The Prediction of Outcome of Patients Admitted Following Head Injury in Coma With Bilateral Fixed Pupils

Abstract

The decision to transfer a patient in coma and often with multiple injuries to a Neurosurgical Department some distance away is usually difficult. If the patient has been in coma since impact it might be presumed that he is not developing a treatable intracranial haematoma, and if both pupils are also unreactive to light we could well presume that he has sustained an overwhelming brain injury for which energetic and expensive treatment is not indicated. Such presumptions can, however, easily lead to unnecessary morbidity and mortality, and for this reason prediction of outcome is of some value provided a forecast with virtually 100% certainty can be made within the first few critical hours of injury when intensive management in a Neurosurgical Department is being considered.