Penetrating Craniocerebral Injury
Penetrating Craniocerebral Injury
In an attempt to assess admission Glasgow Coma Scale (GCS) scores and other radiographic variables after penetrating craniocerebral injury in relationship to outcome, the author evaluated a series of 294 patients with penetrating injuries who presented with a GCS score of 6 to 15 over a 6-year period. Entrance criteria required a replicable neurological examination that was not altered by the presence of hypotension, drugs/toxins, or systemic injury. All patients underwent surgical intervention and aggressive perioperative management, including resuscitative protocols, in the neurosurgical intensive care unit.
The author previously devised prospective models of outcome remained unchanged in this series. The variables most predictive of death include admission GCS score and subarachnoid hemorrhage in one model and admission GCS score and pupillary changes in a second when pupillary response was definitive at admission (p ≤ 0.00005). Other important variables related to morbidity include admission GCS, bihemispheric injury when associated with intraventricular hemorrhage, and diffuse fragmentation (p ≤ 0.001).
In this study a significant relationship between operative intervention and survival (p ≤ 0.01) was found in patients with an admission GCS scores of 6 to 8. No significant relationships between operative intervention and survival were found in patients with admission GCS scores of 9 to 12 and 13 to 15. A significant relationship between operative intervention and morbidity (p ≤ 0.01) was also demonstrated in patients with an admission GCS score of 12 to 15. No significant relationships between operative intervention and morbidity were found in patients with an admission GCS score of 6 to 8 and 9 to 12.
Patients with craniocerebral missile wounds who arrive at the hospital alive often receive variable treatment despite low GCS scores and often dismal prognoses, because there is a lack of consensus regarding appropriate treatment and predictable outcome in these patients. We have previously reviewed a series of patients with admission GCS scores of 3 to 5 and reported that although surgery was significantly related to mortality, it had no effect on morbidity, with poor outcome being demonstrated in the vast majority of surgically treated survivors. In the current paper we discuss outcome following aggressive surgical management in patients whose GCS scores were 6 to 15.
In an attempt to assess admission Glasgow Coma Scale (GCS) scores and other radiographic variables after penetrating craniocerebral injury in relationship to outcome, the author evaluated a series of 294 patients with penetrating injuries who presented with a GCS score of 6 to 15 over a 6-year period. Entrance criteria required a replicable neurological examination that was not altered by the presence of hypotension, drugs/toxins, or systemic injury. All patients underwent surgical intervention and aggressive perioperative management, including resuscitative protocols, in the neurosurgical intensive care unit.
The author previously devised prospective models of outcome remained unchanged in this series. The variables most predictive of death include admission GCS score and subarachnoid hemorrhage in one model and admission GCS score and pupillary changes in a second when pupillary response was definitive at admission (p ≤ 0.00005). Other important variables related to morbidity include admission GCS, bihemispheric injury when associated with intraventricular hemorrhage, and diffuse fragmentation (p ≤ 0.001).
In this study a significant relationship between operative intervention and survival (p ≤ 0.01) was found in patients with an admission GCS scores of 6 to 8. No significant relationships between operative intervention and survival were found in patients with admission GCS scores of 9 to 12 and 13 to 15. A significant relationship between operative intervention and morbidity (p ≤ 0.01) was also demonstrated in patients with an admission GCS score of 12 to 15. No significant relationships between operative intervention and morbidity were found in patients with an admission GCS score of 6 to 8 and 9 to 12.
Patients with craniocerebral missile wounds who arrive at the hospital alive often receive variable treatment despite low GCS scores and often dismal prognoses, because there is a lack of consensus regarding appropriate treatment and predictable outcome in these patients. We have previously reviewed a series of patients with admission GCS scores of 3 to 5 and reported that although surgery was significantly related to mortality, it had no effect on morbidity, with poor outcome being demonstrated in the vast majority of surgically treated survivors. In the current paper we discuss outcome following aggressive surgical management in patients whose GCS scores were 6 to 15.
Source...