Severe Head Injury Clinical Assessment and Outcome

A prospective study of 213 patients with severe head injury and Glasgow Coma Scores of 8 or less was conducted to identify, at 24 hours postinjury, the favorable and unfavorable clinical factors that relate to outcome one year later. According to the Glasgow Outcome Scale, 35 percent were classified Moderate Disability or Good Recovery, 13 percent were classified Severe Disability or Vegetative State, and 52 percent had died. The presence of intact brain-stem reflexes 24 hours postinjury in comatose patients with head injury is a prognostic sign for a good recovery. Favorable clinical signs include eye opening, pupillary reactivity, spontaneous eye movement, intact oculovestibular reflexes, and motor responses such as localizing. A prognosis of poor recovery is associated with nonreactive pupils, absent oculovestibular reflexes, and motor response of extension or no response at all. These negative signs, when present individually, were associated with only a 3 to 4 percent Moderate Disability or Good Recovery rate and an 85 to 91 percent mortality rate. The Glasgow Outcome Scale was also used to define recovery patterns at intervals during the first year afte