Prognostic factors in severe head injury

Abstract

Introduction: Severe head injury is one of the leading causes of death and disability in the population, especially among young males. Method: A retrospective, descriptive study was conducted to evaluate the prognostic factors for patients with severe head injury during the first 24 hours after the injury, and its final evolution in the Intensive Care Unit of the Arnaldo Milian Castro Provincial University Hospital Universitario in Santa Clara in a five-year period. The study included all patients admitted with a diagnosis of severe head trauma. Results: A total of 113 patients were studied, with 44 deaths for a mortality rate of 38.9%. The patients aged 45 or over were a total of 52, of these 27 died (61.4%) giving a relative risk of dying of 1.86. The neurological variables studied, as the Glasgow Coma Scale with a score of 6 points or less had a RR of 3.19, those with pupillary abnormalities had a relative risk of 2.80. Those with an ischemic cerebral hemodynamic pattern, and a high pulsatility index, had a relative risk of 2.21 and 1.86 respectively. The non-neurological variables studied were hyperglycemia, with a relative risk of 3.26; hypernatremia – in 25 patients – with a relative risk of 3.21; systolic blood pressure below 90 mm Hg, a SaO2 below 90% and the presence of metabolic acidosis, with relative risks of 3.03, 2.16 and 2.65 respectively. A prognostic scale was developed with non-neurological and neurological variables, with a score of 0 - 19 points. In it, it was observed that when the score was above 6 points the mortality rate was higher than 50%. Conclusions: The variables studied show a high probability of death in the first 24 hours after the severe head injury, with the proposal of a prognostic scale of mortality in these patients.