CT Scan, ICP and Early Neurological Evaluation in the Prognosis of Severe Head Injury
The prognostic value of careful neurological evaluation using standard terminology performed serially over 72 hours in patients with head injuries of designated severity has been shown by Jennett and his colleagues. The growing use of muscle relaxants with artificial ventilation and the increasing interest in the use of induced barbiturate coma reduces the opportunity for serial neurological evaluations over an extended period. Furthermore, there is a need to identify at the earliest possible stage those patients in whom a particularly poor outcome is to be expected, because it is in this group that newer and perhaps riskier therapies are justified. Inclusion of patients in whom a better outcome is to be expected may yield a falsely optimistic view of a test therapy. One solution is to wait for a certain period of time to ascertain that the head injury is serious. This has the disadvantage that it may delay application of therapy to a point where no treatment can be effective because neurological deterioration has become irreversible.
KeywordsHead Injury Intracranial Hypertension Subdural Haematoma Severe Head Injury Artificial Ventilation
Unable to display preview. Download preview PDF.