[Prognostic factors in rehabilitation after severe craniocerebral injuries]

Even with modern standards of intensive care management and rehabilitation services, severe head injury often results in permanent disability. A review of the literature concerning predictors of outcome after severe head injury is presented. The early identification of those factors which are of greatest significance in determining outcome is of essential value in the appropriate management of rehabilitation therapy. In many cases of severe head injury a reliable assessment of prognosis can be made on the basis of level of coma and brainstem dysfunction, reflecting type and extent of the traumatic brain lesion. Additionally, a broad spectrum of neuroradiological and electrophysiological investigations, as well as measurements of regional cerebral blood flow have been demonstrated to be helpful in establishing rehabilitation prognosis. In studies using a multivariate statistical design, initial level of coma (i.e. initial Glasgow Coma Score), brainstem reflexes, intracranial pressure assessment, the presence/absence of an additional thoracic injury, and age emerged as independent early predictors of outcome after severe head injury. The presence of previous brain damage also seems extremely important. In contrast, the prognostic value of pretraumatic personality factors and of the psychosocial status of the head injured patient requires additional research. Comparison among studies is hindered by differences in patient samples, timing of assessments, and various outcome measures with respect to rehabilitation management.