Management of head injury patients who talked and deteriorated

Of 203 patients with severe head injuries admitted from January 1986 to May 1989 at Songklanagarind Hospital, 32 cases who initially talked prior to deteriorating to a Glasgow Coma Scale score of 7 or less within 48 hours after injury were identified. Many variables were analyzed to ascertain what might be responsible for the differences in outcome. The Glasgow Coma Scale score before neurosurgical intervention was identified, using the logistic regression model, as a significant prognostic predictor. Mortality rate was 40.6%, with two patients left in a vegetative state. Surgically correctable intracranial mass lesions occurred in 29 cases. The most important factors in salvaging these patients are rapid diagnosis and immediate surgical decompression before irreversible brain damage sets in.