Journal of Korean Academy of Nursing (대한간호학회지)

Korean Society of Nursing Science (한국간호과학회)
권호 표지

Comparisons of the Prognostic Predictors of Traumatic Brain Injury According to Admission Glasgow Coma Scale Scores Based on 1- and 6-month Assessments

  • Oh Hyun-Soo (Department of Nursing, College of Medicine, Inha University) ;
  • Seo Wha-Sook (Department of Nursing, College of Medicine, Inha University) ;
  • Lee Seul (Department of Nursing, College of Medicine, Inha University) ;
  • Song Ho-Sook (Department of Nursing, College of Medicine, Inha University)
  • Published : 2006.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.

Keywords

References

  1. Bahloul, M. et al. (2004). Prognosis of traumatic head injury in south Tunisia: A multivariate analysis of 437 cases. J Trauma, 57,255-261 https://doi.org/10.1097/01.TA.0000083004.35231.1E
  2. Bhalla, A., Tilling, K., Kolominsky-Rabas, P., Heuschmann, P., Megherbi, S.E., Czlonkowska, A., Kobayashi, A., Mendel, T., Giroud, M., Rudd, A., & Wolfe, C. (2003). Variation in the management of acute physiological parameters after ischemic stroke: A European perspective. Eur J of Neural, 10,25-33 https://doi.org/10.1046/j.1468-1331.2003.00504.x
  3. Choi, S.C., Narayan, R.K., Anderson, R.L., & Ward, J.D. (1988). Enhanced specificity of prognosis in severe head injury. J of Neurosurg, 69,381-85 https://doi.org/10.3171/jns.1988.69.3.0381
  4. Choi, S.C., Muizelaar, J.P., Barnes, T.Y., Marmarou, A., Brooks, D.M., & Young, H.F. (1991). Prediction tree for severely headinjured patients. J of Neurosurg, 75, 251-255 https://doi.org/10.3171/jns.1991.75.2.0251
  5. Choi, S.W., Koh, H.S., Yearn, J.Y., Kim, S.H., Song, S.H., & Kim,Y. (1999). Clinical analysis of the risk factors and prognostic factors of delayed deterioration following mild head injury. J of Korean Neurosurg Soc, 28, 1316-1323
  6. Das-Gupta, R., & Turner-Stokes, L. (2002). Traumatic brain injury. Disability Rehabilitation, 24, 654-665
  7. Fleming, J.M., & Maas, F. (1994). Prognosis of rehabilitation outcome in head injury using the disability rating scale. The Arch of Physical Med and Rehabil, 75, 133-143
  8. Gouvier, W.D., Blanton, P.D., LaPorte, K.K., & Nepomuceno, C. (1987). Reliability and validity of the disability rating scale and the levels of cognitive functioning scale in monitoring recovery from severe head injury. The Arch of Physical Med and Rehabil, 68(2), 94-97
  9. Johnson, M., & Maas, M. (1997). Nursing Outcomes Classification (NOC). St Louis: Mosby
  10. Kilaru, S., Garb, J., Emhoff, T., Fiallo, V., Simon, B., Swiencicki, T., & Lee, K.F. (1996). Long-term functional status and mortality of elderly patients with severe closed head injuries. J of Trauma, 41(6), 957-963 https://doi.org/10.1097/00005373-199612000-00003
  11. Mamelak, A.D., Pitts, L.H., & Damron, S. (1996). Predicting survival from head trauma 24 hours after injury: A practical method with therapeutic implications. J of Trauma, 41(1), 91-99 https://doi.org/10.1097/00005373-199607000-00014
  12. Ono, J.I., amaura, A., Kubota, M., Okimura, Y., & Isobe, K. (2001). Outcome prediction in severe head injury: analyses of clinical prognostic factors. J of Clinical Neuroscience, 8(2), 120-123 https://doi.org/10.1054/jocn.2000.0732
  13. Rappaport, M., Hall, K. M., Hopkins, K., Belleza, T., & Cope, D.N. (1982). Disability rating scale for severe head trauma: Coma to community. The Arch of Physical Med and Rehabil, 63, 118- 123
  14. Rovlias, A., & Kotsou, S. (2004). Classification and regression tree for prediction of outcome after severe head injury using simple clinical and laboratory variables. J of Neurotrauma, 21 (7), 886-893 https://doi.org/10.1089/0897715041526249
  15. Schreiber, M.A., Aoki, N., Scott, B.G., & Beck, R. (2002). Determinants of mortality in patients with severe blunt head injury. Arch of Surgery, 137,285-290 https://doi.org/10.1001/archsurg.137.3.285
  16. Signorini, D.F., Andrews, P.J., Jones, P.A., Wardlaw, J.M., & Miller, J.D. (1999). Adding insult to injury: The prognostic value of early secondary insults for survival after traumatic brain injury. J Neural Neurosurg Psychiatry, 66, 26-31 https://doi.org/10.1136/jnnp.66.1.26
  17. Van Baalen, B., Odding, E., Maas, A.I.R., Ribber, G.M., Bergen, M.P., & Starn, H.J. (2003). Traumatic brain injury: Classification and initial severity and determination of functional outcome. Disability and Rehablitatian, 25(1), 9-18 https://doi.org/10.1080/713813430