[Prognosis and documentation of the disease course in severe craniocerebral injuries]

35 survivors of severe head injury were consecutively admitted to the Neurological Department, University of Vienna for early rehabilitation. The outcome after a mean observation periods of 19 months was compared with clinical signs (best motor response, pupillary light reaction, pupil size) in the acute stage. The clinical signs were graded semiquantitatively. The outcome was assessed using the Glasgow Outcome Scale and compared with alternatives, the Karnofsky Performance Status and a self-designed neuropsychological rating scale. Both indexes appeared to possess certain advantages which included additional information and sensitivity to change. A significant correlation was established between the long-term outcome after severe head injury on the one hand and the "best motor response" and changes in pupillary light reaction in the acute stage on the other hand. However, the clinical parameter of pupil size in the acute stage does not provide a prognostic indicator of the disability status at the end of the observation period. There was good agreement between the outcome scores derived by means of the 3 rating scales. Solely with respect to the items "orientation and memory function" and "emotions" of the neuropsychological rating scale was no significant correlation obtained with the clinical sign "best motor response" in the acute stage. Our results indicate that it seems possible to assess the outcome after severe head injury not only be means of the widely-adopted Glasgow Outcome Scale, but also using the Karnofsky Performance Status and our neuropsychological rating scale without any marked loss of reliability. The clinical signs - "best motor response" and pupillary light reaction - are excellent prognostic indicators of the long-term outcome after severe head injury.