[Early prognosis of severe cranio-cerebral injuries]

Severe head injuries are still associated with a high mortality (30-60%). Depth and duration of coma are poor prognostic parameters because of therapeutic concepts such as sedation and mechanical ventilation. That is the reason why we looked for prognostic parameters that are independent of therapy and can be obtained during the normal routine at an ICU for head and trauma patients. METHODS. The medical records of 59 patients with severe head injury were studied and analyzed by statistical means. Exclusion criteria were, e.g., thoracic trauma or abdominal injury. All data tested are parameters routinely measured at our ICU. The statistical analysis was based on calculation of the odd's ratio and its range of confidence. RESULTS. We evaluated 16 parameters correlating to patient lethality. All of them can be obtained by routine diagnostic procedures, OP findings and intensive care monitoring. The relevant criteria that raise the mortality risk to 1.9-7.7 are: age, subdural hematoma, subarachnoid hemorrhage, brain edema, midline shift, pupillary reflexes, motoric answer to pain, hemisyndrome, intracranial pressure, heart rate, blood pressure, necessity for vasocactive drug application, coagulation tests, blood glucose and diabetes insipidus. CONCLUSIONS. The evaluated risk factors permit early estimation of the patient's outcome independent of therapeutical interventions. Further studies are necessary to create a score on the basis of the parameters found.