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Head trauma and nonsurvival--a sample survey.
1Division of Neurosurgery, University of California, Irvine Medical Center, Orange 92668.
Surgical Neurology
|October 1, 1988
Summary
Patients with severe brain injury and a Glasgow Coma Score of 3, indicating deep unconsciousness, had no survivors despite aggressive treatment. Considering the high costs and lack of survival, a "dead on arrival" diagnosis may be more appropriate for such cases.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Critical Care Medicine
Background:
- Severe brain and multisystem injury presents significant treatment challenges.
- Aggressive trauma and neurosurgical interventions are often employed for these critical patients.
- Outcomes for patients with the most severe injuries, such as a Glasgow Coma Score of 3, are often poor.
Purpose of the Study:
- To evaluate the outcomes of patients with severe brain and multisystem injury treated with vigorous trauma/neurosurgical techniques.
- To assess the cost-effectiveness of current treatment protocols for non-survivors.
- To explore alternative diagnostic criteria for patients with devastating injuries and no chance of survival.
Main Methods:
- Retrospective analysis of 42 patients with severe brain and multisystem injury.
- Review of treatment protocols, including trauma and neurosurgical interventions.
- Analysis of patient Glasgow Coma Score, apnea status, and survival rates.
- Cost analysis comparing treatment costs versus potential 'dead on arrival' costs.
Main Results:
- None of the 37 patients with a Glasgow Coma Score of 3 at initial examination survived.
- All 37 non-survivors exhibited persistent apnea at 40-60 minutes post-injury.
- The direct cost for the 37 non-survivors was $990,000, averaging $27,000 per patient.
- A 'dead on arrival' diagnosis for these cases would have cost approximately $200 per patient.
Conclusions:
- Vigorous trauma/neurosurgical techniques did not improve survival in patients with severe brain injury and a Glasgow Coma Score of 3.
- The high cost of treatment for non-survivors warrants re-evaluation of resource allocation.
- A 'dead on arrival' diagnosis may be more appropriate and cost-effective for patients presenting with profound neurological deficits and apnea, signifying irreversible injury.