek et al observed high hemoglobin values very rarely.…”

“…Establishing a reliable prognosis after a head injury is difficult as is captured in the Hippocratic aphorism, 'No head injury is too severe to despair of, nor too trivial to ignore' . 1,2 The outcome after this type of injury is difficult to predict, but usually unfa-vourable. Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries.…”