Abstract
The authors have carried out a retrospective study of diffuse brain injury patients to determine if, based on the clinical findings on admission, a prognostic scale of their outcomes could be established. The subjects consisted of 79 diffuse brain injury patients that were admitted and treated at the authors hospital from April, 1987 to April, 1991. Using the Glasgow outcome scale, the outcomes of these 79 cases were as follows : 43 showed a good recovery, 22 had a poor outcome, and 14 ended in death. The items investigated as outcome-predicting factors were the correlations between the outcome and age, the neurological findings (consciousness, pupil movement, brain stem response), the neuroradiological findings (extent of the skull fracture, the amount of diffuse brain swelling, the depth of the lesion, the patency of the cisterns, with or without a subarachnoid hemorrhage (SAH), the extent of injury to the corpus callosum and the primary brain stem, and the presence of intraventricular hemorrhaging), as well as the general condition of the patients on admission, such as the blood pressure, the pulse rate, and the results of an arterial blood gas analysis. Based on chi-square evaluations, the factors that indicated a favorable prognostic outcome were as follows : i ) the patient was under 30 years old ; ii ) there was no skull fracture, iii) the patient had a Glasgow outcome scale of more than 7 ; iv) the bilateral pupils were of normal size ; v ) the brain stem reflexes were responsive ; and vi) the cisterns were patent and there was no SAH. In contrast, the factors that indicated an unfavorable prognostic outcome were CT scans that showed i ) a direct, primary brain stem injury, and ii ) diffuse brain swelling in adults. With regard to the patient's general condition, unfavorable prognostic factors were metabolic acidosis in patients with a simple head injury, hypotension below 90 mmHg systolic, and severe bradycardia or tachycardia in patients with multiple, deep seated lesions. However, a simple corpus callosum injury or an intraventricular hemorrhage did not affect the prognosis. Based on these findings, the authors have established a prognostic scale that will be clinically used for evaluating diffuse brain injury patients on admission.
