Patients with moderate head injury have no treatment guidelines for the acute phase, much because of lack of good evidence-based data. The aim of this study is to investigate the acute phase and presence of deviations from treatment goals in vital parameters, based on guidelines for severe head injuries.
During a 5-year period (2004–09), 118 adults (age ≥16 years) with moderate head injury according to the Head Injury Severity Scale were admitted to a level 1 trauma hospital. Data from the acute phase were gathered pro- and retrospective from medical journals. Outcome was measured as Glasgow Outcome Scale Extended (GOSE) score at twelve months.
Median age was 47 years (range 16–92) and the median admission Glasgow Coma Scale score was 12 (range 3–15). Nine percent had a normal first CT scan, whereas 13 % developed a mass lesion requiring neurosurgery. 32 % needed other surgical intervention and median Injury Severity Scale score was 20.5 (range 4–50). 18 % had intracranial pressure (ICP) monitoring at any time during the first three days. ICP above 20 mmHg was seen in 76 %, and cerebral perfusion pressure below 60 mmHg in 85 %. For the whole group the most frequent deviations from treatment goals during the first three days were found for haemoglobin ≤ 10 g/dl (30%), blood glucose ≥ 8 g/dl (19%) and temperature ≥38° Celsius (18 %). Deviations in blood pressure, oxygen saturation and serum sodium were seen less frequently. 53% of all patients stayed at an ICU the first three days or more after hospital admission. 32 % of those needed mechanical ventilation for at least three days. 59% had a good recovery (GOSE 7–8) at twelve months.
Few patients with moderate head injury had a normal CT scan, thirteen percent required neurosurgery and one fifth needed intracranial pressure monitoring. Half of the patients stayed in an ICU the first three days, and one third of those needed mechanical ventilation. For the whole group there were most deviations related to haemoglobin, temperature and blood glucose. Sixty percent had a good recovery one year after the head injury.
© 2012 European Society of Anaesthesiology