Outcome in severely head injured patients with and without multiple trauma.

BACKGROUND

This work attempts to analyse the potential role of multiple injury in the outcome of non-shock severely head injured patients with a Glasgow Coma Scale (GCS) of 8 or less.

METHODS

386 non-shock adult patients of < 65 years (mean age 33.74 +/- 14.7), treated with the same therapeutic protocol, were studied retrospectively. Multiple traumatised patients classified into Injury Severity Scale (ISS) of < or = 9 and > 9. The ISS classification was also tested in two subgroups of patients with GCS 3-5 and GCS 6-8.

RESULTS

The overall mortality of the 386 patients was 22.79%. Those suffering from extracranial injuries (n = 146, 37.82%) and those without (n = 240), presented similar mortality (21.23% vs 23.75% respectively). The multiple traumatised victims presented mean ISS 9.3 +/- 8.17. Those with ISS > 9 had greater mortality than those with ISS < or = 9, but the difference was not statistically significant (p > 0.05). The influence of ISS was not also significant in the mortality, either patients were of GCS 3-5 or GCS 6-8.

CONCLUSIONS

Multiple trauma in non-shock patients, as it is expressed by ISS does not have any influence on mortality. Mortality is depending on the severity of the intracranial pathology. Perhaps head injury and extracranial injuries have synergistic effect on morbidity.