A new scale for prognostication in head injury

The ability to predict the outcome of head injury helps in the efficient use of resources and communicating with the families of the victims. There is need for a simple, easily applicable, objective scale for accurately predicting outcome after severe head injury. A simple, objective bedside scoring system, known as the Madras Head Injury Prognostic Scale (MHIPS), has been devised. It is based upon six well-established prognostic factors: age, best motor response, pupillary light reaction, oculocephalic response, CT scan findings and other systemic injuries. Each factor has been divided into three subgroups and a score assigned based on prognosis. The maximum total score is 18 and the minimum total score is 6. The validity of this scale has been assessed both retrospectively and prospectively. The initial retrospective study involved 355 patients with severe head injury. After correlating the initial MHIPS score with outcome on discharge from the hospital, it was found that most patients with a score of 12 or under died; most patients with a score of 15 and above had a good outcome; and patients with a score of 13 and 14 were either severely disabled or vegetative. The results of the prospective study, which involved 104 patients with severe head injury, showed that the outcome of 87.5% of the patients could be predicted accurately. The MHIPS is a simple, objective, easily applicable, bedside scoring system that can be used without complex mathematical calculations and investigations.