[Evaluation of treatment outcome in patients after extremely severe head injury (GCS 3-4)]

Advances in the diagnosis and treatment of severe head injured patients (GCS < = 8) have led to major improvement in outcome, but have not eliminated high mortality rates, which range between 38 and 80% as reported in the literature. The aim of this study was to evaluate the outcome of patients with GCS 3 and 4 and to evaluate the role of early and late hypotension (systolic blood pressure SBP < 90 mmHg) in outcome. Sixty two patients with severe head injury were divided into two groups. In Group I-22 patients with GCS 3-4, and in Group II-40 patients with GCS 5-8. There was no significant difference between mortality (p = 0.5), poor outcome (p = 0.36), and the very best outcome in the groups (p = 0.06). There was a statistically significant difference in death rate (p = 0.0012), when hypotension was present at the scene. Our data suggest that patients with extremely severe head injury do not necessarily have a worse outcome, if prompt diagnosis and appropriate aggressive treatment is implemented.