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Roman A. Hayda, MD
• CT scan
Contusion
Bottom line: survival and recovery not predictable except in old pts
• Treat presuming recovery
Factors Influencing Prognosis
Potentially controllable!!
Outcome
• Glasgow Outcome Score:
– 1-dead
– 2-vegetative
– 3-cannot self care
– 4-deficits but able to self care
– 5-return to preinjury level of function
Outcome Prediction
• Glasgow scale (post resuscitation) 44-66%
accuracy in determining ultimate outcome
– 39% with an initial GCS of < 5 made functional
recovery
• CT based scoring (Marshall Computed
Tomographic score) only 71% accurate
Outcome Prediction
• Serum markers (S-100B)
– Accuracy of 83% (Woertgen, J Trauma, 1999)
– Good sensitivity in moderate to severe injury
even with extracranial injury (Savola, J Trauma, 2004)
– May be elevated in 29% fx pts without head
injury (Unden, J Trauma, 2005)
• ICP monitoring
• Evolution of anesthetic agents
• Improvement in neuroanesthetic techniques
• Advantages
– Alignment
– Articular congruity
– Early rehabilitation
– Facilitated nursing
care