Prognostic factors in postraumatic severe diffuse brain injury

Acta Neurochir (Wien). 1998;140(12):1257-60; discussion 1261. doi: 10.1007/s007010050247.


It is usually defficult in clinical practice to establish factors affecting final outcome in patients suffering severe diffuse brain injury (SDBI), due to the absence of specific semiology.

Methods: We studied retrospectively 160 consecutive patients with criteria of SDBI. We performed a statistical analysis of epidemiological, clinical and radiological factors, and relationship with final outcome.

Result: 35% of patients with severe head injury presented SDBI. Sixty percent were 15-35 year old and 73% male. More than 45% of the patients presented GCS 3 or 4. On CT performed during the first 24 h, haemorrhagic lesions appeared in white matter in 35% and subarachnoid haemorrhage was observed in 28%. During the first 24 h., 66% of patients presented values of intracranial pressure (ICP) above 20 mm Hg and a 33% below 20 mm Hg. Twenty percent of the patients had ICP > 20 mm and no response to treatment. According to the Glasgow Outcome Scale (GOS), mortality of more than 50% and 25% of patients with persistent vegetative state or severe disability were observed.

Conclusions: Clinical evaluation, early CT findings, ICP values and their response to medical treatment and clinical complications were found to be related (p < 0.05) to final outcome (GOS).

MeSH terms

  • Adolescent
  • Adult
  • Brain / diagnostic imaging
  • Brain / physiopathology
  • Brain Injuries / diagnostic imaging
  • Brain Injuries / mortality
  • Brain Injuries / physiopathology
  • Brain Injuries / therapy*
  • Disabled Persons
  • Female
  • Glasgow Coma Scale
  • Humans
  • Intracranial Pressure
  • Male
  • Persistent Vegetative State / physiopathology
  • Prognosis
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome