TITLE

Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department

AUTHOR(S)
Fabbri, A.; Servadei, F.; Marchesini, G.; Stein, S. C.; Vandelli, A.
PUB. DATE
May 2008
SOURCE
Journal of Neurology, Neurosurgery & Psychiatry;May2008, Vol. 79 Issue 5, p567
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Subjects with moderate head injury are a particular challenge for the emergency physician. They represent a heterogeneous population of subjects with large variability in injury severity, clinical course and outcome. We aimed to determine the early predictors of outcome of subjects with moderate head injury admitted to an Emergency Department (ED) of a general hospital linked via telemedicine to the Regional Neurosurgical Centre. Patients and methods: We reviewed, prospectively, 12 675 subjects attending the ED of a General Hospital between 1999 and 2005 for head injury. A total of 309 cases (2.4%) with an admission Glasgow Coma Scale (GCS) 9-13 were identified as having moderate head injury. The main outcome measure was an unfavourable outcome at 6 months after injury. The predictive value of a model based on main entry variables was evaluated by logistic regression analysis. Findings: 64.7% of subjects had a computed tomographic scan that was positive for intracranial injury, 16.5% needed a neurosurgical intervention, 14.6% had an unfavourable outcome at 6 months (death, permanent vegetative state, permanent severe disability). Six variables (basal skull fracture, subarachnoid haemorrhage, coagulopathy, subdural haematoma, modified Marshall category and GCS) predicted an unfavourable outcome at 6 months. This combination of variables predicts the 6-month outcome with high sensitivity (95.6%) and specificity (86.0%). Interpretation: A group of selected variables proves highly accurate in the prediction of unfavourable outcome at 6 months, when applied to subjects admitted to an ED of a General Hospital with moderate head injury.
ACCESSION #
31931653

 

Related Articles

  • Nail in the Brain. Schwarzschild, Michael // New England Journal of Medicine;3/4/93, Vol. 328 Issue 9, p620 

    The article presents scout films for a computed tomographic scan of the head of a man seen in the emergency department. The scan shows a nail in the brain. Examination revealed a mild right hemiparesis, which persisted after he became sober and fully articulate. Aside from right-sided facial...

  • Treatment provider is most predictive of ED dismissal in minimally-injured trauma patients: a retrospective review. Hunt, Diane L. S.; Berg, Gina M.; Zackula, Rosalee E.; Ekengren, Francie H.; Lippoldt, Diana; Ablah, Elizabeth; Wetta, Ruth // Journal of Trauma Management & Outcomes;2013, Vol. 7 Issue 1, p1 

    Background: Secondary triage protocols have been described in the literature as physiologic (first-tier) criteria and mechanism-related (second-tier) criteria to determine the level of trauma activation. There is debate as to the efficiency of triage decisions based on mechanism of injury which...

  • Giant Choledochal Cyst Mimicking Massive Gallbladder Hydrops in an Adult Patient: Multi Detector Computed Tomography and Magnetic Resonance Imaging Findings Correlated to Gross and Histopathological Findings. Choi, Joon-Il; Lall, Chandana; Bhargava, Puneet; Imagawa, David K. // Journal of Clinical Imaging Science;Jan-Mar2013, Vol. 3 Issue 1, p1 

    Choledochal cysts are uncommon congenital anomalies of the biliary tree, commonly presenting in infancy, generally in the 1st year of life. Presentation in adult life is less common, accounting for 20% of cases. A 19-year-old female patient presented to the Emergency Department with severe...

  • Hyperdense appendix on unenhanced CT: a sign of acute appendicitis. Suk-Ping Ng; She-Meng Cheng; Fei-Shih Yang; Chi-Yuan Tzen; Jon-Kway Huang; Ng, Suk-Ping; Cheng, She-Meng; Yang, Fei-Shih; Tzen, Chi-Yuan; Huang, Jon-Kway // Abdominal Imaging;Nov2007, Vol. 32 Issue 6, p701 

    The purpose of this study was to evaluate the presence of the hyperdense appendix in acute appendicitis. The CT scans of 183 patients with pathologically proven acute appendicitis were reviewed to determine the prevalence of a hyperdense appendix, defined as a high-attenuated appendix when...

  • Validation of the Excited Component of the Positive and Negative Syndrome Scale (PANSSEC) in a naturalistic sample of 278 patients with acute psychosis and agitation in a psychiatric emergency room. Montoya, Alonso; Valladares, Amparo; Liz├ín, Luis; San, Luis; Escobar, Rodrigo; Paz, Silvia // Health & Quality of Life Outcomes;2011, Vol. 9 Issue 1, p18 

    Background: Despite the wide use of the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) in a clinical setting to assess agitated patients, a validation study to evaluate its psychometric properties was missing. Methods: Data from the observational NATURA study were used....

  • Assess mental clarity; long-term memory.  // ED Nursing;Jun2009, Vol. 12 Issue 8, p89 

    The article discusses emergency department (ED) patients with head injury and assessing the severity of the injury. Madonna R. Walters, trauma nurse at St. Joseph Mercy Hospital in Ann Arbor, Michigan, and Teri Arruda, nurse specialist at Mission Hospital in Mission Viejo, California, describe...

  • Occult pneumothorax, revisited. Omar, Hesham R.; Abdelmalak, Hany; Mangar, Devanand; Rashad, Rania; Helal, Engy; Camporesi, Enrico M. // Journal of Trauma Management & Outcomes;2010, Vol. 4, p12 

    Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as...

  • GP opt-out sends A&E attendances soaring. Hoey, Richard; Wilkinson, Emma // Pulse;7/20/2006, Vol. 66 Issue 29, p14 

    The article reports that the increased attendance at accident and emergency departments in British hospitals can be attributed to general practitioners' out-of-hours care. A new study from Great Britain warned that the new practitioner contract was putting increasing pressure on hospital...

  • Did You Know That...?  // People's Medical Society Newsletter;Apr2003, Vol. 22 Issue 2, p7 

    Presents facts about the sources of dissatisfaction among people who avail hospital emergency department services in the U.S.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics