Determinants of mortality in patients with severe blunt head injury

Martin Schreiber, Noriaki Aoki, Bradford G. Scott, J. Robert Beck

    Research output: Contribution to journalArticle

    102 Citations (Scopus)

    Abstract

    Context: Head injury is the leading cause of traumatic death in the United States. Hypothesis: A set of clinical parameters available soon after injury can be used to accurately predict outcome in patients with severe blunt head trauma. Design: Validation cohort study. Setting: Urban level I trauma center. Patients and Methods: Data from patients with severe blunt head injury, as defined by inability to follow commands, were prospectively entered into a neurosurgical database and analyzed. The impact on survival of 23 potentially predictive parameters was studied using univariate analysis. Logistic regression models were used to control for confounding factors and to assess interactions between variables, whose significance was determined by univariate analysis. Goodness of fit was calculated with the Hosmer-Lemeshow c statistic. The predictability of the logistic model was evaluated by measuring the area under the receiver operating characteristic curve (AUC). Results: Logistic regression analysis revealed that 5 risk factors were independently associated with death. These variables included systemic hypotension in the emergency department, midline shift on computed tomographic scan, intracranial hypertension, and absence of pupillary light reflex. A low Glasgow Coma Scale score and advanced age were found to be highly correlated risk factors that, when combined, were independently associated with mortality. The model showed acceptable goodness of fit, and the AUC was 80.5%. Conclusions: Systemic hypotension and intracranial hypertension are the only independent risk factors for mortality that can be readily treated during the initial management of patients with severe head injuries. When used together, Glasgow Coma Scale score and age are significant predictors of mortality.

    Original languageEnglish (US)
    Pages (from-to)285-290
    Number of pages6
    JournalArchives of Surgery
    Volume137
    Issue number3
    StatePublished - 2002

    Fingerprint

    Closed Head Injuries
    Logistic Models
    Craniocerebral Trauma
    Glasgow Coma Scale
    Intracranial Hypertension
    Mortality
    Hypotension
    Area Under Curve
    Pupillary Reflex
    Trauma Centers
    Validation Studies
    ROC Curve
    Hospital Emergency Service
    Cause of Death
    Cohort Studies
    Regression Analysis
    Databases
    Light
    Survival
    Wounds and Injuries

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Schreiber, M., Aoki, N., Scott, B. G., & Robert Beck, J. (2002). Determinants of mortality in patients with severe blunt head injury. Archives of Surgery, 137(3), 285-290.

    Determinants of mortality in patients with severe blunt head injury. / Schreiber, Martin; Aoki, Noriaki; Scott, Bradford G.; Robert Beck, J.

    In: Archives of Surgery, Vol. 137, No. 3, 2002, p. 285-290.

    Research output: Contribution to journalArticle

    Schreiber, M, Aoki, N, Scott, BG & Robert Beck, J 2002, 'Determinants of mortality in patients with severe blunt head injury', Archives of Surgery, vol. 137, no. 3, pp. 285-290.
    Schreiber, Martin ; Aoki, Noriaki ; Scott, Bradford G. ; Robert Beck, J. / Determinants of mortality in patients with severe blunt head injury. In: Archives of Surgery. 2002 ; Vol. 137, No. 3. pp. 285-290.
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