Prognosis of severe head injury: an experience in Thailand

This study of 300 patients with severe head injury evaluated the clinical predictors determined after admission and associated with significant increase of poor outcome. The overall poor outcome was 58%. Logistic regression showed that age, status of basal cisterns on initial CT, Glasgow Coma Scale score (GCS) at 24 h after injury and electrolyte derangement occurring during admission strongly correlated with the outcome. A probability diagram of the outcome determined at 24 h after injury from the combination of the significant predictive factors provides a basis for determining the interventions to the appropriate target population. Intracranial pressure monitors with sophisticated devices may not be suitable for a developing country. Allocation of resources toward development of adequate intensive care beds and well-trained staff combined with serial CT imaging may be an alternative approach for the improvement of the outcome of severe head injury.