Prognosis in Patients With Severe Head Injury

Abstract

Data been collected prospectively on patients with severe head injury—studied in collaboration between Glasgow, Rotterdam, Groningen, and Los Angeles¹. This data bank allows detailed analysis of the relationship between early features in the head-injured patient at various stages in the first week after injury, and ultimate outcome. All patients were in coma for at least six hours after injury, although in a third of cases this developed only after a period of relative lucidity. Coma was defined as “no eye-opening, no uttering of words, no obedience to commands”, no matter how strong a stimulation was applied. This definition is comparable to that suggested by the Coma Committee of the WFNS—a state of “unrousable unresponsiveness”². Severity in the early stages after injury has been assessed by clinical criteria: responsiveness on the Glasgow Coma Scale, abnormal motor patterns, pupillary responses, eye movements, and autonomic responses.