The blood leukocyte count and its prognostic significance in severe head injury

Head injury is associated with increased blood levels of catecholamines and cortisol. Catecholamines release neutrophil stores, and corticosteroids cause a decrease in the egress of neutrophils from the circulation. The acute-phase response is also characterized by a leukocytosis upon admission. Therefore, it is possible that an increase in the white blood cell (WBC) count might serve as an additional diagnostic and prognostic indicator in head injury.

We prospectively studied 624 patients with severe, moderate, or minor head injury who were admitted to the neurosurgical department of Asclepeion Hospital in Athens between December 1997 and March 1999. In all cases, WBC count was obtained on admission to the emergency department. Factors that might influence WBC were excluded from this study.

Patients with severe head injury had significantly higher white blood cell counts than did those with moderate or minor injury (p < 0.001). Among the patients with severe head injury, a significant relationship was found between WBC counts and Glasgow Coma Scale score, pupillary reaction, and presence of subarachnoid hemorrhage (p < 0.001). In the same group of patients, WBC counts were significantly higher in those with an unfavorable outcome (p < 0.001). Multivariate analysis also showed that WBC counts were an independent predictor of outcome.

WBC counts on admission could serve as a significant parameter of severity of injury and as an additional predictor of neurological outcome in patients with severe head injury.