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Outcome Prediction Score For Adults with Severe Head Injury

Purpose: To predict an unfavorable outcome for an adult with a severe head injury using the equation of Combes et al.

Description

Combes et al developed a prognostic score for identifying patients with severe head injuries who are likely to have an unfavorable outcome. This can identify patients who may require more aggressive therapy. The authors are from CHU de Grenoble in France.


Populations 198 consecutive adult patients with severe head injury

 

Unfavorable outcomes:

(1) severe disability

(2) vegetative state

(3) death

 

Analysis: Cox regression

 

Parameters on admission:

(1) best Glasgow motor response in the Emergency Department, from 1 to 5

(2) age in years

(3) hypoxia

 

Parameter

Finding

Points

Glasgow motor response

localizes

5

 

normal flexor

4

 

abnormal flexor

3

 

extensor

2

 

none

1

hypoxia

PaO2 >= 8 kPa

0

 

PaO2 < 8 kPa

1

 

where:

• I assume that the patient is breathing room air (FIO2 = 0.21).

• The Glasgow motor score also includes a 6th category for obeys commands but this was not reported in the paper as an option. This relates to the definition of severe head injury.

 

X =

= 0.0327 – (0.7382 * (points for Glasgow motor response)) + (0.0402 * (age)) + (1.5319 * (points for hypoxia))

 

probability of an unfavorable outcome =

= logit(X) =

= 1 / (1 + EXP((-1) * X))


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Specialty

Objective

ICD-10