eMedicine Specialties > Trauma > Head and Neck Trauma

Head Trauma: Follow-up

Author: David W Crippen, MD, FCCM, Associate Professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center; Medical Director, Neurovascular Critical Care, Presbyterian-University Hospital
Contributor Information and Disclosures

Updated: Jul 15, 2009

Outcome and Prognosis

The outcome of TBI is related to the initial level of injury. While the initial GCS score provides a description of the initial neurologic condition, it does not correlate tightly with outcome. Various methods have been used in an attempt to predict the outcome of TBI, and these are beyond the scope of this discussion. However, one simplified model uses 3 factors, that is, age, motor score of the GCS, and pupillary response (ie, normal, unilateral unresponsive pupil, bilateral unresponsive pupils), to provide a probability of outcome.

The Traumatic Coma Data Bank analyzed 780 patients with head injuries and identified 5 factors that correlated with a poor outcome, as follows: (1) age older than 60 years, (2) initial GCS score of less than 5, (3) presence of a fixed dilated pupil, (4) prolonged hypotension or hypoxia early after injury, and (5) presence of a surgical intracranial mass lesion.

Many methods exist for evaluating the outcome of TBI. A simple and commonly used method is the Glasgow outcome scale. This divides outcome into 5 categories, as follows: (1) good, (2) moderate disability, (3) severe disability, (4) vegetative, and (5) dead. The scale can be divided further into good outcomes (eg, good plus moderate disability) and poor outcomes (eg, severe disability, vegetative, dead).

Future and Controversies

The most significant controversy today in the treatment of TBI is the minimum desirable CPP to achieve in the patient with a head injury. Previously, a CPP of 79 mm Hg was considered the minimum; however, many now believe that a CPP of 60 mm Hg is sufficient. Further controversy also exists as to whether elevated ICP or decreased CPP is a more important prognostic factor. This is an important distinction because it directs the main goals of therapy in severely injured patients. If ICP elevations are considered a more important factor, then efforts may be directed at lowering ICP as a primary goal and improving CPP as a secondary goal. If one considers CPP to be the more important factor, then the primary goal of treatment should be to maintain an appropriate CPP.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Scott Shepard, MD, to the development and writing of this article.



More on Head Trauma

Overview: Head Trauma
Workup: Head Trauma
Treatment: Head Trauma
Follow-up: Head Trauma
References
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Further Reading

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Keywords

head injury, traumatic brain injury, TBI, brain trauma, brain injury, closed head injury, primary brain injury, secondary brain injury, cerebral injury, penetrating head injury, brain herniation, cerebral herniation, transtentorial herniation, subfalcine herniation, central herniation, upward herniation, cerebellar herniation, tonsillar herniation, Glasgow Coma Scale

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Contributor Information and Disclosures

Author

David W Crippen, MD, FCCM, Associate Professor, Department of Critical Care Medicine, University of Pittsburgh Medical Center; Medical Director, Neurovascular Critical Care, Presbyterian-University Hospital
David W Crippen, MD, FCCM is a member of the following medical societies: American College of Critical Care Medicine, European Society of Intensive Care Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Scott C Dulebohn, MD, Neurological Surgeon, Appalachian Neurosurgical
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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